Public Health and Drug Policing in Malaysia : Using Empirical Evidence for Advocacy

After declaring a “War on Drugs” in 2003, Malaysia adopted harm reduction as official policy in 2006 to reduce substance use related risks and subsequently implemented needle-and-syringe exchange programs and methadone maintenance therapies. Seven years after the inception of Malaysia’s harm reduction policy, the Centre of Excellence and Research in AIDS (CERiA) and the Malaysian AIDS Council (MAC) carried out qualitative research with police officers and people who use drugs to determine attitudes towards harm reduction and drug use, and to elicit perspectives on better approaches in drug law enforcement. We conducted qualitative research with 20 people who use drugs and 11 police officers based in police stations in various states in Malaysia (Kuala Lumpur, Pahang, and Kelantan). These interviews showed that police often lack understanding on the efficacy and operation of harm reduction programs. Interviews with people who use drugs pointed to a host of police practices that constitute barriers to treatment, including physical violence and psychological abuse, corrupt practices and failure to inform individuals of their rights. These results will inform subsequent quantitative surveys to generate further evidence on drug law enforcement and public health implications in Malaysia. Based on these empirical findings, we undertook evidence-based advocacy, maintaining an advocacy log containing key events including meetings with key officials, tweets, emails and text messages that contributed to improving police awareness about harm reduction and drug evidence-based drug policy. This chapter summarizes our approach to and results of evidence-informed advocacy work. Our experience of this qualitative research and its gains for advocacy demonstrate that larger scale interventions involving high-level police officials may be necessary to change policing practices, some of which are structural or are ingrained in police culture but oppose public health evidence. Numerous studies and reports have proven that harsh penalties and oppressive policing negatively impact public health, increase marginalisation, and increase drug-related crime, and that the inverse i.e. decriminalisation paired with access to voluntary health services improve public health and reduce drug-related crime. (Hughes & Stevens, 2012; Fullerton, et al, 2014; GCDP, 2014; Rhodes, et al, 2006) Negative practices have the potential to seep (and in some cases, are already seeping) into other agencies in drug policy and drug control. A consolidated written drug policy would assist in mitigating these issues, as we outline below.Non UBCUnreviewedFacultyGraduateUnknow

How understanding and application of drug-related legal instruments affects harm reduction interventions in Cambodia: a qualitative study

Abstract Background Harm reduction interventions in Cambodia face numerous obstacles because of conflicting understanding and interests and inconsistencies in the implementation by law enforcement officials. This study aims to examine how understanding and application of Drug Control Law (DCL) and Village/Commune Safety Policy (VCSP) affects harm reduction interventions in Cambodia from the standpoints of law enforcement officials, people who inject drugs and people who use drugs (PWID/PWUD), as well as other key stakeholders. Methods This qualitative study was conducted in the capital city of Phnom Penh in 2015. We held five focus group discussions (FGDs) with groups of PWID/PWUD, police officers, Sangkat/commune officers, and local non-governmental organization (NGO) field staff. We also conducted ten key informant interviews (KIIs) with representatives from government agencies, donor agencies, and NGOs. FGDs and KIIs with Cambodian participants were transcribed in Khmer and translated into English. KIIs with foreign participants were transcribed in English. Transcripts were read and re-read to identify emerging themes, which were reviewed and refined to develop common and divergent patterns. Results There was a huge gap between what the DCL and VCSP say and how law enforcement officers and PWID/PWUD understood them. The gap was also evident in how law enforcement officers implemented the DCL and VCSP. Harm reduction services, including health- and non-health-related interventions, were limited and challenged by unsupportive attitudes, misinterpretation of the DCL and VCSP, and the lack of full engagement with NGOs in the development of these instruments. The needs of PWID/PWUD in accessing health care services were not met due to misconduct of authorities while practicing the DCL and VCSP. Further, the misconduct and enforcement of the law and policy lead to increased social discrimination and physical abuses against PWID/PWUD. Conclusions There is a lack of common understanding of the drug-related law and policy and their implications to harm reduction services among both law enforcement officers and PWID/PWUD. Thus, there is a need to mainstream and simplify the law and policy for better comprehension among these actors. To improve the quality and coverage of harm reduction interventions, the gap of understanding and enforcement of laws and policies should be narrowed, and coordination between the government and NGOs and other key stakeholders should be strengthened

How understanding and application of drug-related legal instruments affects harm reduction interventions in Cambodia: a qualitative study

10.1186/s12954-017-0167-9HARM REDUCTION JOURNAL14

Barriers to community-based drug dependence treatment: implications for police roles, collaborations and performance indicators

ntroduction: Worldwide, people who use drugs (PWUD) are among the populations at highest risk for HIV infection. In China, PWUD are primarily sentenced to compulsory detainment centres, in which access to healthcare, including HIV treatment and prevention services, is limited or non-existent. In 2008, China's 2008 Anti-Drug Law encouraged the development and use of community-based drug dependence rehabilitation, yet there is limited evidence evaluating the efficacy and challenges of this model in China. In this study, we explore these challenges and describe how cooperation between law enforcement and health departments can meet the needs of PWUD. Methods: In 2015, we conducted semi-structured, in-depth interviews with all four staff members and 16 clients of the Ping An Centre No. 1 for community-based drug treatment, three local police officers and three officials from the local Centre for Disease Control. Interviews explored obstacles in implementing community-based drug dependence treatment and efforts to resolve these difficulties. Transcripts were coded and analyzed with qualitative data analysis software (MAXQDA 11). Results: We identified three challenges to community-based drug treatment at the Ping An Centre No. 1: (1) suboptimal coordination among parties involved, (2) a divergence in attitudes towards PWUD and harm reduction between law enforcement and health officials and (3) conflicting performance targets for police and health officials that undermine the shared goal of treatment. We also identified the take-home methadone maintenance treatment model at the Ping An Centre No. 1 as an example of an early successful collaboration between the police, the health department and PWUD. Conclusions: To overcome barriers to effective community-based drug treatment, we recommend aligning the goals of law enforcement and public health agencies towards health-based performance indicators. Furthermore, tensions between PWUD and police need to be addressed and trust between them fostered, using community-based treatment centres as mediators. The preliminary success of the take-home methadone maintenance treatment pilot can serve as an example of how collaboration with the police and other government agencies can meet the needs of PWUD and contribute to the success of community-based treatment