Illicit Drug use in the Asia Pacific Region - Burnet Institute

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Situational analysis of illicit drug issues and responses in the Asia–Pacific region 210 detainees interested in vocational training be accommodated (Human Rights Commission of Malaysia, 2003) . Such problems have not been resolved while there is an increasing number of detainees in most DRCs . In addition to the DRCs there are also 60 private drug rehabilitation centres approved by the National Drug Agency, and 121 private clinics that have been approved by the Ministry of Health to treat drug users (Mohamed, 2004a; National Drug Agency, 2004) . About 300 private medical practitioners have received specific training to treat drug users, but up until early 2004 only 168 doctors, trained by the Malaysian Medical Association, had been issued with certificates allowing them to treat drug users . The main concern appears to be that the certificates may contravene some drug laws and that drug substitution therapies may be misused in the treatment of drug users (New Straits Times, 2004) . High relapse rates result in further drugrelated offences; chronic drug users are being sent into a prison system that has become seriously overcrowded (International Centre for Prison Studies, 2004) . In 2004, the Malaysian Inmates Report shows nearly 43,000 prisoners in a prison system with the capacity of 24,850 (Prisons Department, 2004; S .K . Sran, personal communication, 2004) . In 2003, the Human Rights Commission of Malaysia visited nine of the 36 prisons in the country and found overcrowding to be common: the Penang prisons were housing 2481 inmates but the gazetted capacity was only 1200 . There were similar findings in other prisons (Human Rights Commission of Malaysia, 2003) . In addition to the overcrowding in 2004, there are 1954 HIV-positive inmates and an increasing number infected with TB . Health training programs provide prison officers with basic information about HIV/AIDS along with counselling materials for selected officers to conduct the training . However, as of August 2004, only around 200 out of 1200 officers had attended the training sessions . Currently there are no health programs conducted for the inmates (S .K . Sran, personal communication, 2004) . HIVinfected prisoners are segregated from other inmates, but no HIV treatment program is available (Open Society Institute, 2004) . Inmates found to be HIV-infected are segregated in both DRCs and prisons, but there is no further isolation currently in place when HIV-positive inmates are found to be coinfected with TB (B . Venugopalan, personal communication, 2004) . The further risk of TB spreading among other HIV-infected inmates housed in segregated buildings cannot be underestimated . In 2003, the government spent about RM44 million on treating and rehabilitating drug users in the 28 DRCs; in 2002, RM12 million was spent to develop and maintain such facilities (Ismail & John, 2004) . In 2001, the cost of each inmate in a DRC was reportedly RM362 per month (New Straits Times, 2001); it is likely that this amount has increased annually . In 2004, the per person costs were estimated to be RM12 .7 per day . The excessive costs of running DRCs that consistently do not meet desired expectations has led to some discussion on the need to privatise the system, but there are no current plans to do so (S .K . Sran, personal communication, 2004) . Recent advocacy efforts by NGOs and medical professionals have resulted in increasing interest in substitution therapy programs . In 2003, the government consented to a piloted methadone program and the findings proved successful (Gill et al ., 2004) . A similar piloted program took place with the use of buprenorphine with impressive results (Hatim & Habil, 2004) . Currently there appears to be increasing interest in introducing substitution therapy programs beyond the pilot phase, but it is not clear whether these will become longterm programs . Although the clinical trials showed impressive results, substitution still has its many sceptics who cannot be ignored (Izzaddin & Teoh, 2004) . Needle and syringe programs are not currently permitted in Malaysia but small-scale outreach programs targeting drug users can be found: funding for such programs however has limited time frames or remains precarious (L . Ng, personal communications, 2004; V . Balasingam, personal communication, 2005) . Other responses School-based education The National Drugs Agency (NDA) of Malaysia is involved in educational programs . A Student’s Resilience and Interpersonal Skills Development Educational (STRIDE) program has been implemented at primary school level (students aged 7–12 years) . In essence, the objective of STRIDE is to encourage students to ‘say no to drugs’, to resist peer pressures to consume drugs and to ensure Malaysian schools are free of drugs . In 2002, the STRIDE program was implemented in 416 schools (Poh Fah, 2004) . Community development NDA conducts seminars and information meetings to introduce drug prevention programs in workplaces . In 2002, there were 65 such seminars (Poh Fah, 2004) . Information and publicity program A mobile drug prevention unit was created in 1990 to travel throughout the country informing the general public about the drug using problem . In 2002, 300 exhibitions were organised for schools, institutions of higher learning, government departments and public places (Poh Fah, 2004) . Advocacy groups In 2004, Malaysia’s first Harm Reduction Working Group was established, with the Malaysian AIDS Council, in Kuala Lumpur . 211 Country profiles: Malaysia
Situational analysis of illicit drug issues and responses in the Asia–Pacific region 212 A8 .7 References Abdullah, F . (2002) . Greater role for National Drugs Agency on the cards . New Straits Times, 5 April 2002: 5 . Aceijas, C ., Stimson, G ., Hickman, M . and Rhodes, T . (2004) . Global Overview of Injecting Drug Use and HIV Infection among Drug Users . London: Centre for Research on Drugs and Health Behaviour . Andres, L . (2004) . Addicts to be categorized at rehab centres . New Straits Times, 10 August 2004: 11 . Arokiasamy, C .M . and Taricone, P .F . (1992) . Drug rehabilitation in west Malaysia: an overview of its history and development . International Journal of Addiction 27(11): 1301–1311 . Bingkasan, J . and Chin, K .L . (2004) . New ways to treat addicts . New Straits Times, 27 June 2004: 1 . Bolton, K . (1996) . Viewpoint: the Malaysian experience . Drugs: Education, Prevention and Policy 3(3): 301–306 . Centre for Drug Research, Universiti Sains Malaysia (2002) . Rapid Assessment and Response to Injecting Drug User in Kepala Batas, Penang, Malaysia . Penang: Centre for Drug Research, Universiti Sains Malaysia . Chua, D . (2004) . Place emphasis on after-care, govt urged . Malay Mail, 17 June 2004: 10 . Fauziah, M .N ., Anita, S ., Sha’ari, B .N . and Rosli, B .I . (2003) . HIV-associated risk behaviour among drug users at drug rehabilitation centres . Medical Journal of Malaysia 58(2): 268–272 . Futures Group (2003) . Coverage of Essential HIV/AIDS Services: National Questionnaire — Malaysia . United States: Futures Group . Gill, J .S ., Chee Chan, F .L ., Sulaiman, A .H . and Habil H . (2004) . Methadone Maintenance Programme at University Malaya Medical Centre . Paper presented at the Drug Treatment Workshop, Malaysian Medical Association, Pulau Pinang, Malaysia, April 2004 . Habil, H . (2004) . The need for a new approach in Malaysia: tackling the enduring problem of HIV among injecting drug users . 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Ways to improve drug rehabilitation system . New Straits Times, 21 January 2004: 2 . Izzaddin, S . and Teoh, T . (2004) . Mixed feelings about substitute drug therapy . New Straits Times, 1 April 2004: 11 . Johnson, S .H . (1983) . Treatment of drug abusers in Malaysia: a comparison . International Journal of Addiction 18(7): 951–958 . Jusoh, A . (2003) . HIV in Malaysia . Paper presented at Meeting on Behaviour Surveillance System in Malaysia, Shah Alam, Malaysia, 13–14 January 2003 . Kaur, R . and Habil, H . (2002) . The Practices and Context of Pharmocotherapy of Opioid Dependence in South-East Asia and Western Pacific Region . Geneva: World Health Organization, Department of Mental Health and Substance Dependence, especially pp . 55–58 . Kuppusamy, B . (2003) . Malaysia’s war on social ills draws scepticism . South China Morning Post (Hong Kong) [exact date unknown]: 8 . Lee, H .-S . (2002) . A study of poverty and social security in Malaysia . 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Paper presented at Drug Prevention: Family Involvement, University Technology Malaysia, Johor, Malaysia, 19 February 2004 . Mohamed, M .N ., Ali, H .H ., Ibrahim, F .H . and Jusoh, A . (2004) . Estimating the number of injecting drug users in Malaysia . [draft paper not yet published] . Najib, M . (2004) . Cross border drug battle . Malay Mail, 23 April 2004 . National Drug Agency (2004) . Statistik Bulan Disember 2004 . National Drug Agency website: http://www .adk .gov .my/ staju104 .htm . National Narcotics Agency (2001) . Malaysian Country Report . Kuala Lumpur: Ministry of Home Affairs, NNA . National Narcotics Agency (2004) . Statistics on Inmates of Drug Rehabilitation Centre and Kajang Prison . Kuala Lumpur: Ministry of Home Affairs, NNA . Navaratnam, V ., Balasingam ., V . and Othman, H .H . (2002) . Malaysia . In B . Taylor (ed .), I-ADAM in Eight Countries: Approaches and Challenges . Research Report . Washington DC: US Department of Justice, Office of Justice Programs . 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Illicit Drug use in the Asia Pacific Region - Burnet Institute

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