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 42 Treatment In the Government’s primary detoxification unit in-patient treatment usually lasts 14 days, in which clonidine and buprenorphine therapies are provided . NGOs follow the traditional ‘spiritual’ detoxification model of massage, hot baths and prayer . Voluntary or self-referral Yes Compulsory No (although if convicted of drug use, drug users can be sent to a prison where a special unit has been established) . Methadone for No detoxification Substitution therapy Limited to HIV-positive drug users Most common type of treatment provided Primary prevention Yes School-based education Yes Community education Yes 2 .7 .7 Australia’s involvement — NA 2 .7 .8 International involvement — NA Traditional detoxification, often with medication in government facilities but often no medication in NGO system . Post-treatment rehabilitation provided . 2 .8 Malaysia Population: 23,522,482 2 .8 .1 Overview of recent drug trends Although amphetamine-type substances (ATS) (mainly in the form of crystalline methamphetamine) are increasingly popular and appearing to be more accessible in 2003, heroin followed by cannabis are the most common illicit drugs for which people sought and received treatment . Ecstasy use is established but widespread use is unclear . 2 .8 .2 Prevalence of drug use There are varying estimates of the number of illicit drug users in Malaysia, none particularly methodologically sound; the current literature suggests an increasing number of people using illicit drugs . In 2002, the National Drug Agency estimated more than 350,000 drug users in the country, with the media in 2004 citing government sources reporting figures ranging from 400,000 to 500,000 . In 2003, there were 36,996 registered drug users . From January to March 2004 there were 1931 new cases of drug users registered per month . In 2004, the UN Reference Group on drug injecting issues suggested 150,000 to 240,000 injecting drug users (IDUs) with a middle-range figure of 195,000 . 2 .8 .3 Drug supply Malaysia is not a major producer of illicit drugs . However, its close geographical proximity to the Golden Triangle and other Southeast Asian countries that produce heroin and ATS has ensured that the supply of illicit drugs entering the nation is substantial . Drug trafficking through Malaysia most often stems from Golden Triangle countries, with trafficking overland across the long border that Malaysia shares with Thailand, or through various and extensive sea routes between the two countries . 2 .8 .4 Drug-taking practices, risk factors and trends On average, drug users progressed from smoking and ‘chasing’ to injecting over a period of two to five years . Generally the timeframe had shortened . When the quality of heroin decreases, the trend in Kuala Lumpur is to ‘chase’ and to mix the heroin with methamphetamine . There is widespread sharing of needles and syringes, often 60 per cent and greater, as well as of other injecting paraphernalia . Most drug users are aware of the dangers of being identified by law enforcement officers and are reluctant to be caught in possession of injecting equipment, or purchasing such equipment from a pharmacy . Drug users are frequently sexually active and at risk . One study found, among nearly 2000 respondents in 16 rehabilitation centres, 64 per cent were sexually active, of whom 90 per cent did not use condoms; 20 per cent of the respondents were HIV infected and, of these, 81 per cent shared needles and 28 per cent reported being sexually active . The HIV epidemic in Malaysia has for over 15 years primarily affected IDUs; from 1986 to 2002, 76 per cent of all HIV/AIDS cases were found among IDUs . Of the 6756 HIV infections reported in 2003, 75 per cent were among IDUs . 43 Country summaries: Malaysia
Situational analysis of illicit drug issues and responses in the Asia–Pacific region 44 2 .8 .5 Summary table Estimated number of current drug users 350,000–500,000; of these, there are 150,000–240,000 injecting drug users . Main drugs used Heroin, amphetamine-type substances, cannabis, ketamine Drugs injected Heroin, and possibly methamphetamine Estimated prevalence of HIV infection among IDUs 2 .8 .6 Country responses In 2003, 75% of all HIV/AIDS notifications found among IDUs . Policy and legislation Agreements and treaties 1961, 1971, 1988 UN Drug Conventions . Signatory to the ASEAN declaration for a drug-free ASEAN by 2015 . National drug control policy Main drug control legislation Drug control policy lead agency Revised in 1996 with a series of new strategies and priority areas of prevention, enforcement, treatment and rehabilitation, and regional and international cooperation . The prevention strategy is focused on efforts to create an environment to protect individuals and the community from drug use . Dangerous Drugs Act 1952 National Narcotics Agency Law enforcement bodies Royal Malaysian Police, Narcotics Department Drug use addressed in last Yes, but overall a poor response to implement programs National HIV/AIDS Plan Possession of Yes N&S unlawful Harm reduction Overall, harm reduction is not accepted . However, recently there has been an increased acceptance of substitution therapies . Needle and syringe No programs (NSPs) Peer-based approaches Yes (restricted and limited in scope) Supply reduction The focus is on striving to eliminate the supply of illicit drugs and create a drug-free Malaysia by 2015 . The strategy is to strengthen law enforcement measures to curb illicit drugs entering the country . Another important approach is imposing severe penalties to possess, supply, traffic or use drugs . Crop eradication No Demand reduction In 2004, there were 28 government-funded drug rehabilitation centres (DRCs) . In addition to the DRCs there were 60 private drug rehabilitation centres approved by the National Drug Agency, and 121 private clinics approved by the Ministry of Health to treat drug users . The goal is to eliminate drug dependency and prevent recidivism . Treatment overall tends to last for two years . There is a major movement to encourage people to reject use of drugs and mobilise the community towards drug abuse prevention programs . Treatment Since the early 1990s the DRCs have modelled themselves loosely on a therapeutic community . There have been calls since the early 1980s to develop more flexible and individualised programs for those confined to an institutional setting but this has not been adopted; a military approach and minimal concern for innovation are the norm . Voluntary or self-referral Yes Compulsory Yes Methadone for No detoxification Substitution therapy Yes (limited) Most common type Therapeutic community model with a military approach of treatment provided Primary prevention Yes School-based education Yes Community education Yes 45 Country summaries: Malaysia
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Illicit Drug use in the Asia Pacific Region - Burnet Institute

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