Anti-Drugs Campaign: What Works and What Doesn't
Ateneo De Manila University Forum
Microtel Hotel, Quezon City 9:10-9:30

Keynote Speech

Friends from the United Nations Office on Drugs and Crime, International Drug Policy Consortium, the Community Legal Aid Institute; our colleagues from the government: the Department of Health, Dangerous Drugs Board, the Philippine National Police, the Local Government of Cebu; fellow human rights and health advocates, allies from the academe and the church, my fellow Atenistas, an exciting Monday morning to us all!

First, I would like to thank the Ateneo School of Government, the Ateneo Law School, and the Ateneo School of Medicine and Public Health for this brave initiative. The Ateneo community was one of the first few voices that condemned the spate of extrajudicial killings and the rampant human right violations happening in the country. Today, consistent with our One-Big-Fight against this nauseating disregard for human life, we have this platform to start a discourse on the alternatives to the War on Drugs. This gathering is not just a simple academic exercise, a humble exchange of experiences or an innocent exploration of ideas, but a form of protest, a valiant expression of our collective frustration to this violent narrative written in blood-stained cardboards. I laud the Ateneo for being a pioneer in this endeavour and for declaring a Black Sunday yesterday. Let me just say right here, my blue-eagle heart is swelling with pride.

It's almost a hundred days since President Duterte took office and began his campaign against illegal drugs. A hundred days that has already claimed around 3, 100 lives. One thousand five hundred six (1,506) killed during police operations, the rest by vigilante killings. A hundred days and around 720,000 suspected drugs users and peddlers who have surrendered under Oplan Tokhang. The nine per cent (9%) were committed in rehabilitation facilities. The 91% who do not need institutionalized support went back to their communities. By some morbid twist of fate or simply the handwork of people who play gods, some of them also went back to the kill list.

These numbers are so alarming that the President's infamous War on Drugs has attracted international criticisms, ignited a burning senate inquiry-turned-political circus, and worried human rights advocates all over the world. Suddenly, all eyes are on us--the bastion of democracy in Southeast Asia, the bright star of people power-led democratic transitions now experiencing a fast-paced reversal, self-destructing, losing our human rights ethos.

So, what is this war all about? To what cause are we offering thousands of lives for?

A historical fact on the War on Drugs known to every country that has applied a strictly criminal justice approach is this: it has never worked.

Mano Dura in Central America has led to massive prison overcrowding, systematic violations of human rights (this sounds familiar) and the toughening of street gangs linked to drug syndicates further increasing their crime rates. The Latin American War on Drugs filled their jails with people of little education and scant resources, those who are either unemployed or holding down informal-sector jobs. In Thailand, their war on drugs lasted for three months and killed 2,800, only half of which were later found to have anything to do with substance abuse. This lead Thai Justice Minister Paiboon Kumchaya to declare that waging war against narcotics had been a failure. Drug use had actually increased.

The different anti-drug campaigns in Southeast Asia were not able to suppress the demand and supply for drugs. The manufacture, use, and trade have persisted amidst the intensified and violent wars different governments have waged. If the criminal justice approach on the war on drugs has changed anything at all--it was able to overcrowd prisons with people who are poor.

And it has also endangered public health.

Criminalized drug use fuelled the spread of diseases, deterred people from accessing medical treatment, and lead to policies that deny millions of people vital pain medication. By driving drug use underground, injecting drugs is frequently done with unsterile equipment in unsafe conditions. This increased the rates of overdoses and infectious disease, such as HIV/AIDS and Hepatitis, among people who use drugs. Studies examining the impact of law enforcement on drug use in Australia, found that drug use did not decrease, but riskier forms of use did. During their war on drugs, Thai drug users reported increased reluctance to seek healthcare. People who use drugs are often effectively locked out of access to medical care for fear of legal sanctions if they come forward seeking care.

Dito sa atin, paano nga naman sila lalabas at magpapagamot kung may tokhang, may cardboard, may stigma?

Global experience has already warned us: the War on Drugs has not only failed to achieve its goals, it has also fuelled poverty, undermined health, and exacerbated the marginalization of the poor. It has done more harm than drug abuse itself, killed more people than overdose mortalities did. Political leaders regret its implementation. This is why global policy is now taking a pivot.

Vietnam, for instance, made a series of revisions to their Law on Drug Control in 2008 and to their Penal Code in 2009. They downgraded drug possession from criminal to administrative offense. They also took a significantly scaled up access and coverage of core harm reduction services. Malaysia invested RM 69.7 Million of their national budget to support the implementation of harm reduction programs through partnership with civil society organizations. They have been reporting significant reduction in their HIV transmissions. Portugal enacted a comprehensive form of decriminalization of low-level possession and consumption of all illicit drugs. Alongside decriminalization, they expanded treatment and harm reduction services. After nearly a decade and a half, Portugal has experienced no major increase in drug use, reduced rates of problematic and adolescent drug users, reduced incidence of HIV/AIDS, reduced drug induced deaths, and a significant increase in the number of people receiving treatment. The Czech government conducted an in-depth evaluation and found that criminal penalties had no effect on drug use or related harms. In 2009, the country formally adopted a decriminalization law plus elements of harm reduction and treatment into their drug policy. In the Netherlands, neither civil nor criminal penalties apply to possession of amounts equal to or lesser than personal-use threshold. Now, they have lower rates of addiction than the U.S. and much of Western Europe.

The world has learned its lesson.

Under a strict legal regime against drug use, possession, and sale and without a government policy on harm reduction for drugs dependents, a criminal justice approach is doomed to fail. A "war on drugs" will turn out to be a "war on people". Thus, a discourse on the public health issues of drug abuse should be necessarily taken as an alternative strategy to fight this war. It is imperative to shift our drug policy from punishment to treatment. There is a need to introduce harm reduction as the public health solution to our illegal drugs problem.

Harm reduction is a spectrum of policies, programmes and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs. It is a policy model which emerged in the 1980s that focused on reducing overall drug related harms.

We go back to the numbers. According to the Dangerous Drugs Board, only around nine per cent (9%) of the 720,000 drug users who expressed their willingness to access treatment needed to be committed in rehabilitation centres. Ninety one per cent (91%) did not need institutionalized intervention. What do we do with them?

This is where Harm Reduction comes in.

People who use or abuse drugs need different types of interventions. It is not one-size-fits all. The government response is currently limited to criminal prosecution and facility-based rehabilitation. It is clearly inadequate. If the focus of this anti-drug campaign is going to shift from punishment to treatment, we should explore alternatives beyond Oplan Tokhang and residence-based rehabilitation.

Harm Reduction has been part of the discourse, as an essential component of the public health approach to the war on drugs. It has effectively reduced overdose, overdose mortalities, and HIV transmissions. It was also shown to have improved public order and reduced the crime rate in communities. [1] In prison settings in Iran, it has resulted in less violence and self-injury, less suicide, fewer injection-related injuries, less trafficking and use of illicit drugs.[2] In China, it caused crime reduction in affected communities, higher rates of employment among patients, and greater participation of drug dependents in communities and family activities.[3] But wait, there's more.

Harm Reduction strategies are actually cost-effective and affordable. Advocates estimate that only 10 per cent of the approximately $ 100 billion spent annually on drug enforcement around the world would already cover HIV prevention services for people who use drugs for four years.[4] In a study, it was concluded that for every $1 invested in Harm Reduction, over $4 accrue in short-term health-care cost savings.[5]

Harm Reduction is necessary for an effective drug policy. This will be our alternative to the strictly punitive and very violent War on Drugs campaign that has been senselessly claiming the lives of thousands of Filipinos most of them are poor, some of them are innocent, the likes of five-year-old kindergarten student, Danica Mae Garcia and our very own member of faculty, Emmanuel Jose Pavia.

So let me take this opportunity, to ask you dear friends, to have an open mind in exploring an effective and a definitely more humane option for our drug dependents. In fact, we should be reaching out to them, asking them how we can help, what do they need, is there anything we can do.

Drug abuse is a public health issue. We should be providing healthcare assistance to drug dependents, rather than scare them of imprisonment and death. We should be opening community-based out-patient rehabilitation programs, drop-in centres like the operation research done in Cebu. We should be conducting Harm Reduction capacity-building sessions for our local governments, health officers, and NGOs. We should be mainstreaming the public health approach to this anti-drug campaign. We should be offering hope to three (3) million drug dependents and their families.

Let us explore our options and enrich the discourse on the alternatives we have. Let us adopt the public health lens and consider Harm Reduction. Maybe in order to win this war, it is a Florence Nightingale that we need than an Adolf Hitler.

Magandang umaga at maraming salamat!

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[1] Urban Health Research Initiative, University of British Columbia. Insight into Insite. Vancouver, undated. At :http://uhri.cfenet.ubc.ca/content/view/57/92.

[2] Iranian delegation, UNODC Global Consultation on HIV Prevention, Treatment, Care and Support in Prison, Vienna. 16 October 2014.

[3] HM Sun, XY Li, EP Chow et.al. Methadone maintenance treatment programme reduces criminal activity and improves social well-being of drug users in China: a systematic review and meta-analysis. BMJ Open Jan 8; 5(1):e005997.doi:10.1136/bmjopen-2014-005997,2015.

[4] C Cook, J Bridge, S Maclean, M Phelan, D Barrett. The funding crisis for harm reduction: donor retreat, government neglect and the way forward. London: Harm Reduction International, International HIV/AIDS Alliance and Drug Policy Consortium, 2014.

[5] Government of Australia, National Centre in HIV Epidemiology and Clinical Research, "Return on Investment 2:evaluating the cost-effectiveness of needle and syringe programs in Australia", 2009.