Dr Nang Pann Ei Kham, coordinator of the Drug Policy Advocacy Group, speaks to Al Jazeera about the deadly addiction.
Manila, Philippines – Sitting at an undisclosed location in Metro Manila, Alden is busy preparing for his next delivery until his phone beeps. He says it is one of his customers texting to check that he is OK and hasn’t been shot like thousands of others since the start of President Rodrigo Duterte’s war on drugs.
Alden, however, is not a typical drug dealer. He treats hundreds of patients with debilitating diseases and life-threatening illnesses, even though he never studied medicine in college. He may not be a doctor, but he has something very few medical practitioners in the Philippines have: cannabis oil.
Despite a strict prohibition on marijuana – which is made from dried cannabis leaves and flowers – and the threat of Duterte’s crackdown on drugs, Alden manages an underground network that provides marijuana to people suffering from a wide range of medical conditions – including cancer, neurological disorders, and arthritis.
“Like everyone else, you want to transcend your existence,” says Alden, whose real name has been changed to protect his identity. “You want to leave a mark, and here I am thinking I’m coming closer to making that a reality.”
In March, a bill legalising medical marijuana was cleared for debate in the Philippine Congress amid a drug war that has killed more than 8,000 people since Duterte took power last year. The measure was first introduced in 2014, but failed. It was then revived last year, a day before Duterte launched his war on drugs. If the bill passes, the Philippines could become the first country to legalise medical marijuana in Southeast Asia.
Duterte has, surprisingly, expressed support.
“It’s effective,” the president said during his 2016 campaign. “I will not deprive Filipinos of the benefits of medicinal marijuana, but I must have a clear definition of what it is and it must be approved by the FDA [Food and Drug Administration in the Philippines].”
Marijuana use has long been an open secret in the Philippines despite harsh penalties for possession of just a few grammes – including up to 400,000 Philippine pesos ($8,000) in fines, decades-long prison sentences, and, until it was abolished in 2006, even the death penalty.
Before Duterte’s crackdown, it was common to catch a whiff of residual marijuana smoke in the streets or to walk past a group of teenagers discreetly passing around a joint. Now people are more cautious.
According to growers and street dealers at MonsterBud Philippines, a community of marijuana advocates, there’s a shortage of supply while the average street price of locally cultivated marijuana has nearly tripled.
In the mountains of northern Luzon, where the grounds are fertile for growing, marijuana remains particularly widespread. Over the years, some towns have evolved into tourist destinations for those looking to catch a high.
But using or dealing marijuana still comes with considerable risk, especially in Metro Manila – the area most affected by police raids and extrajudicial killings linked to the drug war. Alden doesn’t let the risk consume him. He knows many of his patients would suffer without the supply.
“Even putting [my son] on this medicine, it makes me feel like nothing’s impossible,” said a mother currently treating her son – who suffers from cerebral palsy and infantile spasms – with daily dosages of marijuana.
“The other medicines were limiting. I don’t know if he’ll be able to run or walk or talk properly on his own, but he has a chance [with cannabis].”
“I hate that I have to keep hush-hush. Other people should know that maybe [marijuana] could help their child. It might not work on everyone, but it’s worth a try,” added the mother, who asked to remain anonymous for fear of jeopardising her son’s treatment.
While Duterte’s support for medical marijuana appears at odds with his campaign against illegal drugs, he still strictly opposes its use for recreational purposes. The police also remain committed to the pursuit of those who use or deal the drug.
Alan Ladra, a deputy division chief of the Philippine National Police Directorate For Operations, admits, however, that marijuana remains a secondary concern compared with shabu, local slang for methamphetamine.
Shabu is the most abused drug in the country, according to the Philippine Drug Enforcement Agency (PDEA). In PDEA’s latest annual report from 2015, shabu users accounted for more than 95 percent of drug-related arrests.
Duterte’s positive reception to medical marijuana has energised advocates such as Kimmi del Prado, the founder of the Philippine Cannabis Compassion Society (PCCS), a group campaigning to legalise medical cannabis.
“I think people are now more receptive to [marijuana] thanks to the president,” she said.
Del Prado has been driving the fight for legalisation since the movement’s inception in 2013. It was then, after the death of Moon Jaden Lugtu-Yutuc – a 20-month-old baby suffering from a rare form of epilepsy – that the idea of legalising medical marijuana started to make national headlines.
Lugtu-Yutuc’s parents believed cannabis could have helped reduce their daughter’s intense spasms and given her a chance to live.
Around that time, Maria Cielito was looking for an alternative for her daughter, Nina, who was suffering from a brain tumour and a condition called hydrocephalus. When Cielito heard about Moon Jaden’s story, she began researching the benefits of marijuana and came across testimonies online by Dr William Courtney, a member of the American Academy of Cannabinoid Medicine.
In 2012, Courtney went public with a story about how cannabis oil helped dramatically reduce a baby’s inoperable brain tumour. This inspired Cielito to seek marijuana for her own daughter, but restrictive laws prevented access. She has lobbied in Congress in support of legalisation ever since.
Jay de Leon, the chief researcher at the PCCS and the Philippine Organisation for the Reform of Marijuana Laws, hopes to expedite the measure before the 2019 mid-term elections when congressional representatives are likely to shift their focus to re-election and avoid controversial issues.
“We want this to be the legacy of Duterte. We don’t want another president,” said de Leon. “I may not fully agree with [Duterte] in all of his actions, but he is the only president who has the guts to make this thing happen.”
Duterte’s support for medical marijuana is a bit of a mystery. The 72-year-old leader often equates drug addiction with criminality, threatening to kill addicts and bypass due process for those caught using or dealing. As uncompromising as he appears to be with drugs, he embraces the medicinal benefits of marijuana.
Duterte’s allies represent a majority in the Congress and could, theoretically, easily pass the bill once the legislative session resumes in July, but lingering opposition could delay the process.
Senator Vicente Sotto is one of the bill’s most ardent critics. His support is crucial, advocates say, because he is the leader of the majority in the Senate and has the power to obstruct a quick passage of the bill.
Sotto, a former chairman of the government’s drug prevention and control agency, is an ally of Duterte’s war on drugs. Legislation must be passed by both the House and the Senate for it to become law.
“There’s no need to pass a law that will legalise medical cannabis because anyone who thinks that a component of marijuana can cure them or help them reduce the effects of their sickness can use the compassionate provision of RA 9165. As long as there is no empirical data that proves that marijuana can cure any specific disease, I will not support such proposed measure,” Sotto wrote in a statement to Al Jazeera.
The compassionate provision of RA 9165, or the Comprehensive Dangerous Drugs Act of 2002, allows an exception for people with certain medical conditions to apply for access to marijuana.
Doctors and researchers can also apply to study the drug. None have done so because the application process is simply too bureaucratic, according to de Leon. One patient, he says, waited for four years for approval and still wasn’t granted access.
Jorge Ignacio, chairperson of the Cancer Institute in Manila, is one of the few vocal medical marijuana advocates among doctors in the Philippines. Many of his colleagues, he says, often avoid the subject because they “are probably too scared of the old notion of what marijuana is or they just don’t have an idea of how far the science has come”.
Although Ignacio endorses marijuana as a potential treatment, he is clear to point out that he advocates only for legal access. At the same time, he admits that eight of his patients are currently using marijuana with the help of underground suppliers.
“I only want patients to have access, legally, because I can’t bear seeing them benefiting from it but still hiding and being very discreet about things. It actually hampers my treatment,” said Ignacio, who is one of the four doctors policymakers consulted while drafting the legislation.
If enacted, the proposed bill would allow immediate access to marijuana for about 500,000 patients who enrol in research studies and clinical trials within the first year, according to Ignacio. The bill requires a medical research phase before marijuana is fully commercialised, which could take up to three or four years.
But Alden won’t wait and his patients can’t afford to. No matter what the political climate, he vows to press on.
“It would be unwise for me not to assume that I’m being followed and there’s not an attempt to infiltrate, but I get hundreds of messages asking for oil,” said Alden.
“I could easily quit, but that would be my biggest crime.”