The case for harm reduction

Melbourne, Australia—Here in the 27th Harm Reduction International Conference, people all over the world are sharing their experiences about the harms not so much of drug use but of drug policies. One of the panels—a “situational assessment” of the Philippines convened by the United Nations Office on Drugs and Crime (UNODC)—has drawn a sizeable contingent from the country and is an opportune moment to reflect on where we stand on this matter.

One place to begin is to question the two acceptable responses to drug use in our country: treatment and punishment.

Treatment involves drug use being conflated with addiction and viewed as a kind of pathology for which some kind of “rehab” is required.

Punishment, for its part, involves drug use being conflated with criminality and viewed as a crime for which imprisonment or even death is warranted. Rodrigo Duterte’s drug war is certainly an instantiation of this view, but so is Republic Act No. 9165, which mandates harsh penalties for even just possessing small amounts of drugs.

A majority of Filipinos would probably favor “treatment” over “punishment,” especially in the aftermath of the Duterte drug war. The emerging post-Duterte consensus—aired by most of the presidential candidates in last year’s elections—to move beyond the current punitive approach and pursue a “public health approach” is most welcome and is surely a window of opportunity for drug policy reform.

However, such reforms will have to be critical of what counts as “treatment,” and acknowledge that not everyone who uses drugs actually needs it, in the same way that not everyone who consumes alcohol or caffeine (which are both drugs) requires it. Filipinos may have more openness for cannabis, but as UNODC reports routinely show, only 1 to 2 percent of people who use all kinds of drugs may need inpatient care (not necessarily rehab facilities but can be within hospitals)—and only 4 to 6 percent may need outpatient treatment. The rest may need access to help, but they have other needs—economic assistance, educational opportunities, legal aid—that deserve our focus.

Medicalizing drug use can be just as bad as criminalizing it, as when “rehab” is uncritically seen as good even when it involves confining individuals against their will.

Harm reduction offers an evidence-based alternative to this paradigm. In many countries, harm reduction involves specific programs (i.e., distributing clean needles to people who inject drugs so they don’t infect or get infected with HIV), but it is fundamentally a paradigm of focusing on the harms to individuals and communities whether from drug use, drug policies, or even broader structures like colonialism and racism.

Crucially, as UNODC’s Olivier Lermet emphasized, harm reduction is one of the recommendations of the United Nations General Assembly Special Session in 2016 and is endorsed by member states including the Philippines. “Hence,” Lermet said, “the question is not ‘if’ but ‘when’ and ‘how’ to make it happen.”

Lermet also stressed that far from being a Western practice, many of our neighbors are actually pursuing harm reduction programs. Only the Philippines, Singapore, Brunei, and Laos have no harm reduction programs at all in the region; Indonesia even has a pilot harm reduction program for methamphetamine.

One major barrier is RA 9165, which restricts what can be implemented or piloted in our country. As Corazon Gaite-Llanderal, a retired drug court judge, averred from her extensive experience, this law “is the singular cause of the high congestion rate of our jails and the college dockets of many trial courts.” Her recommendations? A policy declaration that affirms a health-based, human rights-based approach—and the decriminalization of low-level drug offenses.

I would go further by addressing something that’s even more fundamental than RA 9165: The “drug-free paradigm” that is rooted in both centuries of colonialism that vilified traditional practices (including the use of psychoactive substances)—and decades of a prohibitionist drug regime that enabled a global “moral panic” around drugs. Ultimately, it is this paradigm that restricts us to the treatment-punishment dichotomy—and perpetuates the stigmatization of people who use drugs.

Nonetheless, I welcome the administration’s openness to—in the words of Ricojudge Janvier Echiverri, Deputy Executive Secretary for Internal Audit, in attendance here—the “willingness to learn,” “explore what can be done”; the openness to amending the law. I also welcome the proposals to decriminalize drug use from senators like Robin Padilla, if only to serve as openings for further discussion.

My fervent appeal to our government officials, lawmakers, especially those working on drugs, health, and justice, as well as to President Marcos: Repeal and replace RA 9165—and give harm reduction a chance.

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