Abuse, coercion rife in Philippines drugs rehab, rights groups say

• Government wants to improve treatment of drug addicts
• New report found treatment centres below global standards
• Rights advocates call out 'punitive' drug policy

MANILA - When masked vigilantes killed her husband at the height of the Philippines' "war on drugs" in 2016, Liza Igcasinza admitted to the police that she was using banned substances and was forced to spend a year in rehab.

"I was very frightened. The police took our mug shots as if we were criminals," Igcasinza, now 50, told Context.

She was one of thousands of Filipinos who submitted to a harsh regime of rehabilitation treatment rather than take the chance of a worse fate at a time when armed gangs were carrying out summary killings of drug users and dealers.

The International Criminal Court is now investigating whether the former Philippine president, Rodrigo Duterte, directed those killings while in power from 2016 to 2022.

While his successor, President Ferdinand Marcos Jr. has promised a "bloodless" campaign against drugs focused on treatment, rights groups say some facilities still fail standards and have called for more health and social support.

Igcasinza was placed under a community-based programme in her parish church in Caloocan City in northern Manila, where she was required to visit daily for physical, psychiatric and spiritual interventions.

That programme allowed her to kick her addiction and now she is employed by a non-profit group to provide education and psychosocial support to other users.

"I tell them: Many people still believe that we can change. It's hard to fight our addiction, but going through rehab can help us regain the trust of our communities and families, little by little," said Igcasinza.

Others are not as lucky, rights organisations say.

Juno Pegarido, an advocate for community-based healthcare, said drug users were forced to stay in military-style facilities and undergo sudden withdrawal and repeated drug testing.

Mary Catherine Alvarez, executive director of StreetLawPh, an NGO working on drug policy reform in the Philippines, said the country's drug law had "always been punitive".

"Drug use is penalised with a six-month mandatory rehabilitation, and if a person is caught using drugs again while under rehab, the penalty is imprisonment," Alvarez told Context.

"So it is not consistent with guidelines for rehabilitation, which stresses the process of recovery and considers events like relapse as part of that process," she said.

Hidden violations

The Philippines has at least 82 drug abuse treatment and rehabilitation centres, of which 24 are operated by the Department of Health, according to 2023 government data.

But an Amnesty International report published in November last year said coercion and abuse were rife in these facilities, where people "are held against their will and subjected to a range of human rights violations".

The report said recovering drug users were "punished for using drugs" with unscientific methods and were subjected to long periods of isolation for violating facility rules.

Upon release, they must report to authorities for 18 months and undergo random drug tests. Refusal is "taken as evidence of relapse," the report said. It said the government also did not support reintegration into society.

International standards set by the World Health Organization and the United Nations Office on Drugs and Crime say drug treatment should be voluntary, with informed consent and should cover the social and economic issues behind drug use.

But domestic drug laws around the world, including in the Philippines, have favoured detention and other punitive measures for drug use, Human Rights Watch said.

"We recognise that the Marcos administration has said that ... it will look at drugs from the lens of public health," said Rachel Chhoa-Howard, researcher for Amnesty International. "But ... the punitive approach continues."

Prison-like environment

Drug offenders in the Philippines can avoid jail time by submitting to rehabilitation.

The budget for rehabilitation centres around the country has jumped since the "war on drugs" was launched in 2016.

That same year, a 10,000-bed "mega drug abuse and treatment centre" was opened inside the Philippines' largest military camp in Nueva Ecija province, north of the capital Manila.

Amnesty International said the proximity of drug detention centres to police or military bases created a "prison-like environment" for recovering users.

In 2018, the government boasted a "significant increase" to the number of admissions to treatment facilities, with plea bargains responsible for almost 25% of admissions that year.

Kristoffer Claudio, a drug policy reform advocate and lawyer at the Commission on Human Rights, said health practitioners were "rarely integrated" into the criminal justice system, including in drug treatment and rehabilitation.

"Those who do not need such programmes are forced into one that's not evidence-based and not useful for the offender. Moreover, there's no distinction between a person who uses drugs and a person with a drug use disorder. They are treated in the same manner, which makes the intervention for the offender unnecessary," said Claudio.

Flawed drug policy

One of the drivers for drug use in the Philippines is poverty, experts say.

According to the Dangerous Drugs Board, men comprised more than 91% of admissions in 2023, partly, it said, due to high levels of stress and pressure as breadwinners.

A previous study noted that young and poor Filipinos needed drugs to do their various jobs in an informal economy.

Inez Feria of NoBox Philippines, an NGO advocating for evidence and human rights-based drug policy, said some drug users were forced to attend rehabilitation sessions even without money for food and transportation.

The UNODC called compulsory treatment and rehabilitation, which remains common across Asia, as "unethical, ineffective for improving health and public safety outcomes and linked to negative impacts on criminal recidivism and drug use".

Instead of detaining drug users in treatment facilities or jails, Alvarez said the government could replicate successful community-based programmes instead.

"If people can see that there are really positive changes after enrolling into these programmes, maybe rehabilitation will truly be voluntary in our country," she said.