Monday, September 27, 2021

Special Report: After Tokhang, more than 40,000 drug users still not in rehab (First of four parts)

NEARLY two years into President Rodrigo Duterte’s war on illegal drugs, police have rounded up 63,728 people in Cebu under Oplan Tokhang, most of them in the first seven months of the campaign.

More than 55,000 of the surrenderers were drug users, said the Police Regional Office 7.

But few of them have undergone the rehabilitation that was supposed to set them on the path to their reintegration as productive members of society.

Under Oplan Tokhang, which began in July 2016, suspected drug users and pushers who surrender voluntarily when police pay them a house visit avoid criminal charges if they agree to stop their illegal drug activities.

Under the National Drug Rehabilitation Program, surrenderers are provided with Department of Health-led medical and psycho-social treatment before they are referred to other government agencies in the “aftercare” portion of the program for educational assistance, skills training and livelihood opportunities to help in their reintegration into society.

But Cebu Provincial Anti-Drug Abuse Office (Cpadao) executive director Carmen Remedios Durano-Meca said that of the 50,551 people who had surrendered in Cebu Province (excluding the cities of Cebu, Mandaue and Lapu-Lapu) as of December 2017, only 7,501 had enrolled in its community-based treatment (CBT) programs.

And of those who enrolled, only 3,736 had graduated from these programs.

Outpatient program

As of March, only 21 of the Province’s 50 towns and cities had a CBT program for the outpatient treatment and rehabilitation of low-risk and moderate-risk drug users. High-risk drug users are referred to rehabilitation centers for residential treatment.

Meca said no surrenderers had been referred to rehab centers because “most of the surrenderers are casual users.”

She took issue with the high number of people rounded up under Oplan Tokhang, saying: “Some had tried using drugs only once. And some even last used drugs 10 years ago yet.”

In the CBT, low-risk drug users join a one-month program, while moderate-risk users undergo a four-month program, Meca said.

Cebu Province uses the Matrix Intensive Outpatient Program (MIOP), the Department of Health (DOH) mandated framework for the CBT program, where the 16-week program includes individual sessions and group dynamics, values formation, family education, alternative activities, drug testing, and relapse prevention group sessions. Local government units partner with faith-based organizations, which undertake the family education and values formation.

The framework of the MIOP begins with a pre-implementation phase, where the barangay collects data on possible drug users for validation by the Philippine National Police (PNP).

“Then there is coordination with the local government unit (LGU) and the Barangay Anti-Drug Abuse Councils for Tokhang, then the creation of the Tokhang team because now, it is no longer just the police who undertake this,” said Meca.

Oplan Tokhang was suspended twice in 2017 so police could focus on internal cleansing, after it appeared that the project was used by policemen to extort money from victims and to kill at will.

It was relaunched last January with new guidelines prohibiting police from conducting Tokhang visits at night and on weekends, and against people not on the drug watchlist. The police must also now be accompanied by a representative of the local anti-drug abuse council and a human rights advocate.

Tokhang surrenderers are profiled by the PNP and screened by the rural health units using the Assist-BI (Alcohol, Smoking and Substance Involvement Screening Test-Brief Intervention) tool developed by the World Health Organization, to determine their level of addiction, before undergoing physical and medical exams.

Only then does the implementation phase of the 16-week CBT program begin.

Few graduates

As of March, only 15 of the 21 local government units (LGU) offering the CBT program had graduates. The reason is that many surrenderers have extended their stay in the program after failing to meet its requirements.

Meca gave the example of Carmen town where more than 500 surrenderers went through the CBT but only approximately 300-plus qualified for DOH validation.

“They have to finish the 16 weeks to get a Department of Health (DOH) certification,” Meca said. “If they are found positive in the surprise drug tests (conducted periodically throughout the program), balik gyud sila sa uno (they have to go through the whole program again). So they extend their stay in the program. A lot are extending their stay in the treatment program.”

They are assessed also for meeting other parts of the program.

“When they graduate with the DOH certification that they passed the treatment program under the standards of DOH, then they can use their certification to enroll in Tesda (Technical Education and Skills Development Authority) and any other skills training,” Meca said.

With drug dependence a chronic health disorder, the DOH does not consider relapses a sign of treatment failure but a “common characteristic of therapy.”

In its guidance for community-based treatment for drug dependents, developed with the support of the United Nations Office on Drugs and Crime (UNODC), it said dependents will go through this cycle several times, so relapse should not stop an individual from re-accessing treatment services.

Factors for success

Meca said the LGUs that were successful in implementing the CBT program were those that really created a team or special office to run their program.

“Wala nila gisalig sa ilang (They did not entrust the task to their) health officer, but they really hired staff to run the program. So they are able to sustain it. You have to consider that health officers are focused not only on CBT, but on the entire health concern of the municipality or city. So CBT is an added task for them,” she said.

She said LGUs shoulder the cost of the food provided to surrenderers during the CBT program, but that this did not necessarily entice more surrenderers to join or stay in the program.

“Those enrolled in the CBT are those surrenderers who really want to be reformed. They’re really taking it seriously because it’s voluntary. It’s not mandatory,” Meca said. “We assume that those who did not enroll, even if they had been invited many times, were those who really don’t want to change. It’s possible that they are still using drugs. So that’s why those who are not attending the CBT program are being monitored by the Philippine National Police.”

Other surrenderers don’t join the CBT in their areas due to the lack of money for the fare if their house is far from the site of the program and their preference to spend their time on livelihood activities.

“Most surrenderers are breadwinners, like habal-habal (motorcycle-for-hire) drivers,” Meca said.

No program

But other surrenderers simply don’t have a CBT program to attend in their locality.

Although there were surrenderers in all the 50 towns and cities under the Cebu Provincial Government, with the highest number of surrenderers being 2,442 in Toledo City and the lowest being 96 in Pilar town, not all LGUs have been able to put up a program to cater to them.

Funding is a challenge, with many barangays not even having enough money to fund the activities of their Barangay Anti-Drug Abuse Council (Badac).

According to Department of the Interior and Local Government Memorandum Circular 2015-63, the functions of the Badac include drug abuse prevention, gathering data on drug-related incidents and making a list of drug users and pushers, referring drug users for counseling and rehabilitation, and monitoring the cases of drug-related cases filed.

Barangays already have a budget for their Badac, said Meca. But since Dangerous Drugs Board Regulation 4, Series of 2016 on the monitoring of barangay anti-drug abuse campaigns does not specify what percentage of the barangay budget must be allocated for the Badac, some made a small allocation only.

“Some allocated only P2,500 for the whole year for anti-drug activities because their barangay funds are also small to begin with,” Meca said. “What’s important is that for this year, they already allocated a budget for their anti-drug program.”

For the 1,066 barangays under Cebu Province, the average allocation for 2018 is 1.25 percent of their annual barangay budget. In absolute amounts, the average allocation ranges from P5,000 to P50,000.

Outliers include Barangay Mantalongon in Dalaguete which allocated P505,300, or 10.10 percent of its budget for anti-drug activities; Uling, Naga City, which allocated P472,426 for the year (12.39 percent of its barangay budget); Das, Toledo City (P415,000, which is 3.66 percent of its budget), and Poblacion, Toledo City (P462,529, which is five percent of its annual budget).


How does the Cpadao ensure that graduates of the CBT stay drug free?

“In the after-care program, they are still required to report to the barangay regularly for monitoring purposes. For those employed already, they should be able to secure a certificate of employment. What’s important is that we enforce that the private sector implement the drug-free workplace policy so that monitoring will continue through random and surprise drug testing,” Meca said.

How long will the graduates have to keep reporting to the barangay?

“The aftercare program is continuing, so that may never end. It will depend on how long he has been in the program and whether he has already been cleared during the monitoring,” she said.

As for the surrenderers who didn’t join the CBT, Meca said it is difficult for Cpadao to track them since some no longer reside in the barangay, but they would remain in the PNP’s list for monitoring.

“It’s the barangay that will coordinate with the PNP. Each of the 1,066 barangays is assigned a Pulis sa Barangay, who will be their adviser in the Badac,” she said.

Cebu City

In Cebu City, which is not under the jurisdiction of the Cebu Provincial Government, Cebu City Office for Substance Abuse Prevention (Cosap) head Garry Lao said 17 of the city’s 80 barangays already had a CBT program after this was piloted in Barangays Bonbon and Taptap.

The other sites with CBT are Barangays Budlaan, Tabunan, Quiot Pardo, Cogon Pardo, Pung-ol Sibugay, Poblacion Pardo, Suba, Sawang Calero, Sambag II, Tisa, San Jose, Zapatera, Agsungot, Adlaon, and the Cosap office in Carreta, which caters to “walk-in clients and those under parole and probation.”

Lao said they could not force the barangays to establish a CBT program in their areas. The Cosap just campaigns for it by speaking with their barangay officials.

“Di ni pugsanay. (We don’t force them.) They are the ones who have the list of their surrenderers,” he said.

In fact, the CBT program in some areas was already “inactive,” Lao said, so Cosap had it “terminated” in three barangays—Zapatera, Agsungot and Adlaon.

Though they started out well, later their implementation had become intermittent, he said.

“It has to be the Badac (who should sustain it). As chairman of the Cebu City Anti-Drug Abuse Council, I always encourage them to activate their surrenderers,” Lao said.

48 sessions

The DOH trained the city in its CBT, which consists of a six-month program, where 24 sessions are for Cosap’s outpatient rehab program “We Care,” and 24 sessions for aftercare, Lao said.

Sessions are twice a week. Every session is an hour to an hour-and-a-half.

“If you’re absent once, you will have to have an extension of one week,” he said, because a lesson plan is followed during the classes.

Cosap has a licensed social worker, licensed psychometrician and a medical specialist. They visit the barangays and do home visits of drug surrenderers every Saturday, he said.

A total of 348 drug users have enrolled in the city’s CBT program. But only 140 were actively joining the sessions, he said. The rest were frequently absent.

Some 58 had graduated from “We Care” and been referred to aftercare.

Lao said there were barangays with surrenderers but no CBT program. And it was not due to a lack of a budget or personnel. Rather, it was because the barangay officials did not want to take on the task. Fearing retaliation, they wanted more help from the police.

The city has 9,178 surrenderers, according to the Cebu City Police Office.


The DOH’s Guidance for Community-Based Assessment, Treatment, and Care Services for Drug Users in the Philippines, released under then Health Secretary Janette Garin, lists principles for implementing quality drug dependence treatment as outlined by a UNODC-WHO 2008 discussion paper.

Among the principles are that the treatment be accessible, affordable, voluntary, grounded on scientific knowledge and evidence-based so the specific needs of each patient can be addressed, involve the community, and offered as an alternative to incarceration, where possible.

The treatment should be integrated into existing health and social services. And where feasible, special subgroups like adolescents, women (including pregnant women), sex workers, ethnic minorities and homeless people, should be given services designed to meet their needs, the guide said.

In Cebu, however, Meca said only minors received special treatment.

“Minors are treated separately under the social welfare department. The community-based treatment program of the adults is handled by the health unit of the municipality or city. But they use the same framework.”

There are 2,434 females and 2,247 minors among the 63,728 drug surrenderers in Cebu.

For the sustained recovery of drug dependents, the guide also recommends providing: (a) safe housing, such as halfway houses or community housing, “to allow continued contact with service providers while granting a higher level of independence and reintegration into the community than inpatient treatment”; (b) skills development and employment assistance; and (c) legal support, to prevent unresolved legal issues from hindering them from finding employment and causing relapses.

While skills training is part of the aftercare of Cebu’s CBT program, Meca said there was no system yet on assisting Tokhang surrenderers on housing or legal concerns.

“So far, I have not encountered any legal assistance concerns among the surrenderers,” she said.


Garin called drug dependence “a burden to health, social and economic stability of our country,” citing its links with the development of mental disorders, the spread of infectious diseases, disruption of peace and order due to crimes, and loss of productivity impacting the individual, family and community.

Yet the guidance recommends voluntary participation in treatment, saying clients were more likely to adhere to treatment when it was offered to them on a voluntary basis, rather than forced on them by their family or community.

The problem with the voluntary approach is that there are no consequences for not undergoing rehab, which is probably why most surrenderers have chosen to skip it.

Hoping that outside the CBT system, they will just rehabilitate themselves is wishful thinking.

“Few people who use drugs, once dependent, will stop using because they are concerned about the police and law enforcement. This is because ‘dependence’ means a compulsion to continue to use, as well as experiencing unpleasant symptoms once drug use is discontinued,” the DOH guide said.

As for those who did submit themselves to rehab, many have fallen at the rehabilitation stage, and so haven’t moved on to the reintegration stage to become productive members of society.

This leaves Cebu with a lot of Tokhang surrenderers identified but still not free of illegal drugs.

Unless local governments get more creative in enticing drug dependents to participate in their CBT programs, Oplan Tokhang will be just a registry of drug users—or worse, a kill list for abusive authorities and vigilantes—instead of the peaceful solution to the drug problem that it was intended to be.

Forty-seven surrenderers have been killed in Cebu, nine of them in buy-busts, 38 in assaults by unknown gunmen. Some 57 other surrenderers have been arrested in anti-illegal drugs operations.

Tokhang was supposed to be the surrenderers’ chance to change, but its one-strike policy does not take into account the science of addiction.

Drug addiction is a chronic, relapsing brain disease, the WHO acknowledges. And many addicts sell drugs to support their habit. Unfortunately, in the Duterte administration’s law enforcement component on the war on drugs, addicts who relapse don’t get second chances.

Duterte has time and again hailed the killing of drug users and pushers who allegedly resisted arrest and posed a threat to law enforcers.

“That’s good,” Duterte said last August after 32 drug suspects in Bulacan were killed in a raid. “If we could just kill another 32 every day, then maybe we could reduce what ails this country.”

Addicts, be warned.

(Part 2: Church girds for war against drugs)


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