Substance Abuse – Emerging Trends

Substances
"
Cannabis
Ganja, Cannabis, Hashish.
Opioids
Heroin, morphine, codein, pethedine, DF118,
ATS
Syabu, ice crystal, yaba, pill kuda, ecstasy (MDMA)
Psychotropic's
Benzodiazepines (Domi, UpJohn)
Inhalants
Solvents, aerosols, anesthetics
Others.
Ketamine & Eramine
Others.
Tobacco, betel nut, air ketum, cough mixture, alcohol
Background
"
• In 1970, only 711 addicts were identified but in 1982,
a total of 26,513 addicts were identified and rose up
to 92,310 in the following year.
• In 1983, the Prime Minister declared drugs as the
nation’s number 1 enemy, and a threat to national
security.
• The Drug Dependent Act was passed – all the drug
users needed mandatory detainment in “Pusat
Serenti” for up to 2 years for total abstinence of drug.
"
"
 There were 27 “Pusat Serenti” all over the country,
catering for 9,000 addicts at any one time.
 Government spent RM30 a day on each drug
offender in Pusat Serenti.
 For each offender, the government spent at least
RM25k for one whole course of rehabilitation.
Results are
DISAPPOINTING…
"
 The relapse rate was up to 90%
 The number of HIV had risen from 4 cases in 1986 to
51,256 cases by 2002, of which 76% (38,954) were
drug addicts using needles
 Cases of Hepatitis B and C were increasing
 Criminal offences were still high
 Over crowding in Pusat Serenti, with 17,000 drug
offenders in the year 2000 alone
"
Finally…
"
 In 2005, methadone was reregistered for use in Malaysia but
must adhere to the policy and
standard operating procedure
(SOP) strictly.
 Is part of the harm reduction
programme
Example:
"
Purpose of MMT
"
 To reduce the transmission of HIV infection among
the IDUs and partner.
"
 As of June 2010, over 13 471 individuals were
registered across the country’s 211 free MMT service
outlets
 An additional estimated 20 000 individuals were
accessing fee-based OST through private
practitioners.
Harm Reduction In
Malaysia
Needle and syringe programmes
"
(NSPs)
2. Opioid substitution therapy (OST)
and other drug dependence treatment
3. HIV testing and counselling
4. Antiretroviral therapy (ART)
5. Prevention and treatment of
sexually transmitted infections (STIs)
6. Condom programmes for PWID (people
who use IV drugs) and their sexual
partners
7. Targeted information, education and
communication for PWID and their sexual
8. Vaccination for, and diagnosis and
treatment of, viral hepatitis
9. Prevention, diagnosis and treatment of
tuberculosis (TB)
HIV/ AIDS
Result?
"
Global AIDS Response, Country progress reports –
Malaysia, 2012
Global AIDS Response, Country progress reports –
Malaysia, 2012
"
 More than 20 000 registered MMT clients, 66% are
actively working in a salaried job.
 This indicates that MMT services can significantly
stabilize an individual’s lifestyle, helping the person
to maintain social commitments and become a
contributing member of society.
Based on UN recommendations,
we have to achieve 60%
coverage of an estimated 170 000
PWID in Malaysia by 2015.
CAN WE DO IT?
What should we do?
"
 Rapid scale-up of free MMT services over the past
five years across the country
 Multiplication of a variety of service access points,
including across closed settings, mosques,
government hospitals and district health clinics;
 Development and implementation of a national
MMT provider registration and accreditation
system along with capacity-building modules to
scale-up human resource capacity;
"
 Allocation of significant resources from national
budgets;
 Integration of MMT in existing health systems as
well as in a comprehensive package of interventions
to prevent HIV,STI transmission;
 Collaboration through genuine and honest
partnerships among government agencies leading
public health and drug control activities, and civil
society, religious leaders and medical professionals;
 High-level commitment and leadership from key
agencies
OTHER ILLICIT
SUBSTANCES
"
"
"
 Opiate addiction has shown decreasing trend, from
67% in 2005 to 50% in2010.
 BUT
 Stimulant (Amphetamine Type Stimulant) has
increased from 8% in 2009 to 36% in 2010.
Why?
"trafficking opioid in the Wa
 Re-enforcement a ban on
Territory, Mekong region.
 ‘Displacement’: a campaign against one drug (opium
and heroin) can lead to the rise of an equally or
potentially even more harmful substitute
(methamphetamine).
 The surrender of Khun Sa and his Mong Tai Army
(MTA) in 1996,the largest player in the Burmese
opium market, disrupted the regional heroin trade
and caused price instability. Rising opiate price
fasten the displacement.
Mcketin, R., Kozel, N., Douglas, J. & Ali, R. 2008. The rise of methamphetamine in
Southeast and East Asia. Drug and alcohol review, 27, 220-228.
"
 Unlike opium production, there is little restriction on
the geographic location of synthetic drug
manufacture.
 In July 2006, Malaysian law enforcement authorities
seized what was believed to be the one of the world’s
largest ever detected clandestine methamphetamine
laboratories (from 39 kg in 2005 to 145 kg in 2006)
 Chemicals remain more readily available and
regulated loosely.
"
 There is an increase in cyber trafficking.
 Increasing drug trafficking by sea, requiring further
networking among different types of authorities. It is
evident that they are difficult and require highly
technical coordination.
"
 ATS appeal to what is perceived to be a modern
lifestyle, both recreationally and occupationally.
 Opium is perceived as a substance for ‘old people’ and
‘backward hill tribes’, while heroin is perceived as a
drug for losers, a thing of the past, perceived as
dangerous and addictive.
 ATS on the other hand has a social acceptance,
particularly among urban young Asians. ATS are
consumed in entertainment facilities, such as bars,
karaoke clubs, and nightclubs. ATS are considered to
be non-habit forming and more ‘fun’ to use.
How to combat?
"
Advocacy And Awareness
Raising
"
 Governments and users still are not fully aware of
the problems associated with ATS use, and the rapid
increase of ATS use among youth in particular. More
advocacy is needed to educate policy makers, law
enforcement, health care providers, donor agencies,
civil society and community on ATS.
 More research and data are needed on ATS market
trends, ATS use, patterns of use and harmful
practices. A survey on use and patterns of use is
needed.
"
 Awareness raising with drug users on how to use
more safely is necessary. In particular with
vulnerable groups (youth, migrants and sex workers)
to educate them of the risks and possible harms of
ATS use.
 Strengthen information exchange beyond
boundaries, not only between countries among the
same types of authorities but also between different
authorities of different countries. The authorities that
need to be associated include, for instance, drug
control, law enforcement, maritime, laboratories,
correctional, prosecution, and judiciary.
Treatment and harm
reduction
"services
 Traditional law enforcement and supply reduction
approaches and zero tolerance attitudes have not
succeeded to reduce the supply and the demand for
ATS. Incarceration of ATS users in compulsory drug
treatment/detention centres is ineffective. There is
evidence of serious human rights abuses and relapse
rates are extremely high upon release.
"
 Preventive measures should be enacted such as
discouraging injection, distributing condoms and
lubricants, needle and syringe exchange programmes
(NSEP), personal hygiene and providing of
information, education and communication (IEC)
materials for drug users, their sexual partners and
their families.
"
 Psycho-social support needs to be strengthened by
expanding voluntary counselling and testing (VCT),
nutrition support and ATS counselling.
 Users of the same age need to reach out to other
users; this will have greater impact.
 Engaging educational materials for clients are
needed, such as short films.
Blickman, T. 2011. Amphetamine Type Stimulants and Harm Reduction.
"
 A “ replacement ” strategy for
methamphetamine dependence?
 Dexamphetamine substitute treatment for
amphetamine dependence shows promising
results and appears to be effective and safe in
particularin preventing relapse.
 Aripiprazole –anti psychotic drug.
Sulaiman, A. H., Gill, J. S., Said, M. A., Zainal, N. Z., Hussein, H. M. & Guan, N. C. 2012. A randomized, placebocontrolled trial of aripiprazole for the treatment of methamphetamine dependence and associated psychosis.
International Journal of Psychiatry in Clinical Practice, 1-8.
Conclusion
"
 The evolution of the contemporary drug problem has
been influenced by a range of drivers.
 Demographic trends, such as gender, population age
and levels of urbanization
 Socioeconomic, such as levels of disposable income,
inequality and unemployment.
 Sociocultural factors, such as value systems, religion
and youth culture.
 The drug control system and the way it has been
implemented
"
 “The further one looks into the future, the more
unpredictable the evolution becomes.
 What can be said for sure is that Governments and
societies will continue to face different policy choices
when tackling drug-related and crime-related
problems while securing international peace and
development and upholding human rights.”
~~~~~~ World Drug Report 2012, UNODC, United
Nations Office on Drugs and Crime