Is the Philippines Ready for Harm Reduction?

In 2016, with the goal of eradicating the illegal drug trade in the country, then-President Rodrigo Duterte vowed to kill the estimated 3 million people who used drugs in the Philippines. That promise led to an infamous drug war that reportedly killed anywhere from 6,000 to 30,000 people—many of whom were urban poor, including dozens of children—breaking families and pushing many even deeper into poverty. 

Before that war even began, a senator appealed to the Philippine government to prioritize public health and human rights instead of criminalization and punishment in its anti-drug campaign. 

“The government must promise hope, not death, to drug respondents. It must guarantee health care assistance, not violence. This is the more effective, affordable, and compassionate anti-drug policy,” said Senator Risa Hontiveros. 

Hontiveros was advocating an approach called harm reduction. 

Harm reduction is a framework used to design programs and practices that aim to reduce the negative health, social, and legal consequences associated with drug use, policies, and laws. Instead of judging all drug use as wrong and wanting to create a drug-free society by way of fear and force, it acknowledges drug use as part of human life (meaning people are likely going to keep doing it) and seeks to minimize the risks associated with drug use and harm caused by harsh drug policies. 

Current president Ferdinand “Bongbong” Marcos Jr. said he would continue Duterte’s war on drugs, with a shifted focus on catching “bigger fish” and rehabilitating drug users. But the killings associated with the program continue, necessary drug policy reforms have not been made, and the illegal drug trade in the country persists.

With the failure of the drug war still fresh in the country, is it finally time for the Philippines to embrace harm reduction?

The origins of harm reduction can be traced to syringe exchanges and medical-grade heroin and methadone prescriptions in the United Kingdom, done in response to the AIDS crisis in the 80s and 90s. Providing people with clean syringes to inject drugs prevents them from sharing needles, which is how many people contract infections like HIV. Prescribing people substances prevents them from illegally acquiring possibly more dangerous versions on the street, which may lead to arrest or overdose.

In his book “In the Realm of Hungry Ghosts: Close Encounters with Addiction,” addiction expert Gabor Maté writes about Switzerland’s response to the growing number of HIV infections due to illicit intravenous drug use.

The country initiated a trial of either heroin maintenance or methadone treatment supplemented with heroin. People who used heroin got regulated doses from the government instead of through illegal trade. That way, experts were able to ensure the quality of the drug and the safety of its administration. The trial showed several benefits. 

For starters, there were no fatal heroin overdoses. Among participants, there was a decrease in crime of all kinds, including shoplifting and drug dealing. The participants’ ability to work also improved, with a more than double increase in permanent employment following the trial. 

In 2020, Oregon decriminalized personal possession of all drugs in the state. Instead of facing criminal penalties, people caught with small quantities of drugs like heroin and cocaine could either accept a one-time assessment of treatment and other health needs or pay a $100 fine. The program had a slow start, but experts are hopeful more people will receive treatment, which includes access to resources like housing and employment assistance. 

Harm reduction is gaining recognition as a framework for drug-related issues in Asia, too.

Malaysia, for example, successfully reduced the rate of HIV prevalence among people who inject drugs after implementing opioid-substitution treatments, needle and syringe programs, and voluntary, confidential, and free care and treatment services. According to Gloria Lai, the International Drug Policy Consortium’s director in Asia, the approach worked precisely because it treated drug use as a health and human rights issue rather than a criminal one. 

Harm reduction practices around the world also include drug testing kits, drug care at music festivals, and safe injection sites. 

While policies like these have shown positive effects on the health of individuals and communities, many have criticized their principles. A common argument against harm reduction is that its policies encourage drug use. People who use drugs reduce the risks associated with doing so, and are given little incentive to stop altogether.

According to Inez Feria, founder of harm reduction organization NoBox Philippines, the overarching goal of Philippine drug policy is a drug-free country with zero tolerance for non-compliance. Unfortunately, that ideal has been used to justify punitive actions that violate human rights and pervade health responses. 

The Philippines’ Republic Act 9165, or the Comprehensive Dangerous Drugs Act of 2002, embodies this stance against drug use and has been used to argue against local harm reduction efforts. In 2015, for example, Senator Vicente Sotto III halted a clean needle provision program organized by a local government unit in Cebu, which sought to minimize the transmission of HIV through shared needles. Under the Act, having clean needles is considered possession of paraphernalia, which is punishable by law. According to Sotto, providing people who use drugs with clean needles is tantamount to providing murderers with clean knives. 

“It’s as if we’re saying if we can’t stop criminals from using rusted knives, the government might as well provide murderers with clean and stainless knives so that nobody dies of tetanus when they stab each other,” said the senator. 

Feria added that the paradigm of a drug-free society has also allowed degrading and repressive actions, harsh discipline, monitoring, and surveillance to become accepted as inevitable parts of drug policy. 

“This drug-free narrative has turned drugs into a convenient political tool that has successfully been used for social control, and with deadly outcomes as we have seen, with no consideration for evidence or data in policy and program development,” said Feria.

While there are those who argue that harm reduction runs in direct opposition to the law, others point out how the spirit of the constitution itself calls for the principles that harm reduction champions. 

“Our constitution states that the State should protect and promote people’s right to health, and it is essential to understand what this means in the context of drug-related programs and policies. The emphasis on drug-free approaches and abstinence has overshadowed the promotion and protection of this right,” Feria said.

She added that the Comprehensive Dangerous Drugs Act needs to be reviewed and overhauled based on evidence, scientific knowledge, and diverse lived experiences related to drugs. According to her, this includes recognizing the negative impact of criminalization and removing criminal sanctions for drug possession, use, and use-related activities.

The Philippines’ drug policies, by and large, are still driven by stigma, politics, and morality instead of facts and science, posing a challenge to harm reduction.

“I think that the biggest hurdle for harm reduction in the Philippines is the high level of stigma against people who use drugs, and people who have anything to do with drugs, which is driven by a severe lack of evidence-based knowledge about drugs,” said Lai, from the International Drug Policy Consortium.

She added that for harm reduction to take off in the Philippines, the government has to listen to people who know what they’re talking about, including communities who have experienced the impacts of the current approach to drug policy.

“[The government] would need to create conditions that are safe for people to have an open and honest discussion about drugs. I don’t know when that would be possible though,” said Lai.

There is already some progress in this regard, at least on paper. Earlier this year, Philippine lawmakers discussed the legalization of the medical use of cannabis. Meanwhile, the HIV Law and Mental Health Act lays out legal standards for the provision of services that are based on scientific findings and that respond to the needs of specific groups of people. The United Nations Joint Programme for the Promotion and Protection of Human Rights in the Philippines also provides an opportunity to review and reform current policies.

But some groups are also taking action right now. There are people actively seeking out those who inject drugs to help them work around infections like HIV and hepatitis. Organizations assist local government units in navigating the current policies while developing and implementing harm reduction programs. There are also legal groups whose work revolves around reforming local drug policies and providing people who use drugs with access to legal resources when they need them. The work is urgent and important, but it has to be done discreetly in the country’s current punitive and restrictive environment lest it put the organizations at risk of legal action.

Despite the cloud cast by the Philippines’ war on drugs, these efforts show that there is hope for policies based on harm reduction to find ground. But one other factor has to come into play.

“A major [factor] is for law enforcement to step back and allow harm reduction experts and authorities to lead responses to drug use and dependence, and to allow people who use drugs to feel safe to seek treatment and care services when they need it,” said Lai. 

Using a harm reduction framework to shape drug policies in the Philippines is an opportunity to rethink a paradigm that has proven to be disruptive, and to have a more open conversation about drugs. 

“Of course, there are people who end up having problems with drug use, and people end up being dependent on drugs, and that needs to be addressed. But it needs to be done in a paradigm that doesn't criminalize drug use and in a paradigm that's really focused on supporting people. The hurdle is still the same because it's not just Duterte that embraced this drug-free paradigm. It's something that's been around in our country for so long, and that's the biggest hurdle, I think, this idea that all drugs are evil,” said Gideon Lasco, a medical anthropologist who has written extensively about drug use and policy.

Harm reduction provides a shift in perspective. In the eyes of harm reduction, the policies around drug use can sometimes cause more harm than the drug use itself.

Instead of looking at people who use drugs as criminals needing punishment, the harm reduction framework seeks to develop a range of services that prioritize human dignity, health, and well-being. That shift can help address problems that arise not only from drug use itself but from the policies and societal attitudes towards drugs. These include preventable deaths from extrajudicial killings, suicide due to stigma, overdose, or lack of access to health and medical services. It helps prevent over-incarceration and the physical, mental, and emotional abuse that comes with it. Harm reduction also looks at providing legal assistance to those facing the justice system on drug-related grounds. 

It’s not only about eliminating drug use, because as various wars on drugs around the world have shown, people will always use drugs. It’s about correcting harsh, often violent policies around drugs that kill people, incarcerate the youth, or break apart families. 

The views and opinions expressed in this article are solely that of the interviewees. VICE neither endorses nor encourages consumption of narcotics/psychotropic substances.