Illicit Drug use in the Asia Pacific Region - Burnet Institute

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Situational analysis of illicit drug issues and responses in the Asia–Pacific region 246 Health and treatment responses The Philippines Department of Health is the lead agency in the conduct of treatment, rehabilitation and after-care of drug-dependent people (Dangerous Drugs Board, 2005) . The roles of the Department of Health among others are: • to participate and coordinate with other agencies in the conduct of secondary prevention (intervention) • to participate in the conduct of primary prevention in coordination with PDEA and other NGAs; and • to participate/coordinate with PDEA in the prevention/control of the diversion/misuse of medicines and legitimate production/ importation of plant sources by drug traffickers/clandestine laboratories/users . Number of people accessing treatment services As of January 2005, the number of residential and outpatient centres for drug-dependent people totalled 69 (Dangerous Drugs Board, 2005) . In 2004, there were 54 residential and one outpatient facility reporting in the Integrated Central Case Registry and Monitoring System (ICCRMS) of the DDB . From all reporting facilities, a total of 5787 cases were reported in 2004 (81% new admissions; 15% readmission; 4% outpatient cases) . From the figures of 2003, there is a decreasing trend in new admissions, relapse and outpatient cases . This trend has been attributed to the high cost of treatment, which has proved to be a deterrent for people to undergo treatment (Dangerous Drugs Board, 2005) . For 2004, the majority of clients were male (9:1 ratio), single (53%), aged 20–29 years (41%), unemployed (38%) . The most commonly abused drugs were shabu (85%), cannabis (32%), cough/cold preparations (4%), benzodiazepines (4%), inhalants (3%) and ecstasy (1%) . The route of administration reported by clients was inhalation, sniffing, smoking and oral ingestion (Dangerous Drugs Board, 2005; United Nations Office on Drugs and Crime, 2004b) . The National Poison and Control Centre of the Philippine General Hospital conducts a census of patients admitted and detoxified (Dangerous Drugs Board, 2005; United Nations Office on Drugs and Crime, 2004b) . From January to December 2003, a total of 108 drug-related cases were recorded . Drugs identified as being used by patients were shabu alone or in combination with other drugs, cannabis and volatile substances . Drug dependence, drug/chemical abuse and drug-induced psychosis were identified as the cases of admission for both sexes . Five cases were recorded as drug-related deaths among male patients (Dangerous Drugs Board, 2005; United Nations Office on Drugs and Crime, 2004b) . The National Center for Mental Health Detoxification Unit attended to 123 in-patient and outpatient cases from January to October 2004 (Dangerous Drugs Board, 2005; United Nations Office on Drugs and Crime, 2004b) . Of this number, 103 were male . The highest number of cases were diagnosed as druginduced psychosis . As of October 2004, a total of 249 inmates serving sentences for drug-related cases volunteered for treatment (Dangerous Drugs Board, 2005; United Nations Office on Drugs and Crime, 2004b) . The therapeutic community program in prisons applies to inmates who (1) volunteer for treatment, and (2) have at least two years of their sentence remaining to serve in the Bureau of Corrections . Based on the intake interview of service providers in the Therapeutic Community Center, the commonly abused drugs of inmates prior to their incarceration were methamphetamines, cannabis and cough syrups . There are also non-government treatment centres that include outpatient and residential treatment . Treatment fees are estimated at 75,000 peso for a 45-day treatment stay . The government treatment centres subsidise treatment fees . The patient typically pays for pre-administration examination, HIV tests, x-rays and a patient uniform . Detoxification is delivered by some nongovernment treatment centres, however ‘cold turkey’ is the standard approach . The 12 Steps is the model mostly used by government treatment centres along with the therapeutic community model, which is being used by a few treatment centres . Formal schooling is provided in some government rehabilitation centres and patients receive skills training, and physical, mental and spiritual rehabilitation . Multi-disciplinary teams are used in treatment centres . The average length of stay in a rehabilitation centre (government) is six months . A person apprehended or arrested who is found positive for illicit drug use is imposed six months rehabilitation in a government centre for the first offence; a second offence requires imprisonment . Other responses Harm reduction Harm reduction interventions are limited in Cebu, Mandaue and Lapulapu Cities . In Cebu, the organisation USPF currently conducts a small-scale needle and syringe program (NSP) through their community health outreach workers . They promote the cleaning of needles and syringes with bleach and water . The program is unable to access many IDUs in Cebu, so crude ways of cleaning needles and syringes remain widespread . Demand reduction For programs on drug demand reduction, see Dangerous Drugs Board (2005) and United Nations Office on Drugs and Crime (2004b) . Demand reduction initiatives among all age groups consist of three approaches, according to the DDB . The first is primary prevention for non-users with the DDB as the lead agency and involves collaboration with the Department of Education, Department of Labour and Employment, the Commission on Higher Education, and other government and non-government organisations . The mass media also play an important role . The second approach is secondary prevention for ‘experimenters’ and casual drug users . The Department of Health is the lead agency with support from the Department of Social Welfare and Development, local government units, and the Philippine National Police . The third approach is tertiary prevention for drug-dependent people . The Department of Health is again the lead agency supported by all law enforcement agencies, local governments and NGOs . The DDB has established drug testing programs for schools, workplaces, the military, law enforcement and security personel . Moreover, guidelines have been laid out for the establishment of Special Drug Education Centers in every province, which will have the role of sponsoring drug abuse prevention programs for out-of-school youth and street children . In an effort to bring the drug abuse fight to the grassroots level, the Lakbay Kontra Droga (Caravan against drugs) was initiated . Various government and non-government entities have been mobilised to heighten the level of awareness among Filipino people on the government’s current anti-drug campaign as well as the multi-sectoral initiatives . The project includes community anti-drug rallies 247 Country profiles: Philippines
Situational analysis of illicit drug issues and responses in the Asia–Pacific region 248 and a motorcade, and voluntary reporting of the barangays of their watch-list of drug users and ‘pushers’ . In further pursuit of drug prevention and control, the DDB has conceptualised Barkada Kontra Droga (Peer groups against drugs), a peer-based anti-drug advocacy program . Alternative activities to drugs are included in the program, such as sports, indoor games, cultural and socio-civic activities, and the conduct of competitive activities that bear anti-drug messages . A series of training courses focusing on life skills, leadership, income generation and resource mobilisation are also provided . A citizens’ brigade will be formed for the purpose of reporting on drug use and pushing . Reporting will be made via a call centre or text messaging . The DDB also has plans to initiate the program ‘Adopt a Drug Dependent’ to help indigent clients who want to volunteer for treatment but are financially incapable . The program will be a partnership between the government and private sectors such as Rotary Club, Lions Club and other NGOs and private individuals who will pay the cost of the treatment and other incidentals . The program also encourages the sponsors to provide gainful occupation after treatment through job placements . The National Drug Education Program (NDEP), Department of Education: Drug education is part of the learning area of Makabayan (Nationhood) from Grade 1 to 6 and also at high school level . Informal education approaches are also being implemented to support existing knowledge imparted in classrooms . Ancillary services such as counselling or related help are also being strengthened . Random drug testing shall be initiated among public and private high schools . Sexually transmitted infections including HIV/AIDS (2004–2005) The aim of this project is to provide technical assistance and support to address the STI and HIV/AIDS Program of the country with the Department of Health as the primary partner of cooperation . The program is supported with emphasis on advocacy, policy/guidelines development, resource mobilisation, capacity building and research . Special attention is provided for the following components of the program: condom use program for prevention, local governance, surveillance, ARV procurement, technical assistance, IDU baseline survey . Funding is from the national budget and other sources from regional budgets . Funding for the program is US$60,000 . NGO involvement The KATOTOHANAN Foundation is one of the most active NGOs involved in drug abuse prevention and control . Through DDB Regular Member representing the NGOs, Ambassador Miguel Perez-Rubio, the Foundation has engaged in activities in pursuit of their continuing campaign against dangerous drugs like radio guestings, advocacy campaigns, linkaging and coordination . These include the Lakbay Kontra Droga campaign, the establishment of links with Daytop International to enable it to conduct a therapeutic community (TC) training in the Philippines, among others . A major accomplishment of Ambassador Perez-Rubio was his request for Daytop International to conduct a training campaign on the TC, which shall be funded by the United States State Department so that the Department of Health may institute a comprehensive TC counselling methodology in the governmentrun rehabilitation centres . Resource allocation to different sectors with respect to drug issues National government expenditure 2005 The total proposed expenditure program for 2005 amounts to P907 .6 billion (AU$21 .6 billion) . Analysis by the Department of Health shows the proposed health budget is 9,826,727 thousand pesos (AU$234,069) . The Dangerous Drugs Board is allocated separate funding . In 2003, the DDB obligation was 83,193 thousand pesos (AU$1,981) . Education, not including universities and colleges, has a proposed budget of 102,629,586 thousand pesos (AU$2,444,641), National Defence has a proposed budget of 46,036,935 thousand pesos (AU$1,096,602) . Presently, a proportion of the gaming agency profits are allocated to DDB . The DDB is responsible for allocating funds to projects/ agencies based on a predetermined set of criteria (personal communication, DDB, 2005) . 249 Country profiles: Philippines
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