The Stigma of Substance Use and Addiction Among Filipino Immigrants and in the Philippines

Dear Editor,

In a recent article, Maina et al ¹ identified the critical issues about substance use and addiction faced by immigrants in Canada, including Filipinos. Among these issues, they highlighted that stigma remains one of the substantial barriers to help-seeking for substance use and addiction among immigrants. ¹ In this paper, I expound on the social, cultural, and religious underpinnings of substance use and addiction stigma and their implications among Filipinos as they migrate from the Philippines. I also argue for several interventions that can be used to address substance use among Filipino immigrants.

First, substance use and addiction are illegal and criminalized in the Philippines. ² This criminalization of substance use and addiction is exemplified in the Philippine War on Drugs. Wherein the Philippine President ordered law enforcement agents to engage in extensive door-to-door operations that covered 5.6 million houses, resulting in the arrest of 53 025 “drug personalities” and the surrender of 1 189 462 people. ² Substance use and addiction stigma and discrimination can also transform into violence, as exemplified during this period, where an estimated 7 000 to 13 000 people accused of drug dealing or substance use were killed during legitimate police and vigilante-style operations. ²

Second, substance use and addiction are considered a medium to destroy the Filipino youth. The church promulgated this argument and perspective. ³ For instance, in a statement, they emphasized that drug producers and traffickers as the “worst saboteurs and are worthy of the highest punishments” since they destroy the youth. ³ At the same time, they ascribed young Filipinos who have engaged in substance use as “mental and physical wrecks” who are “unredeemable.” ³

Third, substance use and addiction are tantamount to an attack on human dignity and social-moral decay. The church and its leaders also promulgated this perspective. ³ They claimed in another statement that substance use and addiction is a health and moral crisis that “dangerously and seriously” menaced Philippine society. ³ They also shared with the public that substance use and addiction are the most widespread abuse against physical well-being in the country. Likewise, they labeled drug trafficking as evil since it encouraged people to practices in contradiction to moral law. ³

With over 80% of the Philippine population identifying as Roman Catholics, ⁴ together with criminal penalties, the influence of religion and the legal system on promulgating substance use stigma and its repercussions can be felt in various areas of life.^2-5 Evidence suggests that the church’s perspective on substance use and addiction can lead to discrimination by peers and family members. ⁵ For instance, a person who has used drugs recalled his colleagues at work telling him that “you can’t be with us, you’re not on our level. You’re an addict, we’re good people.” ⁵ Stigma can also lead to poor healthcare and help-seeking behaviors. For instance, people who inject drugs or engage in sex work may not be tested for blood-borne and sexually transmitted illnesses in rehabilitation and treatment centers. ⁴ They may also self-isolate and avoid people because of shame, reducing their access to social support and resources. ⁵

Overall, a pervasive stigma against substance use and addiction is ingrained among Filipinos as they migrate out of their country. However, several steps can be considered to address stigma and, in general, substance use among Filipino immigrants. First, they may need to be introduced to legal policies on substance use and its treatment in receiving countries, such as Canada, to address their fear and apprehension of incarceration, violence, and discrimination, which they may have experienced in the Philippines. Second, they may also be oriented toward the availability, accessibility, and nature of treatment programs since these may differ from the Philippines, where substance use is approached with criminal penalties. ² Third, health promotion and risk reduction programs for Filipino immigrants can be conducted with a culturally-appropriate approach. For instance, commonly used Filipino slang can be used to refer to substances (eg, “shabu” or “bato” for crystal methamphetamine). Fourth, since discrimination and violence can be pervasive in the Philippines,^2-5 assurance of safety and protection from discrimination may help provide a sense of security and encourage help-seeking among Filipino immigrants. Lastly, while the church may have participated in promulgating stigma, Filipinos who have used addictive substances steadfastly cope by clinging to their spirituality (eg, praying and doing church service). ⁵ Thus, provisions for spiritual interventions can be an essential repertoire of recovery and rehabilitation programs for Filipino immigrants.