A Fifty-year challenge in managing drug addiction in Malaysia

The history of substance abuse in Malaysia can be divided into pre- and post-independent era. In pre-independence, the main drug of abuse was opium which was initially consumed by immigrants from China who were introduced by the British colonialist to work in \ud Malaya. The post-independence era began in the 1960s when young adults were inß uenced by the “Hippy” subculture. At this time, consumption patterns changed where more Malays were involved in drug abuse compared to other ethnic groups (1, 2). \ud By the early 1980s, the prevalence of drug addiction increased and this increasing trend made the Malaysian government consider heroin addiction as a national threat. The national anti-drug task force was formed to control trafÞ cking and to rehabilitate addicts who \ud were involved in heroin addiction (3). Legislation was introduced where mandatory death sentence was implemented for those who smuggled more than 15 grams of heroin. Drug addicts found to be positive for heroin were forced to undergo compulsory \ud rehabilitation for two years (4). Nationwide, up to 28 government drug rehabilitation centres were established, and at any particular period, each centre accommodated up to 500 inmates. Approximately RM50 million a year was spent to run these centres (5). The centres were initially managed on a total abstinence philosophy; however this approach produced poor results. The latest survey showed that 85% of drug addicts relapsed after completing their rehabilitation at these centres (4, 6). In view of the poor results, substitute treatment with methadone was introduced recently to these centres (7).One of the visions of the Malaysian government was to create a drug addiction free nation by the year 2015. However, the increasing number of drug addicts has caused a surge in demand for rehabilitation centres, resulting in the inability of these centres to cope. For example, the number of drug addicts increased by 1% from year 2001 to 2002, but the number of drug addicts detected in year 2003 was 36,996, a 16% jump from the previous year (31,893). Furthermore, the National Drug Agency reported that 45% of the cases were repeat addicts. As for distribution of new cases, by ethnic group the Malays constituted 71%, Chinese 10.6% and Indian 8.2%. The majority (70%) were in the socially and economically most productive age group (20-39 years) and almost 98% of the addicts who occupied these rehabilitation centres were male. Currently, the number of drug users in the country is estimated to be 250,000 but the number is predicted to reach half a million by year 2015 (3, 8-10). The resulting economic,human resource and social loss is not quantiÞ able as the vacuum left by these people in various employment sectors are currently being Þ lled by migrant workers. Thus, it is evident that the increasing trend in drug addiction poses a threat to the future of the nation (1, 6, 9)

Heroin addiction: the past and future

Substance misuse, in particular heroin addiction contributes to health and social problems. Although effective medical treatment was available, earlier efforts confined the treatment of heroin addicts to in-house rehabilitation which required them to be estranged from the community and their families for 2 years. The in-house rehabilitative programme, implemented for at least three decades has produced low abstinence rates. On the other hand, being ‘away’ meant that many heroin addicts faced employment problems and family relationship difficulties upon completing the in-house rehabilitation. However, recently, the concerted efforts by various government and non-government organisations, and the acknowledgement that heroin addiction is a medical illness has resulted in a revamp to approaching treatment of heroin addiction. At present, methadone substitution programmes have been offered as part of treatment programme for heroin addicts in Malaysia. This new programme has been shown to be effective in treating heroin addiction and would need support and cooperation from all groups involved

FROM FREE TRADE TO PROHIBITION: A CRITICAL HISTORY OF THE MODERN ASIAN OPIUM TRADE

The article begins by exploring America\u27s current war on drugs and how it represents a misuse of its power and misperception of the global narcotics trade. It continues and puts forth that Asia\u27s opium production may soon increase to levels that will defeat the war on drugs now being waged by the United State and United Nations and goes into the the extent of Opium production in Asia. It then looks at a history of Opium trade, including the era which began prohibition and then the cold war, which began the expansion of the Asian opium trade. The article then discusses bilateral suppression. In 1972, President Nixon began the war on drugs, which actually stimulated the global market. Opium trade and production increased through the 1980\u27s and 1990\u27s. The article concludes by stating that production of drugs responds in unforeseen ways to reform, and before starting such reform, anti-narcotics agencies need to consider the full range of outcomes

Spartan Daily, September 22, 1999

Volume 113, Issue 16https://scholarworks.sjsu.edu/spartandaily/9445/thumbnail.jp

The experience of long-term opiate maintenance treatment and reported barriers to recovery: A qualitative systematic review

Background/Aim: To inform understanding of the experience of long-term opiate maintenance and identify barriers to recovery. Methods: A qualitative systematic review. Results: 14 studies in 17 papers, mainly from the USA (65%), met inclusion criteria, involving 1,088 participants. Studies focused on methadone prescribing. Participants reported stability; however, many disliked methadone. Barriers to full recovery were primarily ‘inward focused'. Conclusion: This is the first review of qualitative literature on long-term maintenance, finding that universal service improvements could be made to address reported barriers to recovery, including involving ex-users as positive role models, and increasing access to psychological support. Treatment policies combining harm minimisation and abstinence-orientated approaches may best support individualised recovery

Managing Madness: The ethics of identifying and treating mental illness

This essay analyzes different contemporary models for defining mental illness and offers a new framework that promotes the use of normative values during the clinical diagnostic process. Although ethic centric models for identifying mental illness do currently exist, these accounts are limited. Specifically, these accounts acknowledge the relationship between mental illness labels and implied responsibility in making their argument to support a normative framework, yet do not explain what capacities are necessary for an agent to have full responsibility. Recognizing this shortcoming, this paper provides an enriched model for identifying mental illness by marrying a normative conception of psychiatric dysfunction to a differential model for assigning moral responsibility. To end this paper looks at how this model may be applied in clinical practice by working through a specific case study of Alcohol Dependence Disorder. Ultimately, I conclude that a normative conception of mental illness married to an account of responsibility is a more appropriate and comprehensive model for recognizing and treating psychiatric dysfunction in clinical practice. By carefully balancing normative and pragmatic considerations, physicians can create more effective and just therapeutic regimens that are tailored to individual patients’ circumstances and needs

Commune Health Workers' Methadone Maintenance Treatment (MMT) Knowledge and Perceived Difficulties Providing Decentralized MMT Services in Vietnam.

BackgroundWith the initial establishment of countrywide methadone maintenance therapy (MMT) system, Vietnam is in the process of expanding and decentralizing the MMT program to community-based healthcare settings.ObjectiveThe study aimed to measure the MMT-related knowledge and perceived difficulties in treating patient who use drugs (PWUD) among community-based healthcare providers, e.g., commune health workers (CHW), and examine its correlated factors.MethodsA total of 300 CHW from 60 communes in two provinces of Vietnam completed a survey using Audio Computer-Assisted Self-Interview (ACASI) method. Twelve true-or-false questions were used to assess the CHW's MMT-related knowledge. The CHW's background characteristics and perceived difficulties treating PWUD were recorded.ResultsThe mean MMT knowledge score was 8.2 (SD = 1.2; range: 5-11). Misconceptions toward the benefits, procedure, and side effects of MMT were prevalent. The participants perceived varying degrees of difficulties in recruiting, engaging, and communicating with PWUD. With all covariates holding constant, younger age (standardized ẞ = -0.166; p = 0.0078) was associated with less MMT-related knowledge. Number of PWUD seen in a month and MMT-related knowledge was associated with less perceived difficulties treating PWUD. Conclusions/importance: The finding shed lights on the CHW's knowledge gap, which need to be addressed to facilitate the decentralization of MMT services in Vietnam. In preparation for a decentralized MMT service delivery model, specially designed training is warranted to equip CHW with knowledge and confidence to provide MMT-related services to PWUD

Governance of substance use as a by-product of policing in Norway : a historical account

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