Part 1: Drugs 101: What you need to know about the PH drug situation

What is a drug? What is an “illicit” or an “illegal” drug? A drug is a substance – natural, or man-made, that can affect a person’s mood and function. The effects can be harmful or benign, depending on the dose.  Many drugs are psychoactive – they can influence mental functions and cause dependence such that a person will crave for the sensations of pleasure, or power, that it may create.  Substances such as caffeine, alcohol, and nicotine are the most well known and used, and are legal (the last two are available everywhere, albeit with restrictions).

Substances that are “illicit” or “illegal” – generally considered contraband except for specific medical uses – can be highly addictive, have high abuse potential, and may result in aggressive, unpredictable, or “crazed” behavior. The International Narcotics Control Board (INCB) classifies these substances and their production and distribution as highly regulated. These include substances such as opium, heroin, cannabis (marijuana), cocaine, shabu or methamphetamine, and prescription drugs such as diazepam (Valium).

Most of these substances have proven medical uses – including narcotic painkillers, anti-anxiety agents, cough syrups, or agents used for anesthesia.  Safeguards to regulate supply and use exist, such as prescriptions by physicians or the use of “yellow pads” and “S2” prescriptions by professionals who can prescribe regulated drugs. Some of these drugs and other chemicals are used in the manufacture of more addictive ones.  Pseudoephedrine, found in many cough and cold preparations, is a precursor for the production of methamphetamine.  There are also substances that are thought to be “gateway” drugs – if you try them, they will lead you to use other illicit and more addictive drugs.

Why do people get addicted, or dependent on drugs? There is likely no single reason but some factors may be with the drug itself, personal and personality factors and social and peer pressure.  People take the psychoactive drugs for many reasons – primarily because it “feels good.” Others are encouraged by the supposed “rewards” for taking such type of drugs such as they can help “forget problems,” “think more clearly,” “make me excited, active, alert,” “makes me sleep and rest when I need it,” “makes  me enjoy sensations, music, sex, more.”  However, it is also likely that over time, tolerance to these effects develops, and some of these people need larger or more frequent doses, leading to habituation and dependence.  If they do not have their “fix,” they can exhibit withdrawal symptoms.  Think of what happens when you miss your morning coffee.

However, it should also be clear that majority of people who try drugs do not get addicted and can control their use; some will become dependent and chronically addicted. Some will commit crimes that may be violent and sensational, and may involve celebrities and make it to the headlines, thus fueling public perception relating the crimes to “drug users.” But committing crimes is not limited to the addicted, as this can be attributed to a relatively large dose, a new and inexperienced user, taking different drugs together (drug cocktails) or with alcohol and easy access to firearms and weapons.

'DRUG PERSONALITY.' A drug suspect beside his alleged drug paraphernalia awaits processing by Manila police. Photo by Alecs Ongcal

'DRUG PERSONALITY.' A drug suspect beside his alleged drug paraphernalia awaits processing by Manila police.

Photo by Alecs Ongcal

Only one in 300 Filipinos who use drugs have been to a rehabilitation center (4,392 out of 1.2 million estimated users). Drawing conclusions on the magnitude of the drug problem from data of people in rehabilitation would be analogous to writing about the overall health of Filipinos using data derived from hospital ICUs.  They only form a part of the picture.

How does one enter rehab, and what goes on in there? The requirements for admission to rehab are drug dependency examination result from an accredited physician and clearances from the barangay, police, and the Regional Trial Courts of no pending court cases. Getting these clearances may inhibit access to rehabilitation. Those involved in petty crimes may have problems in obtaining the necessary clearances.  

Drug dependents being treated by private doctors or who may go to hospitals or rehab centers abroad are not included in the statistics, but they are considered a minority and are generally more affluent than the typical rehabilitation center client.

Several treatment modalities may be used in the rehabilitation centers. These modalities and approaches are described in the DDB website:

Other rehabilitation centers also incorporate strenuous physical activity into their programs including manual labor, sports and aerobics; recall Cebu prison inmates “moonwalking” in their orange uniforms.

It is not clear which approaches have been the most effective in terms of preventing relapse. Theoretically, any rehab program should be intensive, coordinated, long lasting, individualized, sustained and run by experienced professionals.  An authoritative reference, Drugs and Drug Policy – What Everyone Needs to Know, states that treatment for stimulant addiction (such as methamphetamines and cocaine) does not usually work and the most common treatment outcome is relapse. There is no “perfect” approach, and all of them have high relapse rates, thus, there is really no “quick fix” or “magic bullet” to stop drug dependence. In some countries where heroin and narcotic addiction are common, use of drug substitutes is practiced. These substitutes enable users to reduce their dependence on heroin, allow them to be functional, and live a more controlled life.   

Not all drug users need treatment. A form of “recovery” is the most frequent form of exit from all types of behavioral problems including, but not limited to, addiction to pornography, computer games, sex, alcohol, smoking, gambling, and drugs.  A combination of factors may help – “growing up,” starting a job, fulfilling familial responsibilities and expectations, experiencing the burdens  of addiction. It does not help if one goes back to a situation where family, partners, and peers continue to abet and encourage use.

Where will all the recent surenderees go? The reported number of people who have  recently “surrendered” to authorities as “drug users” has been reported at 120,000 and still rising.  This sudden surge has led to long lines for admission for rehabilitation. Unfortunately, there are no rehabilitation facilities that can accommodate them, should they fit the criteria for admission. Even if the capacity of rehabilitation centers would magically double, merely 10,000 people could be accommodated – less than 10% of “surrenderees.”   For the majority, there is no rehabilitation program existing and alternatives have to be proposed.  (READ: Part 2: The Philippines as target market for illicit drugs) – Rappler.com

Vicente S. Salas, MD, MPH, FPAFP, is  an international consultant on HIV and AIDS, migration health and sexual and reproductive health who headed a team that wrote the first situation analysis of HIV and Injecting Drug use in the Philippines (2008), and authored a chapter, “HIV in Injecting Drug Users” in the book AIDS in the Philippines (2010). The recent spate of killings, a major focus of the new president, and the increasingly shrill discussions about drugs, drug addicts, drug lords and drug pushers prompted him to write this piece.