HELPING THE ADDICTS WITH METHADONE

By Ravichandran D.J Paul

KUALA LUMPUR, April 21 (Bernama) -- Drug addiction is a serious menace in
Malaysia with an average of 16 new addicts and 18 repeat addicts recorded per
day for the whole of last year.

Another noteworthy fact in the 2008 statistics provided by the National Drug
Information System Unit (Nadi) is that 6,413 (51.92 per cent) of the 12,352 drug
addicts identified were repeat offenders.

Based on the high number of recidivist, Lee Lam Thye, the former chairman of
the National Anti Dadah (Drug) Association of Malaysia (Pemadam), rightly
concluded that the rehabilitation programmes have failed to meet their
objectives.

Lee expressed this during the recent Addiction Medicine Association of
Malaysia (AMAM) roundtable here entitled `Looking Into the Window of Treatment
Opportunities for Drug Dependence'.

Another notable remark on the state of the rehabilitation process in
the country comes from Prof. James F. Scorelli who in his International Journal
of Psychosocial Rehabilitation cited that `Malaysia's drug rehabilitation
programme is not working as the country's relapse rate is above 50 per cent.

Hundreds and millions of Ringgit have been spent over the years in
rehabilitating the increasing number of addicts, while their criminal behaviour
is a real threat to the society.

Malaysians will recall the numerous Pusat Serenti, the precursor to Puspen
(Narcotic Addiction Rehabilitation Centre), the drug rehabilitation centres
nationwide that were often in the limelight for rioting inmates.

Drug addiction is a complex behavourial and biological disorder that can be
treated as pointed out by Dr Sivakumar Thurairajasingam, a consultant
psychiatrist and lecturer at the Monash University School of Medicine and Health
Sciences campus in Malaysia.

Nevertheless, the treatment goal today is no longer total abstinence from
drugs which in reality can only be achieved by a small group but a realistic
approach like harm reduction that can help a bigger group of addicts.

Hence, like in the developed nations, Malaysia too has adopted the Drug
Substitution Therapy (DST) since 2002 which is a more promising option in
treating addicts. Basically, the addicts are given safe substitute drugs while
they undergo rehabilitation. However, there are some issues that need to be
looked into if we are to see better results from DST.

Both Lee and Dr Sivakumar pointed out that the main treatment approach now
is very regimented where the addicts are incarcerated in rehabilitation centres.
This is not an ideal approach especially when no single treatment will suffice
for the different levels of addiction - novice, habitual, hardcore. The
treatment success rates of up to 20 per cent recorded by government run
institutions clearly indicate the shortfalls.

Lee felt that such regimented treatment only created unfounded fear and
prevented other addicts from seeking treatment voluntarily.

"Treatment for drug addiction should be voluntary and the addicts should not
be subjected to arrest or harassment. The best way to go about this is to give
them the confidence to seek treatment," added Lee.

Another pertinent point based on Lee's observation is that parental and
community support is needed but both groups have chosen to be indifferent
towards drug addicts.

Though the DST using Buprenophine introduced here in 2002 was well received,
it hit a snag in 2004 after reports of abuse. Nonetheless, in 2005 the National
Methadone DST (MDST) project was adopted by the government.

Though the MDST has its fair share of criticisms, studies conducted by
University Malaya in its pilot MDST project recorded a retention rate of up
to 90 per cent of the drug addicts who turned up voluntarily within one year.

The MDST is basically an office based treatment with addicts coming in to
receive their oral dosage of methadone during the induction period and taking
the substitute drug at home during the maintenance period. The personnel who
attends to these addicts will also monitor the treatment progress.

This therapy directly deals with the physiological processes that underlie
addiction as well as psychological craving. Studies also revealed that HIV
positive addicts on MDST exhibit a higher level of compliance towards
Antiretroviral treatment (ARV) with an equal success rate compared with non-drug
related HIV positive cases.

With the success recorded by MDST in other nations and in keeping up with
the United Nation's Millennium Development Goal, Malaysia has now embarked on
methadone up scaling.

At present, there is a concerted effort in making MDST more accessible to
the addicts who want to turn around voluntarily.

AMAM's president Dr Steven Chow who presided the round table noted that
since 2001 at least 600 private medical practitioners have volunteered for the
MDST scheme under the Doctors-Who-Care-Programme.

Nonetheless, it is an uphill task looking at the challenges faced by the
private practitioners and the addicts in the MDST Programme.

Firstly, says Dr Chow addiction is a stubborn disease and often involves
stubborn patients and thus it is not going to be easy to confide the addicts to
come forward and seek treatment voluntarily.

Secondly, there is no financial support or resources from the government for
the private practitioners involved in the MDST programme.

Thirdly, doctors have to deal with issues pertaining to law enforcement like
their drug addict patients being arrested by the police and thus their treatment
cycle being disrupted.

The third scenario is clearly attested by Datuk Dr Lim Boon Sho,
vice-president of AMAM, whose two patients were nabbed recently by the police
while both were under suboxone, a substitute drug allowed under the Poisons Act
1952.

"A patient of mine who was brought in by the father for DST was nabbed
right outside the clinic after he received the first round of treatment. Another
patient a Seberang Perai Municipal Council worker who followed DST with me
religiously since the last two years had shown good signs of recovery but was
also nabbed after receiving the treatment from me. This really perplexed me and
caused anxiety to the addicts' family.

"I find that there is a serious miscommunication on this substitute drug,"
he said.

The philanthropic doctor who has been treating drug addicts in Seberang
Perai starting with opium addicts over the last 30 years says he derives great
satisfaction from seeing the addicts recover and get back with their lives and
loved ones.

Based on his own experience, Dr Lim stated that private practitioners
providing DST recorded success rates of up to 75 percent.

The round table also noted that there could be some miscommunication on the
pertaining laws prompting the arrest of addicts under DST but a representative
of the police pointed out that they were probably arrested for their previous
crimes.

Whatever the shortcomings, DST using methadone is now seen as the holy grail
in recovering from opiate addiction. On April 8, University Malaya set a new
milestone in MDST with the opening of its new UM Centre for Addiction Sciences
and Methadone Research Clinic near here.

The centre's chief coordinator Dr Rusdi Abdul Rashid noted that the centre
was the outcome of the successful pilot MSDT programme launched in 2005 with the
treatment conducted at UMMC's psychology clinic.

After a matter of weeks most were able to get back to work and enjoy a
better quality of life. The clinic is expected to see between 200-400 patients
per month with at least 200 of them from the psychology clinic's waiting list.

Dr Rusdi believes that the clinic is set to play a significant role in
fulfilling the government's target of treating up to 60 per cent of the
estimated 72,000 heroin addicts by 2015.

MDST is probably the best bet for now in treating drug addicts with many of
the drug rehabilitation centres adopting the programme. But the anticipated
rising number of drug addicts still remains a cause of concern and will continue
to impose a burden on the community and the government in treating the addicts.
-- BERNAMA