Psychiatrist: Don’t Jail Drug Users Or Force Them Into Rehab

By Boo Su-Lyn | 03 September 2019

Most Cure & Care centres don’t provide proper treatment to drug users as they still do cold turkey.

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KUALA LUMPUR, Sept 3 — A psychiatrist advocating drug use decriminalisation called for narcotics users to be allowed to volunteer for treatment instead of being imprisoned or forced into rehab.

Dr Sivakumar Thurairajasingam, who is Deputy Head (Education) at the Clinical School Johor Baru, Jeffrey Cheah School of Medicine and Health Sciences at Monash University, said the Drug Dependants (Treatment and Rehabilitation) Act 1983 should be amended as it appeared to be punitive, frequently threatening incarceration against people deemed to be dependent on drugs.

The consultant psychiatrist noted that “mere suspicion” sufficed to arrest one under the Act, with authorities allowed to remand one suspected of drug use for 14 days just to get the drug test results.

He also said public medical officers would immediately consider a suspected drug user to be “dependent” once their test results came out positive, even if the nabbed suspect may have been trying narcotics for the first time. Once they’re considered “drug dependents”, narcotics users will then be sent to a correctional system, like Puspen or Cure & Care centres run by the National Anti-Drugs Agency (AADK).

“The benefits of decriminalising — it saves money. It stops people from getting into prisons. It frees up law enforcement resources.

“Rather than prioritising enforcement, you prioritise health. It reduces stigma,” Dr Sivakumar told the Second Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM) Malaysian Health Care Conference here over the weekend.

Dr Sivakumar told CodeBlue after the conference that positive drug test results did not necessarily mean that one was dependent on narcotics, saying that drug addiction required withdrawal symptoms and increased use or tolerance.

“We need people to be given an option of getting into a treatment centre, where they can get medical and psychological treatment. They don’t get much of that — where they can voluntarily walk into a centre, or if caught, given an option,” he said.

He urged the government to discuss what kind of civil punishments should be meted on people who use drugs, like fines, under decriminalisation, instead of using criminal sanctions like jail or compelling drug users to go for treatment.

Dr Sivakumar said most of AADK’s Cure & Care centres did not provide proper treatment to drug users, as they still practiced the cold turkey approach. Once drug users leave such centres, they’re not allowed to go back.

“Cure & Care is run by AADK. AADK has always been changing. They started out as enforcement, then somewhere in the middle, they sort of changed to treatment. What I hear now is they’re back to enforcement,” he said.

Dr Sivakumar said a good example of a Cure & Care centre with a strong medical arm is one in Tampoi, Johor Baru, which gets visiting doctors from a hospital.

At the conference, Dr Sivakumar cited the experience of Portugal that decriminalised drug addiction in 2001, where the number of people arrested and charged with drug offences declined by over 60 per cent between 1998 and 2011, while the number of people in treatment for drug addiction rose by the same rate during that period. Addiction treatment in Portugal is not compulsory for narcotics users.

Drug use in Portugal also fell, with statistics below US rates and the European average. New HIV cases also dropped from 1,575 cases in 2000 to 78 cases in 2013, while drug overdose fatalities declined from 80 in 2001 to 16 in 2012.

Dr Sivakumar cited 2015 Home Ministry figures that found the annual cost per offender in prison was RM20.69 million, almost three times higher than private methadone treatment per person costing RM7.3 million. Public methadone treatment cost RM6.56 million per person annually.

“It’s so much cheaper treating people in a harm reduction way, either in the public system or private system, compared to prison.”

Dr Sivakumar Thurairajasingam, consultant psychiatrist

For every person in prison for drug offences, he said, there could be 40 more outside, which means that only about 2.5 per cent of drug users are in jail. About 60 per cent of Malaysia’s prisoners are incarcerated for drug offences, costing the government RM400 million per annum, according to the Prisons Department’s 2015 statistics.

“When people get into prison, we are paying. If it’s not an effective system, why are we paying?” Dr Sivakumar questioned.

He revealed police statistics from January to June 2016 in Selangor that found 88 per cent of drug-related charges were from the demand side — use or possession — with drug use based on urine tests comprising two-thirds, or 67 per cent, of that. Trafficking only made up 12 per cent of drug charges.

“A lot of people still look at addiction as behavioural — that’s how addiction portrays itself,” said Dr Sivakumar.

“Hypertension portrays differently. Addiction — people come across differently. They get into crime, they steal, it’s how the disease portrays itself.”

Dr Norsiah Ali, the head of clinic at Masjid Tanah Health Clinic in Melaka, similarly told the conference that drug addiction was a lifelong condition.

“We are here today to advocate on the needs for our patients to be free out there, to be away from being labeled as a criminal, and tell to the rest that this is a medical condition.

“They have got some changes in their brain that require medications to get them to behave normally,” she said.

The addiction specialist said Malaysia’s harm reduction approach for drug use — in which buprenorphine was first used in 2002 to treat opioid addiction — was one of the country’s most successful interventions. She highlighted the fall of HIV prevalence among intravenous drug users, from almost 70 per cent of total HIV cases contributed by injecting drug users in 2005 to 3.4 per cent in 2017.

“Nowadays, it’s not so common to see patients on methadone having HIV infection.”

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