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Guidance for Community-Based Treatment and Care Services for People Affected by Drug Use and Dependence in the Philippines Cbtx

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Guidance for Community-Based Treatment and Care Services for People Affected by Drug Use and Dependence in the Philippines Cbtx Guidance for Community-Based Treatment and Care Services for People Affected by Drug Use and Dependence in the Philippines CBTx FOREWORD Drug use and dependence remain to be a burden to health, social and economic stability of our country. They are interlinked with problems of intoxication, development of mental illness and mental disorders, spread of infectious diseases like HIV/AIDS and TB, disruption of peace and order due to petty and heinous crimes, and loss of productivity which can have a direct or indirect impact to an individual, family and community. Proactive ways in addressing the ill-effects of drug use and dependence are therefore highly essential. We need to try better approaches which are evidence-based and culturally adaptive. While concerned efforts have already been instituted, much is still to be done in achieving our goals. Community-based assessment, treatment, and care services for drug users in the Philippines can be a cost-effective and are proven alternative models that can be done in a caring country like ours. Based on a public health and human rights approach, this can make our services more accessible, addressing issues on stigma, fear of social, economic, and legal consequences, and can ensure treatment compliance. Development of model programs anchored on the principles of effective drug use and dependence treatment would help us provide quality services which are accessible and affordable aligned with our DOH “Kalusugang Pangkalahatan” / Universal Health Care High Impact Five (Hi-5) strategy. This document was developed to serve as a guide for all our health providers and stakeholders who are working in the drug use and dependence prevention, treatment and care in our country. MESSAGE Drug abuse remains to be a public health concern as it continues to block the aspirations of the Filipinos for a better future. There are those who are fortunate to have summoned the courage to escape drugs’ clutches; and they continue to seek our help in dire times. Treatment and rehabilitation is the most humane aspect of the anti-drug campaign as it reintegrates former drug dependents into the society. We are resurrecting dreams. We are empowering former victims. And we are helping them live-out the future that rightfully belong to them. Bringing these services to the communities through this initiative of the Department of Health together with the Dangerous Drugs Board, and with the support of the United Nations Office on Drugs and Crime, is an essential step in winning the battle against drugs. Communities play a significant role in the anti-drug campaign. After the family, the community becomes the anchor by which individuals thrive; their capacities are harnessed and their growth as citizens starts. It is then important to capacitate and empower people and communities with programs that will help protect and preserve the welfare of its members. This is a proud moment for all. We are venturing on improving partnerships, strengthening collaborations, and enhancing human-rights based models and practices in the field of treatment and rehabilitation. I believe that our faith in the innate capacity of every individual to do good and to become better is what makes us believe in this cause of keeping our homes and communities drug-free. To all the people who have been instrumental in the success of this initiative, congratulations for a job well done and thank you for pursuing a cause that is noble. Secretary ANTONIO A. VILLAR, JR., PH.D. PREFACE This Guidance for Community-Based Treatment and Care Services for People Affected by Drug Use and Dependence in the Philippines consists of five parts. Section 1 sets the background and nature of substance use and dependence. Section 2 discusses the context of treatment, including policy framework to combat illicit drug use and describes the national health system. Section 3 presents the community-based treatment approach, its philosophy, service delivery models, and components. Section 4 covers the guidelines for interventions including those for screening, assessment and treatment planning, case management, counseling, medical and pharmacotherapy, treatment of psychiatric comorbidities, and sustained recovery management. Guidelines for medication- assisted treatment are also discussed in this section. Section 5 presents the tools for screening, treatment and evaluation. This document is intended to guide health professionals and other key stakeholders involved in the response to drug use and dependence in the Philippines. It is hoped that structural responses to drug dependence will be enhanced upon adaptation of the guidance – toward a voluntary community-based treatment approach. NESTOR F. SANTIAGO, JR. MD, MPHC, MHSA, CESO III Assistant Secretary of Health Office for Health Operations ACKNOWLEDGMENT The Department of Health Dangerous Drugs Abuse Prevention and Treatment Program (DOH- DDAPTP) is most grateful to: Members of the DOH Executive Committee for their continued guidance and support: Undersecretary Vicente Y. Belizario, Jr. and Assistant Secretary Gerardo Y. Bayugo, Office for Technical Services; Undersecretary Kenneth Y. Hartigan-Go and Assistant Secretary Paulyn Jean B. Rosell-Ubial, Office for Health Regulation; Officer-In-Charge- Undersecretary Lilibeth C. David, Office for Policy and Health System; Undersecretary Nemesio T. Gako, Office for Administration and Finance/DOH Representative, Ex-Officio Member, DDB; Assistant Secretary Nestor F. Santiago, Jr., Office for Health Operations; Assistant Secretary Elmer G. Punzalan, Office for Special Concerns; and to the Honorable Secretary, Janette P. Loreto-Garin, for her encouragement and advocacy in the national health response to the drugs situation in the Philippines. DOH - Disease Prevention and Control Bureau (DOH-DPCB), Director Irma L. Asuncion and Dr. Ernie Vera, Degenerative Disease Office Members of the Dangerous Drugs Board through the leadership of Honorable Secretary Antonio Villar and Undersecretary Edgar Galvante; the DDB Secretariat led by Undersecretary Jose Marlowe Pedregosa and Assistant Secretary Benjamin Reyes, for their superb support in making this project a reality. The following individuals for their active participation in the adaptation workshop, series of meetings and editing for the finalization of this guidance document, for without their expertise and cooperation, this would not have been made possible: Dr. Alfonso Villaroman and Dr. Bien Leabres, TRC Bicutan; Dr. David Baron, TRC Argao; Dr. Joselito Feliciano, Philippine National AIDS Council; Dr. Leah Panopio, DOH Central Screening and Referral Unit; Dr. Jonathan Neil Erasmo, DOH Regional Office VII; Atty. Malene Jade Brion, Mr. Rustum Fanugao and Dr. Gene Gulanes, DOH Regional Office XI; and Mr. Francisco Gallera, DOH-DDAPTP Ms. Teresita Pineda, Ms. Josefa Anna Desiderio, Ms. Joan Marie Sison, Ms. Leonor dela Rosa, Mr. Don Edgar Santos and Ms. Ella Marie Dimaculangan, Dangerous Drugs Board Dr. Ilya Abellanosa Tac-An, Cebu City Health Department/Social Hygiene Clinic; Dr. Kibbtiya Uddin, Zamboanga City Health Office; Ms. Siegred Canuya, Makati City Anti-Drugs Abuse Council Dr. Eden Divinagracia, Philippine NGO Council on Population, Health and Welfare; Mr. Jerson See, Cebu Plus Association, Inc.; Ms. Lourdes Jereza; Cebu City HIV and AIDS Advocate; Mr. Jeffrey Somera, HDES Zamboanga City; and Mr. Toribio Gonzales, Angeles Support Group Dr. Ethel Daño, WHO; and Dr. Irene Lim, Bureau of Jail Management and Penology; Contributors of the UNODC “Guidance for Community-Based Treatment and Care Services for People Affected by Drug Use and Dependence in Southeast Asia” United Nations Office on Drugs and Crime Regional Office for Southeast Asia and the Pacific (UNODC-ROSEAP), most especially Mr. Olivier Lermet, Ms. Karen Peters, Mr. Gray Sattler, Ms. Sasiporn Petchroongratana and Ms. Maria Cristina Ignacio for their guidance and coordination throughout the development process. All our partners: DOH Central and Regional Offices, Local Government Units, other government agencies, academe, media, non-government and civil society organizations, and peer support groups who are fully supportive in our fight against illicit drug abuse. JASMIN T. PERALTA, RMT, MD, RN, MPH Program Manager Dangerous Drugs Abuse Prevention and Treatment Program CONTENTS LIST OF ABBREVIATIONS AND ACRONYMS .................................................................................................. I LIST OF BOXES AND FIGURES ..................................................................................................................... II DEFINITION OF TERMS ............................................................................................................................. III 1. NATURE OF SUBSTANCE USE AND DEPENDENCE .............................................................................. 1 2. CONTEXT OF TREATMENT ................................................................................................................ 7 2.1 POLICY FRAMEWORK TO COMBAT ILLICIT DRUG USE ........................................................................................ 7 2.2 NATIONAL HEALTH SYSTEMS ....................................................................................................................... 9 2.2.1 Community level services ........................................................................................................... 11 2.2.2 Primary Care .............................................................................................................................
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