Paperwork on legality and enforcement for experts meeting: Legalisation of cannabidiol products for medicinal use in Malaysia.

The term medical cannabis is not just a recent phenomenon but has long been introduced and used in the community. Many countries have legislatively amended cannabis from controlled to lesser regulated or unregulated substance groups – depending on the approved usage for either one, two, or all purposes of medical, recreational, and industrial purposes. It is not a surprise that cannabis was ranked as the most widely used substance worldwide. The prominent urge for legalisation in several countries is mainly due to industrial and economic pressure and, to a certain extent, for medical reasons. However, there are many issues reported from the legalizing countries, hence, the current legislation needs to be carefully scrutinized before any amendment is made so that in the long run, the later implementation will not produce any harm to the Malaysian population and the nation as a whole, especially to the young generations

E-cigarette use and perception among Malaysian: findings from text-mining analytics

Introduction: E-cigarette use among adults are steadily increasing over the past few years. It is highlighted by the significant increases in online search queries and sharing of information through social media, such as Twitter. However, little attention has been given on understanding the reasons that led to e-cigarette use among Malaysian. In particular, study that leverage the opportunity to extract critical information from textual data in social media by using text mining technique. It is the aim of this paper to share the potential use of such technique by providing overview of processes and examples of the insights derived from the analysis. Methods: In this study, the textual analytics was used to identify topics and extract meanings from social media posts, in this case Twitter. The messages posted by Malaysian users from 2012 to early 2017 containing any of the selected keywords or phrase (i.e., #vape, #ecig, #vaping, #ejuice, #vapemalaysia) were collected using its search application programming interface (API). A total of 4211 messages containing original tweets were retrieved. Results: The result from the text mining analytics show that mainly there were three themes emerged on the reasons of e-cigarette use, namely: the sense of being part of a bigger community, e-cigarette is perceived more fun as compared to smoking conventional cigarette, and flavour of e-liquid. The result also shows that there was a spike on Twitter activity in 2015, where the topic on vape community were mostly posted. Discussion: The three themes identified in this study reveal initial reactions of public to Malaysian Government initiatives to regulate e-cigarette. It is believed that such findings would allow the government and medical practitioners to better understand public knowledge levels and identify current misunderstandings

A snapshot of pre- And Post-intervention changes among cardiovascular disease patients participating in the new Smoking Cessation Program

Background: The study evaluates the changes of pre and post stages of behavioral change, motivation level, and smoking status among cardiovascular disease patients, participating in the new smoking cessation program in Hospital Tengku Ampuan Afzan, Kuantan. Methods: A total of 65 adult cardiac patients were randomly distributed into two groups, i.e., intervention and control group, who were baseline smokers and assessed in three phases. Initially, the first, second, and third phase collected the information about their demographic details, their smoking status, and smoking status using cotinine amylase strip, respectively. Results: It showed that behavioral change was significant for the control group (P value = 0.031), while motivation level improved for both groups (i.e., control, P value = 0.000 and intervention group, P value = 0.001). The smoke quitting status percentage was higher for intervention group 41.9% and lower for control group 20.6%; however, the P value was insignificant for both control group (1.000) and intervention group (0.250). Conclusions: This study suggests a need for more personal testimonial videos to focus on other smoking-related diseases

Prescribing patterns of benzodiazepine in Malaysia from 2014 to 2016

Background: Although benzodiazepines (BZDs) are often prescribed to treat wide range of psychiatric and neurological conditions, they are also associated with various harms and risks, as well as tendency of inappropriate prescribing. To date, the prescribing patterns of BZDs at outpatient tertiary hospital in Malaysia are still scarce. Objectives: To examine the patterns of BZDs prescribing at outpatient tertiary hospital in Malaysia. Methods: A cross‐sectional retrospective study was conducted from January 2014 to December 2016 using the prescriptions received by the outpatient pharmacy of tertiary hospital. Prescriptions with any seven types of BZDs (alprazolam, bromazepam, clobazam, diazepam, clonazepam, loraxepam, and midazolam) were identified and included in this study. Information on patients' age and gender, prescription date, drug name, dosage, frequency, duration, quantity supplied, and prescriber's name were extracted from the prescriptions. Only prescrip- tions for patients' age of 18 and above were included in this study. Total number of prescriptions with BZDs, total number of patients received BZDs, and total number of each type of BZDs were measured yearly and over 3 years. Data were analyzed descriptively using Stata v13. Results: A total of 5711 BZDs prescriptions were issued (n = 1959, n = 2051, and n = 1701 for year 2014, 2015, and 2016, respectively) from January 2014 to December 2016. BZDs were prescribed for 1947 patients (n = 895 in year 2014, n = 934 in 2015, and n = 782 in 2016). Alprazolam (39.7%, n = 3542) was the most frequently pre- scribed followed by lorazepam (21.1%, n = 1880), diazepam (20.7%, n = 1851), clonazepam (17.1%, n = 1530), and less than 1% to other BZDs. Sixty percent (n = 5422) of patient were prescribed with short‐acting BZDs, 21.6% (n = 1928) intermediate‐acting BZDs and 17.1% (n = 1530) long acting BZDs. Majority (90.7%, n = 5015) of BZDs prescription were for psychiatric disorders, in which, higher per- centage (82.3%) of BZDs were prescribed as anxiolytics followed by 17.1% as hypnotics. Among all BZDs, alprazolam, and lorazepam showed decreasing pattern over 3 years period. Conclusions: Short‐acting BZDs (alprazolam and lorazepam) were highly prescribed at the outpatient tertiary hospital in Malaysia. The main indication of the BZDs was as anti‐anxiety. However, data avail- able were from the prescriptions only. Thus, further research is required to examine the use of BZDs at patient‐level

Mislabelling of nicotine content in electronic cigarette liquids in Malaysia: implications on public health

Electronic cigarette (e-cig) is a battery-operated device which vaporises nicotine solution into a form of inhalable aerosol. The level of nicotine in the liquid for e-cig (e-liquid) may vary and the typical nicotine concentration reported is between 6 to 24 mg of per ml. Based on the National Electronic Cigarette Survey (NECS) 2016, 83.9% of e-cig adult users in Malaysia preferred eliquid with 6 mg/ml nicotine. In Malaysia, nicotine in products other than tobacco is regulated under the Poisons Act 1952, restricting its sale by licensed health professionals only. However, the sale of e-liquid containing nicotine is widespread and vapers are not assured of the accuracy of content versus that on the label of the e-liquid bottle. OBJECTIVE: To determine the actual nicotine concentration in selected e-liquid brands marketed in Malaysia. Methods: Samples (81 brands) obtained from respondents of the NECS 2016 were analysed using gas chromatography mass spectrometry (GC-MS) in selective ion mode (SIM) at a certified laboratory. Results: 15 samples labelled as no or zero nicotine were found to contain nicotine. Nine samples contained level of nicotine higher than what their labels indicated. Interestingly, 57 samples had nicotine concentrations that were lower than that indicated on the labels. The nicotine concentration percentage difference between labelled and result from analysis was found to be as low as from -99.16% to -1.28% in 64 samples, while in 4 samples the difference was higher; 0.083% to 163.0%, and the remaining 13 samples had no mention of nicotine concentration on their labels. Conclusion: Significant discrepancy was detected in nicotine concentration between the labelled and analysed values among the collected e-liquid samples. Strict regulation and enforcement is needed for e-cig liquids to ensure safety of users and compliance to current regulations on nicotine

National E-cigarette Survey (NECS) 2016 in Malaysia method and population characteristic

E-cigarette and vape (ECV) use has become a worldwide phenomenon since 2010. This study aims to determine the prevalence of ever user, current user and factors associated with ECV use among Malaysian adults. This will provide evidence for policy makers to formulate appropriate measures towards regulation of ECV in Malaysia and can become a reference for other similar countries. Method: Complex sampling design was used to represent 19 million of Malaysian adult household. Samples were stratified by states and urbanity. Sampling units were districts, enumeration blocks and living quarters. All adults from the selected houses were invited to participate in this survey. Analysis was done using sampling weight and complex sampling analysis. Results: A total of 4,288 individual responded in this survey. Majority of the respondents were at 25-44 years of age group (44%), completed at least secondary level of education (69%), of Malay ethnicity (73%), Muslim (79%) and married (68%). Male and female were equally represented. Seventy two percent of the respondents were from the urban residential area (n=2,123). The prevalence of current ECV users was 3.2%, with an estimated number of 602,122 in the population. The prevalence was 3.3% and 2.9% in urban and rural respectively. ECV users were common among 18-24 years old, male and those with tertiary level education. Discussion: This study able to represent Malaysia and results can be used to guide healthcare managers to manage e-cigarette use in the country

Evidence of the Practice of Self-Medication with Antibiotics among the Lay Public in Low- and Middle-Income Countries: A Scoping Review

The current scoping review is an attempt to explore the key reasons, determinants, patterns and prevalence related to self-medication with antibiotics (SMA) among the lay public. An online search was conducted using Google Scholar, Science Direct, ProQuest and PubMed. A two-phase mapping approach was used. In the first phase, studies were screened. In the second phase, the data were extracted from selected studies followed by the assessment of data quality. A total of 24 studies were included; 20 were cross-sectional, 3 were qualitative and one was observational. The most common indications were flu, cough, common colds, sore throat, diarrhea, toothache and fever. The most common determinants reported were past good experience and suggestions from friends or relatives. The use of SMA was observed to be more frequent in younger aged individuals belonging to low- or middle-income groups. The prevalence rate was reported to be high among the South Asian lay public and may be a major contributor to antibiotic resistance. In conclusion, this scoping review identifies a need for education campaigns and mass media campaigns to strengthen lay public awareness about the side effects and risks associated with SMA. In addition to this, there is a need to implement strict policies by government agencies to restrict over the counter availability of antibiotics

Prescription-level of tramadol utilisation at a tertiary hospital setting in Malaysia: changing trends over a 7-year follow-up period

INTRODUCTION It was reported in a previous study that tramadol was the most frequently prescribed analgesic in Malaysia’s hospital outpatient setting. However, little is known of its trends of prescribing. OBJECTIVES This study evaluated the trends of tramadol prescribing in Malaysia. METHOD This retrospective cross-sectional study was conducted using the prescription database of a tertiary hospital in Malaysia. All tramadol prescriptions in outpatient setting issued for adult patients aged ≥18 years old from 2010 to 2016 were included. The annual number of prescriptions and patients measured in repeat cross-sectional estimates for each year were evaluated. Descriptive statistics and linear trend analysis were applied using Stata version 15.1. RESULTS A total of 64594 tramadol prescriptions were prescribed for 40965 patients from 2010 to 2016. Prescriptions for tramadol increased by 52.7% from 7643 in 2010 to 11763 in 2016, with an average annual increment of 7.1%. The number of new patients prescribed with tramadol increased gradually throughout the study period (a 7.2% increase annually) with the majority (75.6%, n=30974) of them receiving one tramadol prescription. CONCLUSION: Tramadol prescribing increased gradually over a 7-year study period, with the majority of patients receiving only one prescription of tramadol - most likely indicating the use of tramadol for acute pain conditions. Further investigation on the indication and its clinical outcomes are required to ensure safe and rational use of tramadol

Self-Medication with Antibiotics: Prevalence, Practices and Related Factors among the Pakistani Public

Self-medication with antibiotics (SMA) has become considerably common in developing countries, which is a critical factor for driving antibiotic resistance. Individuals involved in SMA generally do not have adequate knowledge regarding the appropriate use, indications and dosage of these drugs. The objective of the present study was to investigate population SMA practices, knowledge and sociodemographic factors associated with SMA in Islamabad, Pakistan. The study adopted a cross-sectional methodology and data collection was performed through an anonymous, structured and pilot-tested questionnaire, which was interview-administered. Inferential statistics and multivariate logistic regression were performed. Out of 480 participants, 55.6% (n = 267) were male with a mean age of 37.1 ± 10.1 years; the total prevalence of SMA was 32.5%. Ciprofloxacin (42.9%) was the most commonly used antibiotic to treat coughs or colds, a runny nose, flu or sore throat, diarrhea or fevers, which were relevant reasons for SMA. Findings from multivariate logistic regression showed that predictors of SMA were: male gender (95%CI: 0.383–1.005), age (95%CI: 0.317–0.953) and highest level of education (95%CI: 0.961–0.649). Despite reasonable access to healthcare facilities, people are still obtaining antibiotics without prescription, bypassing diagnostic and consultative healthcare services. Thus, the government must implement strict healthcare policies to restrict the sale of antibiotics without prescriptions, while at the same time, targeted public awareness campaigns about the proper use of antibiotics are also required