The Wrong Way to Fight a Drug War

If you’ve tried shabu, you’ll understand its allure. Taking it begins with ritual — folding foil into a chute, rolling paper towel into a wick and heating the gleaming crystal into running liquid trailing vapor. Inhaling it feels unbelievably clean, as if your body and mind are scrubbed of all weight. It was so good I tried it only once.

Shabu, or crystal methamphetamine, manipulates the reward pathways of the brain, flooding it with dopamine. As with other addictive drugs, repetition hinders the brain’s transmitters and receptors, pushing users to seek replenishment artificially. A fraction of users get stuck in that cycle, leading to anti-social behaviours or even criminality. Even kicking that drug can lead to dependency on other substances, increasing the likelihood of relapse. This is why it is an addiction — not just shabu — that is at the heart of a public health crisis in the Philippines.

Rodrigo Duterte, speaking to Filipinos’ alarm about widespread shabu use, was elected president in June 2016 on his promise to solve the country’s drug problem. But his government’s strategy, based on fear and law enforcement, is misguided. Since he began his presidency, on average 33 people have been killed per day — more than 4,500 suspected drug users — by police, with more than 23,500 more deaths under investigation. The vast majority comes from the poor, who cannot afford private rehabilitation programs.

This drug war has been dramatic, but its effectiveness is dubious. Even official numbers remain hard to come by. Last year, the president fired the head of the government’s Dangerous Drugs Board for standing by the agency’s statistic of 1.8 million Filipinos who used drugs once within a year. That contradicted the president’s own estimate, which fluctuates between 3 million and 4 million full-fledged addicts.

Despite voicing good intentions, Duterte’s insistence on prioritizing a punitive, rather than rehabilitative, approach to addiction is proving shortsighted. Fear alone is unsustainable.

“Among all the presidents I’ve known, Duterte’s the only one who’s taken the drug problem seriously,” said Rechi Cristobal, a specialist I spoke with who has spent years as a counsellor training health workers. Yet in tackling addiction, Duterte’s tactics may be harming more than helping. “It’s scared everyone to the point that instead of seeking help, they’ve just gone underground.”

This is an urgency the president must face. “He has set back the stigmatization of addiction by 10 years,” Cristobal said.

In the last year, local government agencies, community organizers and the private sector have been compensating for the Duterte administration’s lack of preparation. But the lessons have been learned the hard way. In November, the government triumphantly opened a 10,000-bed “mega rehab” facility in a remote part of the country — which ended up mostly empty. Dionisio Santiago, the new chairman of the Dangerous Drugs Board, called the project a “mistake.” He was similarly fired and then accused of corruption, which has not been proven. Yet his assessment was on point: The resources, Santiago said, “should have been used for community-based rehab initiatives, small ones that can accommodate maybe 150 to 200 patients.”

Earlier this year I interviewed doctors, addiction therapists, hospital dorm managers, social workers, community organizers, teachers, priests and drug-policy reform advocates to understand the scope of the Philippines’ drug problem and the efforts to address it. I found reasons to be optimistic, but only if the government listens sincerely to those involved in fighting drug addiction and allocates limited resources wisely.

I spoke with Bienvenido Leabres, a doctor who leads a government-run rehabilitation centre on the outskirts of Metro Manila. When I visited the center, some 600 patients, ages 13 to 71 at the time — 95% of whom are addicted to shabu — were undertaking “therapeutic community rehabilitation”: a month of detoxification followed by roughly a year of residential treatment in which patients and their families learn how to manage the social and psychological issues that led to addiction. During this phase, counselling, education and vocational training are essential; in a country lacking economic opportunity, the drug trade thrives by creating another dependency — financial — among addicts through a pyramid scheme of petty dealing.

Leabres’ team does heroic work, but such centres are limited. Underfunding by past administrations led to a shortage of resources, and in the early months of Duterte’s drug war, they struggled with overcrowding. The Philippine law mandates rehab for drug-related offences, yet officials have lacked the training to discern between users who can stop and addicts who need more intensive treatment. According to Leabres, only about 5% to 10% of users become severely addicted, needing inpatient rehabilitation, while others need only outpatient care. “Nobody is beyond help,” he said.

Some communities are trying to fill in for the government’s failures. That’s what Luciano Felloni, an Argentine Catholic priest who has lived in the Philippines for decades, is doing. In September 2016, as the number of drug suspects being killed in his community skyrocketed some three months into Duterte’s term, Felloni, working with a local leader and a city official, started an outpatient program in the parish.

“We realized, let’s be proactive,” he said. “What can we do from our little point of view to help a campaign against drugs — but to do it in the right way? In a way that will really benefit, not harm, the community.”

Initially, the project was met with hostility from the police and scepticism from those it sought to help. Felloni’s team then asked neighbourhood matriarchs to quietly persuade addicts to attend. Fear of being killed kept the first batch to only six patients. Within a year, enrollment grew to at least 40 in each of the second and third batches — but only after elloni’s team advocated successfully for, upon completion of the six-month program and proof of sobriety, the removal of their patients from government watch lists.

These lists of untried suspects have been at the centre of Duterte’s drug war, with his supporters citing, as proof of their efficacy, the hundreds of thousands of people scared into surrendering to authorities.

But according to human rights lawyers, the lists are haphazardly compiled, unverified and inaccessible to the public. One could be told if they’re on the list but had no way to be cleared from it. In the early weeks of the Duterte administration, few foresaw that the watch lists would mirror the lists of those killed. Social workers told me about people in poor communities who had surrendered, thinking it would earn them handouts. Other counsellors told me about parents who regretted registering their children in an effort to scare them straight.

Despite vowing in July that his drug war would be “as relentless and chilling” as the day it began, Duterte has, to his credit, conceded some failings. He called the first year of his drug war “a fiasco” and admitted that the problem would persist beyond his tenure.

The irony is his usual bluster overshadows, and undermines, the gradual progress of those in the trenches. Efforts are evolving to include treatment of addiction in general, not just shabu. Government agencies are increasing training and education. Community and inpatient rehab initiatives are sprouting. At Leabres’ hospital, facilities were expanded through support from public and private sectors. And Duterte’s administration is completing an initiative started by his predecessor requiring municipalities to organize anti-drug councils to fight drug use and trafficking — though their focus and usefulness remain questionable.

In a sunny basement beneath Felloni’s church, I spent time with some who proved the value of programs that support those most vulnerable in this public health crisis. The eight eagerly showed off what they’d achieved. Rightly so.

One jeepney driver had started taking shabu to work longer hours, finding himself hooked for 30 years; when we talked, he’d been drug-free for 10 months and had connected with the daughter he never knew. A widow, whose husband had been on a watch list, spoke about rebuilding her family. Another clean-cut young man cried recounting his eight-month sobriety — and how his journey has just begun. All gushed about spending their first Christmas with loved ones in too many years to remember. A former government worker declared, “I never knew life could be so good without drugs.”

Duterte and his apologists should spend time with such Filipinos. In them, they’d glimpse the opportunity our country has — if we resist abandoning our pursuit of equality, compassion and the salvation of not just so many lives, but our nation’s very soul.

(Miguel Syjuco is a Filipino novelist and contributing opinion writer to The New York Times)