Human Rights-Based Approach to Drug Policy Reform
Introduction to Ines Feria and NoBox Philippines
Ines Feria, the founder and executive director of NoBox Philippines, has over 25 years of experience in studying and advocating for drug policy reform. Her background includes:
Academic studies in psychology and medical anthropology at the University of the Philippines.
Practical initiatives such as running a residential center for individuals with drug-related concerns.
Crafting a youth-friendly, school-based drug education initiative.
Panelist for drugs and health during the informal interactive stakeholders consultation leading up to the UN General Assembly Specialist session on the world drug problem.
Co-chairing the UNAIDS and UNODC Asia Pacific expert advisory group on compulsory facilities for people who use drugs.
Serving as a civil society representative in the technical working group for a human rights-based approach to drug control under the UN Joint Program on Human Rights.
Addressing the UN Human Rights Council in 2022 regarding the Philippine drug policies' human rights implications.
Harm Reduction: Removing the Box of Conventional Thinking
NoBox Philippines aims to challenge conventional thinking around drug use and drug policy, inspiring individuals to see a more complete picture. This approach seeks to improve solutions and, eventually, improve lives, all while anchored on human rights and human dignity.
A Story of Trust and Respect
A personal anecdote illustrates the importance of trust and respect in dealing with individuals who use drugs. Two brothers in their twenties, Miguel and Bobby, who had previously been in a residential center, called late at night seeking shelter and safety. Instead of contacting their parents, they contacted the center. The center provided them with a warm meal and a safe place to rest, recognizing that they had been using "Shabu" (methamphetamine) for days and were likely exhausted and hungry.
This story highlights how our perceptions of drug use and people who use drugs shape our responses. The center's response was based on trust and understanding of the brothers' needs, acknowledging their humanity rather than simply focusing on their drug use.
Shifting the Focus: From Drugs to People
The human rights-based approach places the person at the center, focusing on their circumstances and needs rather than solely on their drug use. This contrasts with typical responses that treat drug use as a criminal issue or the person as a victim lacking agency.
Revisiting the Original Intent
There is a need to revisit the original intent of drug laws and policies, such as Republic Act 9165, which aims to safeguard the well-being of citizens, particularly the youth. Similarly, the UN Convention on Drugs emphasizes concern for and protection of mankind's health and welfare.
From Drug-Free to Health, Safety, and Well-being
Currently, the goal often seems to be a drug-free Philippines, leading to measures that prioritize eliminating drugs at all costs. A shift is needed to focus on health, safety, and well-being, exploring what it takes to keep people healthy and safe today.
A Framework for Understanding Drug Use: The Drug, Set, and Setting Model
The drug, set, and setting model provides a framework for understanding the context in which drug use occurs. If you take the rat park example where rats were placed in a big space where they were free to roam around. There was a use wheel for them. They had other rats, so they were able to connect and mate. So they had all these other things going on. And it showed that when that happened, the rats weren't really going for the lever that they press.
Drug Use as a Human Activity and Experience
Drug use should be viewed as a human activity and experience, neither inherently good nor bad. Like any activity, it is engaged in because it provides some benefit or serves a purpose. However, like other activities, it also carries risks.
The Importance of Context
The context in which drug use takes place shapes the experience, influencing both the pleasure/benefit and the risks involved. Context matters.
Non-Problematic Drug Use
The majority of people who use drugs do so in a non-problematic way. According to the World Drug Report, this means they do not have a substance use disorder diagnosis and do not cause harm to themselves or others. They are able to fulfill their responsibilities and maintain normal relationships.
The focus should be on the smaller percentage of people who experience problems related to their drug use and ensuring they have access to the treatment and support they need.
Understanding the Drug, Set, and Setting
The drug, set, and setting framework helps to understand the various factors that influence a person's drug use experience:
Drug: The type of drug and its predictable effects (e.g., stimulants like Shabu increase heart rate and suppress hunger; depressants lower heart rate and breathing).
Set: The person's individual characteristics, including their expectations, motivations, patterns of use, knowledge about the drug, and health status.
Setting: The context in which the drug use takes place, including the presence of trusted companions, the safety of the environment, access to water, family dynamics, and broader policies.
Examples of Drug Set and Setting
An example is a person using Shabu to manage responsibilities, like washing clothes to earn money. This contrasts with someone using Shabu every day, leading to sleep deprivation, dehydration, and potential heart problems. It emphasizes the importance of considering a range of realities and not automatically assuming drug use is a concern.
There are nuances that need to be understood. For instance, a person with hypertension and PTSD taking Shabu may find it helps them feel better, highlighting the complexities that need to be understood instead of automatically assuming an illegal substance will cause someone harm.
Implications for Treatment and Policy
The drug, set, and setting model has implications for treatment approaches. Assessments should be based on a complete picture of the person's circumstances, rather than a one-size-fits-all approach. It is important to determine what are the harms and risks, and not immediately jump to the idea that it's the drug. Drugs may be part of the picture, but it's not necessarily the starring role. We need to understand that.
The Drug, Set, and Setting model also ties into how the Drug Enforcement Administration handles plea bargains. As it stands, it seems a lot of people are forced to agree to plea bargaining, and then they're mandated to go to treatment community based programs, or worse, in a rehab, confined in a rehab program.
Honest and Accurate Drug Education
Open and honest drug education is essential, providing information that people can use to protect themselves and make informed decisions. It should be based on the drug, set, and setting model and not rely on scare tactics.
Providing accurate information, even about potential benefits, is a basic right, akin to the right to life. People use drugs because they provide some benefit, and it is important to understand this without judgment.
Treatment vs. Health and Social Support Response
The term "treatment" may not always be appropriate. Instead, we should focus on providing health and social support responses tailored to individual needs, considering the drug, set, and setting. A range of options should be available, and access should be voluntary.
DOH (Department of Health) recognizes that, because if you look at the administrative order of DOH, they actually mentioned the right to withdraw, the right to say no and right to withdraw. And yet, if you look at the other policies, it's saying they have to finish, they have to graduate. Worse if criminal justice expanded the reach into treatment. Now they say you have to finish or you get sanctioned. So there's really something wrong and distorted in the whole system that needs to be corrected.
Ethical Standards and Human Rights
Ethical standards, human rights, and harm reduction are interconnected. Prioritizing health and social support over incarceration increases the chances of transforming lives.
Examples of Harm Reduction Services
Ensuring basic needs are met: providing access to sleep, food, and hydration.
Implementing Chip sitting: staying with a person having a bad experience to provide reassurance and support.
Providing practical information: such as guidance on recovery positions for intoxicated individuals, recognizing alcohol poisoning symptoms, and staying hydrated when using stimulants.
Drug safety checking: testing substances to identify potentially dangerous ingredients.
Law enforcement assisted diversion (LEAD): diverting individuals found with drugs into social services instead of arresting them. It is now rebranded as let everyone advance with dignity.
Providing Safe consumption facilities (SCFs): clean, sterile spaces where people can use drugs under medical supervision.
Providing Substitution therapy (OST): Providing doses of substances that will prevent the withdrawal, the up and down, to reduce their cravings, people now are able to be more stable and in terms of looking for jobs, maintaining jobs, employment, school and so on.
Administering Naloxone: a medication that reverses opiate overdoses.
Regulatory Frameworks and Environment
The environment for providing these services is also important. Regulatory frameworks should support harm reduction efforts, including decriminalization or even legalization.
Harm Reduction: A Definition
Harm reduction is anchored on respect for human life and dignity. It seeks to optimize health, safety, and well-being while minimizing identified risks and harms associated with the substance, a behavior, and the environment. In light of that, we must look for dynamic approaches that are always trying to seek better methods to optimize health and well-being.
Conclusion
Always remember you are dealing with human realities, human relations and human rights. It is really never about the drugs, it is always about people. Do not let the roles you play in life make you forget that you are human.