Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

AUG 2 9 2017

ADMINISTRATIVE ORDER
No. 2017- OOIS

SUBJECT: Guidelines for Community-Based Treatment and Support Services for

Persons Who Use Drugs in Primary Health Care Settings

I. BACKGROUND AND RATIONALE

In response to the unprecedented influx of drug users who surrendered to authorities under the
government's Barangay Anti-Drug Clearing Program, DOH established a task force that
developed an algorithm on dealing with surrenderers (Client Flow for Wellness and recovery
from Substance-Related issues), which was subsequently approved by the Dangerous Drugs
Board (DDB). Under this framework, the venues for care and service provision to Persons Who
Use Drugs (PWUDs) are stratified according to the severity of their condition. Using the figures
reported by the United Nations Office for Drugs and Crime (UNODC) in the World Drug
Report 2016, it is estimated that only about 1-2% of drug dependents will require initial care
in a residential drug treatment facility; 4-6% will need structured outpatient services; while the
remaining 90-95% can be managed with community-based treatment and care services, hence
this guideline was formulated.

This policy was informed by the recommendations in the document Guidance for Community-
Based Treatment and Care Services for People Affected by Drug Use and Dependence in the
Philippines and based on the Principles and Policies Governing Community-based Treatment
and Care Services (Annex A). This was enhanced through a consensus development workshop
participated by various stakeholders representing national government agencies, local
government units, public and private health care facilities and providers, and civil society
organizations.

II. OBJECTIVES

A. To prescribe guidelines for the effective implementation of community-based treatment

and support services for PWUD in all primary health care settings that covers the
following:

1. prevention and promotion

2. treatment and rehabilitation
3. after care and reintegration
4. monitoring and evaluation

Building 1, San Lazaro Compound, Rizal Avenue, Sta Cruz, 1003 Manila • Trunk Line 651-7800 Direct Line: 711-9502, 711-9503
Fax: 743-1829 • URL: http://www.doh.gov.ph; e-mail: officeofsoh@doh.gov.ph
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B. To prescribe guidelines that are premised on the principles and values of

appropriateness, accessibility, affordability, acceptability, effectiveness, efficiency,
equity, and quality.

C. To provide reference guidelines to Local Government Units (LGUs) in the enactment

of ordinances, resolutions, or other policy issuances in implementing community-
based treatment and support services under their jurisdiction.
D. To adopt the global evidenced-based guidelines and principles as may be applicable in
community settings.

III. SCOPE OF APPLICATION

A. This Order shall initially prescribe the minimum components of a community-based

treatment and support program covering the critical phases of drug treatment,
management and rehabilitation of PWUD in communities in all primary health care
settings.
B. This shall also apply to all individuals, institutions and organizations involved in the
provision of community-based treatment and support services, including the intended
beneficiaries or PWUD being managed or assisted in the community.

IV. DEFINITION OF TERMS

A. Abstinence -refraining from of use of an addictive drug.

B. Aftercare - services that help recovering drug dependents to adapt to everyday

community life after completing earlier phases of treatment and rehabilitation through
planned follow-up treatment intervention.

C. Community-Based Treatment- holistic model of treatment in the community which

provides a continuum of care from outreach through integration including
maintenance pharmacotherapy, and coordination of services and assistance from a
number of health, and non-health specialists to meet the PWUD needs.

D. Person Who Uses Drugs (PWUD) - individual who has used, abused, or 1s
dependent on a dangerous drug.

E. Random Drug Testing - conduct of a drug test, using approved methodologies, the
timing of which is not announced, or is unknown to a PWUD.

F. Random System Audits - is quality management system tool intended to mitigate

further commission of lapses in the implementation of policies, procedures, standards,
and guidelines in relation to safety, quality, and competencies of facilities and
personnel. This is conducted at random and choice of area for audit shall be decided
by monitoring and evaluation team prior to the audit.

G. Relapse- the recurrence of drug use after apparent recovery.

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H. Rehabilitation - a dynamic process or intervention emphasizing on aftercare and

follow-up treatment, directed towards attaining change in physical, psychological,
social, and spiritual life ofthe PWUD.

V. GENERAL GUIDELINES

This Order aligns with the Philippine Health Agenda (PHA) 2017-2022 to guarantee
services for both well and the sick in addressing triple burden of disease including
substance use disorder.

A. Community Based Drug Rehabilitation Program shall be implemented m all

communities in line with the 12 Legacies for Health by 2022.

B. All primary health care facilities in communities shall endeavor to provide

community-based treatment and support services for PWUD as an essential part of a
continuum of care for PWUDs.

C. All primary care health facilities providing community-based treatment and support
services shall be part of a network (eg Anti Drug Abuse Councils or ADAC) with
resource mapping to ensure that PWUDs receive holistic and integrated care.

D. All primary care health facilities providing community-based treatment and support
services, specifically, the health worker in charge, shall follow the algorithm of
"Client Flow for Wellness and Recovery from Substance Related Issues" provisions
ofDDB Regulation No.4, series of2016 (Annex B).

E. All primary care health facilities shall adhere to monitoring and evaluation
requirements from DDAPTP (DOH Regional Offices reporting to Central Office) or
ADAC as may be appropriate relative to quality implementation of the community-
based treatment and support services for PWUD and shall require PWUD or their
duly recognized representative to comply with client satisfaction survey
requirements for program improvements.

F. All primary care health facilities providing community-based treatment and support
services shall institute policies that adhere to human rights and dignity ofPWUD.

G. All health service providers and support workers shall (1) adhere to the highest
possible professional and ethical standards in the performance of their functions,
and (2) show sensitivity to culture, ethnicity, religion, age, gender and sexuality in
dealing or relating, treating and managing PWUD.

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VI. SPECIFIC GUIDELINES

A. Respect for Human Rights and Dignity in Primary Care Facilities for Community-
Based Treatment and Support Services for PWUD

Community health service providers and support workers shall:

1. Provide services in a non-stigmatizing and respectful manner to PWUD

2. Obtain informed consent from PWUD or a legal representative prior to initiating
any service
3. Guarantee PWUD the option to withdraw from the program subject to the
guidelines of the Local Government Unit (LGU) for admission and discharge
4. Develop individual care plan jointly with the PWUD
5. Protect the rights to privacy and confidentiality of the PWUD, Collection and
disclosure of personal data shall be in accordance with the Data Privacy Act of
2012.

B. Promotion and Prevention Program in Community-Based Treatment and

Support Services for PWUD

1. ADAC shall lead in the formulation of the plan of action for community-based
treatment and support services on the promotion and prevention of drug abuse
in communities in coordination with other members of the network in LGU.

2. The DDAPTP LGU Coordinator shall supervise the community health team
tasked with the promotion and prevention program for community-based
treatment and support services in primary care facilities and other service
providers as may be identified.

3. Focus of operational strategies and interventions of the program are the

following, but not limited to: (a) educating communities on ill effects of drug
use and abuse, (2) encouraging PWUD to voluntarily undergo the appropriate
tests, (3) mobilizing different sectors or actors to collaborate, support and build
capacities to treat and manage PWUD (4) establishing good media relationship
for possible media mileage.

4. The campaign slogan "Sa DROGA Talo Ka, ACHIEVE ang PAGBABAGO!"
shall be adapted by the primary care facility in advocating for the promotion
and prevention of drug abuse in communities.

All messaging materials shall be approved by the DOH Health Promotion and
Communication Service with DOH DDAPTP, for concurrence by the DDB.

Information, Education and Communication (IEC) materials shall be monitored

by the ADAC Communication Team.

5. The program shall use the 4 Steps in Operationalizing the Core Messages, which
are:
a. Raising knowledge and awareness: Alamin ang wasta, Makiisa sa
Pagbabago
b. Creating perception: Kaisa mo ako
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c. Directing attitude: Kasama mo ako

d. Ensuring behavioral change: Ikaw at ako, tungo sa pag achieve ng
pagbabago

6. The preferred language for communicating the messages shall be any of the
following: English, Filipino, or Local Dialect.

7. Only licensed counselor, psychologist or psychiatrist shall provide counseling

services to PWUD. Other service providers such as psychometritian and
rehabilitation practitioners shall provide counseling services only under
supervision by licensed counselor, psychologist or psychiatrist.

B.l Program for Low Risk for Drug Abuse and Dependence

1. PWUD assessed as low risk for drug abuse and dependence shall be provided
with at least one (1) service from each of the following service categories:

a. Individual and Family Programs - e.g. orientation and briefmg,

seminars, brief intervention, family counseling, individual counseling
b. Community Care Interventions - e.g. skills training, livelihood
opportunities, job placement
c. Health Psycho-education - e.g. drug awareness lecture
d. Psychological/Social I Spiritual Support Services - e.g. recollection,
retreat

The minimum duration for this program is one (1) month.

2. PWUD shall receive additional support through network collaboration if

deemed appropriate or essential. These interventions shall include, but not
limited to, the following: livelihood projects, recreational activities,
Alternative Learning Systems (ALS), and employment.

3. PWUD can be subjected to voluntary Random Drug Test Administration for

the planned duration of his/her program. If found positive, PWUD shall be
referred to a physician for further assessment and appropriate intervention.

4. PWUD shall be provided with an Individual Treatment Card/Book. All

services received by the PWUD and results of the drug testis shall be recorded
in the treatment card/book.

5. PWUD shall be issued a "Certificate of Community Program Completion"

upon successful completion of the program. This shall be signed by the head
of the primary health care facility or service provider who directly supervised
PWUD' treatment. Additional signatories shall include the Health Officer,
DDAPTP Program Coordinator, or Local Chief Executive.

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B.2 Program for Mild Severity of Drug Use and Dependence

1. PWUD assessed as mild severity for drug abuse and dependence upon
assessment shall be provided with at least one (1) service from each of the
following service categories:
a. Case Management with individual treatment plan
b. Psycho-education/Advocacy - may include topics on diseases related
substance abuse and dependence, triggering factors, legal consequences
of substance use, family values
c. Brieflntervention
d. Education/Employment Support - e.g., alternative learning system,
livelihood, vocational skills, food processing, bread and pastry making,
job placement/employment
e. Relapse Reduction
f. Motivational Intervention

The minimum duration for this program is four (4) months.

2. PWUD shall receive additional support through network collaboration on a

voluntary basis. These shall include, but not limited to, the following: tree
planting, street/drainage cleaning, garbage collection and/or segregation,
assisting in medical missions, or recreational activities.

3. Random Drug Test Administration can be performed any time within the
duration of the program. PWUDs shall be oriented of the process and
informed of the test results and the appropriate, possible or alternative
treatment available, including support services. PWUD shall be referred to a
capable physician for further assessment and appropriate intervention, if found
positive.

4. PWUD shall be provided with an Individual Treatment Card/Book. All

services received by the PWUD and results of the drug testis shall be recorded
in the treatment card/book.

5. PWUD shall be issued a "Certificate of Community Program Completion"

upon successful completion of the program. This shall be signed by the
primary care facility staff or Chief or service provider who directly supervised
PWUD' treatment. Additional signatories shall include the Municipal or City
Health Officer, DDAPTP Program Coordinator, or Local Chief Executive.

C. Community Support, Aftercare and Reintegration (CSAR) Program

1. CASR shall focus on relapse reduction and reintegration into the community.
PWUDs who have successfully completed general interventions, treatment
and rehabilitation programs shall be referred to take this program.

2. The program consists of the following core services/interventions:

a. Medical/Dental Services
b. Psychological Services

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c. Social Services

The minimum duration for this program is six (6) months and may be
extended depending upon assessment of the community health team.

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3. ADAC shall lead the Community Health Team in this program in close
collaboration with other network members such as, DSWD, LGU, PNP, and
NGOs.

4. PWUD shall receive additional interventions, such as but not limited to the
following: family support group sessions (family visioning and crafting of
mission by the PWUD and their families), family psycho-education to address
stigma within the family, parent feedback, organization of parent-helping-
parent, weekly family process groups, and weekly dialogue/seminar/lecture of
parents and significant other.

5. Random Drug Test Administration can be performed any time within the
duration of the program for signs of relapse. This shall complement the history
taking and physical examination results performed by primary health care
facilities (public and private). If found positive, PWUDs shall be referred to a
capable physician for further assessment and appropriate intervention.

6. PWUD shall be provided with an Individual Treatment Card/Book. All

services received by the PWUD and results of the drug testis shall be recorded
in the treatment card/book.

D. Monitoring and Evaluation

1. Regional DDAPTP Coordinator shall designate a Local DDAPTP Coordinator

to carry out the responsibility of monitoring and evaluation of Community-
Based Treatment and Care Services.

2. Regional DDAPTP Coordinator shall schedule quarterly meetings with all

primary health care facilities providing community-based treatment and
support services under its area of jurisdiction. The specific agenda for the
quarterly meeting shall include status of implementation of the program,
identification of gaps and challenges, and interventions.

3. ADAC shall undertake Multi-level monitoring using a standard tool and shall
provide feedback to DDAPTP local coordinator pertinent to health and health-
related concerns for appropriate action by DOH.

4. Random Systems Audit shall be conducted to all primary health care facilities
(public and private) by a DDAPTP designated professional quality provider at
least once a year. Notice of audit shall be sent to the primary health care
facility selected one (1) month prior to the scheduled audit.

a. Coverage of the audit shall include implementation of procedures,

standards, guidelines, policies, safety, facilities, and competencies of
personnel

b. Result of audit shall be submitted to the DDAPTP Regional Office for

appropriate action.

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5. PWUD or their duly recognized representative shall be required to submit

complete client survey forms at the end of the program.

a. Feedback forms shall be equal to 10 percent of the total number of

PWUD clients who completed the program.
b. All completed survey forms shall be analyzed and reported to DDATP,
for presentation during the annual system audit.
6. DDAPTP Regional Coordinators shall gather for an annual evaluation meeting
of the program implementation of primary health care facilities for drug abuse
and treatment and support services in communities. The evaluation results or
outputs shall be forwarded for appropriate action by all concerned offices or
entities.

E. Roles and Responsibilities

DOH DDAPTP shall be responsible for the oversight functions of this Order. The
respective ADAC with the designated local DDAPTP coordinator shall coordinate
closely with the designated DDAPTP regional coordinator.

Annex C provides the specific functions and responsibilities of key actors.

VII. REPEALING CLAUSE

All issuances which are inconsistent with this Order are hereby repealed.

VIII. EFFECTIVITY

This Order shall take effect immediately after publication in a newspaper of general
circulation or in the DOH website.

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Annex "A"

Principles and Policies Governing Community-based Treatment and Care Services

The following principles, enunciated in the Guidance for Community-Based

Treatment and Care Services for People Affected by Drug Use and Dependence in the
Philippines, shall govern community-based approaches to rehabilitation:

• continuum of care from outreach, basic support and reducing the harm from drug use to
social reintegration, with no "wrong door" for entry into the system;
• delivery of services in the community- as close as possible to where drug users live;
• minimal disruption of social links and employment;
• integrated into existing health and social services;
• involve and build on community resources, including families;
• participation of people who are affected by drug use and dependence, families and the
wider community in service planning and delivery;
• comprehensive approach, taking into account different needs (health, family, education,
employment and housing);
• close collaboration between civil society, law enforcement, and the health sector;
• provision of evidence-based interventions;
• informed and voluntary participation in treatment;
• respect for human rights and dignity, including confidentiality; and
• acceptance that relapse is part of the treatment process and will not stop an individual
from re-accessing treatment services.

Furthermore, the implementation of these guidelines shall be in compliance with

existing international agreements and treaties, statutes, regulations, and other policy
issuances, such as, but not limited to, the following:
• Transforming our world: the 2030 Agenda for Sustainable Development
• ASEAN Work Plan on Securing Communities Against Illicit Drugs 2016-2025
• Philippine Development Plan 2017-2022
• Republic Act No. 9165, otherwise known as the Comprehensive Dangerous Drugs Act of
2002, and its Implementing Ru1es and Regulations
• Executive Order No. 4, Providing for the Establishment and Support of Drug Abuse
Treatment and Rehabilitation Centers Throughout the Philippines
• Executive Order No. 15, Creation of an Inter-Agency Committee on Anti-Illegal Drugs
(ICAD) and Anti-Illegal Drug Task Force to Suppress the Drug Problem in the Country
• pertinent regulations and resolutions of the DDB, including Board Resolution No. 3,
series of 2016 (Re: Guidelines on Handling Voluntary Surrender of Drug Personalities)
and Board Resolution No. 75, series of2015
• pertinent issuances of the DOH regulating the standards in the provision of treatment and
care services for drug use and drug dependence.

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 {/ANNEX B"

OOERATE • SEVERE
2.Saaeling

LOW

ODE RATE

ABUSE TREA WOR CLIENTS

&.GENERAL 6. COMMUNITY -BASED 7. HEALTH FACILITY-BASED 8. INPATIENT

TREATMENT & REHAB OUTPATIENT TREATMENT TREATMENT & REHAB
& REHAB IDetoXJficatJOn
IDrug reatment & rehab
IRelap~ PreventiOn
Res1dent1al care 1n mental
health fac1ht1es

I Ja11s
Halfway care

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Roles and Responsibilities of Key Actors In Community-Based Approach

Components Responsibilities Key Actors Tasks

Community • Awareness • Community members • Identification of drug
ratsmg • Community based users
• Public workers • Preliminary screening and
education • NGO peer outreach basic needs assessment
• Health workers • Basic counseling and
promotion • Other individuals and support
organizations operating in • Referral of people who are
the community believed to have a substance
•ADACs abuse problem to
community health centers
Community-based • Provision of • Health center staff • Provision of basic health
Health Services basic health care • Community volunteers education and brief
(Primary Health Care) including • Representative/s from counseling on risks of drug-
assessment and local authorities related problems
with or without management of • Provision of support to
Community-based minor injuries drug users who are not drug
Recovery Facilities and diseases dependent
such as: • Liaising with NGOs in the
community and referral of
Recovery Clinics patients back to community
(Substance Use organizations for follow-up
Disorder Outpatient and aftercare
Clinics) and • Referral of drug users to
Recovery Homes step DOH-accredited physicians,
up care from a community based recovery
recovery clinic or facilities, DATRCs
primary care facility
or step down care
from a higher level of
treatment.

Treatment and • Treatment of • Health care I • Assessment, diagnosis,

Rehabilitation Centers severe and or medical staff rehabilitation, treatment and
complicated • Rehabilitation care of substance use and
cases practitioners dependence
• Administration services
Hospitals/ medical • Provision of • Health care I • Diagnosis and treatment of
centers medical, medical staff drug use disorders and
surgical, • Volunteers potential comorbidities
diagnostic and • Medicated detoxification
emergency (if required)
services • Psychosocial counseling
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• Counseling and • Mental health examination

provision of • Treatment of medical
outpatient problems
substance use
disorder clinical
services
Non-governmental • Ensure a • NGO staff • Education about the
organizations continuum of • Volunteers effects of drugs including
care HIV prevention education to
• Provide the community
ongoing support • Training of drug use
to clients and disorders to law
family enforcement
• Focal points • Collaboration with other
for client stakeholders and
management and organizations in the
coordination of community
care • Psychosocial counseling
• Help support groups
Law • Referral of • PDEA, PNP and other • Collaboration with
Enforcement drug users to law ADAC, health sector and
health care enforcement organizations in
providers agencies the identification and
• Assist drug preliminary screening of
users m drug users
receiving • Discussion with drug
help users and families of
in the options for treatment
community

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