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Philippine President Ferdinand Marcos Jr. has promised that his war on drugs will be different from the deadly and problematic one waged by his predecessor Rodrigo Duterte, which drew widespread allegations of human rights abuses.

But since Marcos took power in June, even as officials aiming to reduce demand for drugs and boost prevention and rehabilitation efforts.

There is more at stake, too, in how the nation’s drug policy will proceed. In March, as Duterte’s tenure neared an end, the a bill that would allow presumption of guilt and the death penalty to be used against drug suspects.

At the U.N. Human Rights Council’s of the Philippines last month, the Marcos administration offered assurance that it would not reinstate capital punishment, which was abolished in 2006. Nevertheless, the bill could still advance through the Senate.

In this state of limbo, advocates who have long pressed for more humane treatment of people who use drugs hope that the new president and an unprecedented will provide more space to implement programs helping those who are suffering instead of punishing them.

Minimizing Risks

Harm reduction is a field that focuses on�� instead of eliminating them, with the well-being of individuals and communities as the central goal. The philosophy grew out of global programs in the mid-1990s, such as clean needle and syringe dispensation and HIV testing to stanch the AIDS epidemic.

At the time, Inez Feria was preparing for a career in workplace psychology when she had the opportunity to observe a rehab treatment program. She found that the staff’s treatment of participants was at odds with everything she had come to know about human behavior, cognition, decision-making and social learning. The interactions, she said, “reeked with disrespect.”

Feria realized that a number of social, economic, and other factors contribute to the risks and harms of drug use. And she wanted to work toward minimizing these risks in a respectful, humane way.

In the early 2000s, Feria began running a live-in center for people seeking help in relation to their drug use and partnered with a civic organization to provide drug education for voluntary participants at a government high school and youth in barangays, local administrative units in the Philippines.

In 2014, Feria founded. Known as NoBox Philippines, the group was the first in the country to openly advocate for the health, rights and equity of people involved with drugs. Previously, their only recourse had been private rehabilitation detention facilities.

Based in Quezon City, Manila, the organization has ramped up its harm reduction trainings and amplified its promotion of better drug policies, even when there was . The Philippine Drug Enforcement Agency concedes to over 6,000 drug-related killings during his presidency; the that the actual toll could be closer to 30,000.

However, advocates have an uphill battle to garner popular support for their efforts, especially after the fear tactics used by Duterte. In 2019, showed that 82% of Filipinos��who responded supported the war on drugs despite bodies from summary executions lining the streets every morning and ��that inmates had to take turns lying down to sleep.

International organizations like the U.N. and Amnesty International say that illegal drug use in the Philippines is lower than the global average. However, the problem, entrenched in the country since Spanish colonialists began importing opium in the 17th century to sell at a profit to Chinese “coolie” labor migrants, is not likely to vaporize anytime soon.

In December 2021, the Philippine police calculated that 1.2 million – 1.1% – of people in the Philippines used illegal substances. In 2019, Duterte claimed there were up to 8 million drug dependents, not just users, nationwide. This past September while visiting New York City, Marcos cited official statistics that said����were addicted to drugs.

Human rights violations in the Philippines dominated the 51st U.N. Human Rights Council meeting in Geneva in October. In an at the convention, Feria urged humanitarians to stop quibbling over numbers and repair the damage done to people by the war on drugs.

Drug Problems Are Public Health Problems

Panki Nadela has seen the damage firsthand and dealt with the consequences. He is co-founder and executive director of IDUCare, that is the only one of its kind run exclusively by people who actively use drugs.

He says the current drug-fighting efforts have only made the situation more dangerous by hurting poor people and scaring away those who need medical care and social services the most.

Largely backed by The Global Fund, IDUCare educates people who inject drugs about the importance of using clean needles. The organization also provides free HIV testing, HIV antiretroviral therapies and hepatitis C treatments. Unlike governmental programs, IDUCare does not make the provision of education and health care conditional on quitting drugs.

“It was, let’s just help our brothers. If they aren’t killed by the police maybe they’ll die of HIV.” – Panki Nadela, IDUCare

Nadela, a Cebu native, was an infant when the current president’s father Ferdinand Marcos declared martial law in 1972. Illegal drugs were a part of the atmosphere when he was growing up, but he never expected to get addicted.

It started when Nadela was a freshman in high school and his friends invited him to try over-the-counter cough syrup after classes.

“We were just having fun. We were just curious,” he remembers. Next came alcohol and dalliances with shabu, a methamphetamine hydrochloride derivative known in the U.S. as ice. According to the governmental Dangerous Drugs Board, shabu accounts for 90% of drug-related arrests in the Philippines.

Shabu took root in the Asia-Pacific when the U.S. military left its surplus of the performance-enhancer behind after World War II and remains popular for its stimulating effects, attracting workers such as drivers desperate to be alert and productive for long hours. It’s also an affordable drug – a 0.1-gram dose good for three hours costs the equivalent of $1.75.

Nadela soon found an even cheaper fix — nalbuphine, a painkiller with the brand name Nubain. So-called galleries in Cebu City’s red light district provided the analgesic, needles and a place to inject it for about 35 cents.

He began using Nubain socially, then daily. When he attended a four-day harm reduction training session in Manila in 2018, he took some Nubain with him. He finished the stash in two days – the next two felt insurmountable.

“I couldn’t stand, I was weak,” he says, recounting how he could not hold down any of the delicious food served at the hotel. Two decades after his first microdose of Nubain and three years after establishing IDUCare, he realized that he was addicted.

The use of drugs has led to another public health crisis in the Philippines, which has seen a spike in HIV/AIDS cases, with 17,000 new HIV infections reported in 2020 compared with 5,000 in 2010, according to the . The same document predicted 23,100 more infections in 2023.

Only 40% of infected people in the Philippines have access to the antiretroviral therapy drugs that suppress HIV to undetectable and virtually incommunicable levels in the bloodstream. Availability of HIV testing is even lower.

Since 2018, IDUCare has tested 3,000 people for HIV and treated over 200 for hepatitis C, free of charge. Some members of the police force have even shown up for the shots.

Hepatitis C treatment normally costs the equivalent of a month’s salary for most Filipinos. The World Health Organization research project that supplied the medication recently ended. Nadela says that IDUCare will administer the leftovers to the last drop.

When Covid-19 restrictions challenged operations, IDUCare leveraged remote technology to disperse educational materials and obtained front-line health worker passes to keep delivering HIV treatments to some 205 preexisting clients. To Nadela, the coronavirus seemed minor after the threats of working during Duterte’s administration.

“We’re not brave – we were all really scared. I don’t know why we didn’t stop but we were already used to it. We were already facing danger before,” Nadela said. “It was, let’s just help our brothers. If they aren’t killed by the police maybe they’ll die of HIV. It didn’t come up in our minds that we would stop.”

Nadela thinks he might be seeing change ahead. In July, IDUCare held its first assembly of local officials to discuss how to respond effectively to the drug problem in their communities. While 15 leaders received invitations – over 20 showed up.

“We just told them what we were doing,” Nadela recalled. The transparency went over well; everyone signed a commitment to reduce harm together.

Nadela, who has found new purpose in the work, is now focusing on plans to diversify funders, hire his volunteers as paid staff, and become a “one-stop shop” for pre-laboratory procedures, diagnostic screenings, doctor visits and treatment.

“In a way the discrimination is still there, but then they see, these drug workers are doing fantastic,” he beams.

Sometimes, though, he still braces for a knock on his door at night – a visceral reminder that caring for people who inject drugs is still as perilous as any illegal substance out there.

The Push For Decriminalization

Under Operational Plan Toktok Hangyo, which means knock and plead, launched by Duterte in 2016, police made lists of drug suspects and went to their homes without warrants. By year’s end, the police had knocked on 6 million doors and logged over 1 million “surrenders” by alleged drug pushers, dealers, and users.

Those who came forward landed on Duterte’s de-facto hit list. People awaiting rehabilitation and treatment ended up dead or in overcrowded jails.

Efforts to change the , including the criminalization of withdrawal antidotes and clean needles considered punishable paraphernalia, have failed in the past.��Sen. Risa��Hontiveros said in an email that she plans to reintroduce legislative reforms after gathering input from public health advocates and evidence about the grassroots impact on drug use prevention.

Meanwhile, local advocates point to the Philippines’ involvement and leadership in recent international meetings as evidence that their efforts are gaining momentum.

In April 2021, NoBox Philippines, IDUCare, and four other partner organizations coordinated the first . Over 600 people attended the four-day online event, featuring 21 sessions led by Filipino and international experts in harm reduction and drug policy reform. Half of those present were from local and national government.

CORRECTION: An earlier version of this story erroneously stated that the summit was held by Harm Reduction International.