ARTICLE REVIEWTopic: MALAYSIAN DRUG TREATMENT POLICY: AN EVOLUTION FROM TOTAL ABSTINENCE TO HARM REDUCTION

By B. VICKNASINGAM & MAHMUD MAZLAN

Based on the journal that I choose, Malaysian Drug Treatment Policy; An Evolution From Total Abstinence to Harm Reduction, it discuss about to look out at the various treatment and rehabilitation programs in the country and how new approaches have been experimented with the aim of reducing the number of substance abusers and more importantly reducing HIV infection among this group. This journal also discuss about the reasons why initially certain programs were implemented and the reasons why the current shift in policy has taken place in the country. This journal is quite suitable for the article review because it discuss among a public health framework by using drug as a medical.

Nowadays drug policies was using everywhere and being replaced or modified as we are now faced with new challenges. Based on Bergeron and Kopp (2002) used Gusfield (1981) understanding on public health towards drug use where a causalist strategy for drug health policy and consequentialist one was used to explain public health policy. There are two major possible aims for the treatment of addiction is put forward that is the first is abstinence will be the main aim and a set of therapeutic techniques can be used including methadone but with the aim of progressive withdrawal and second is abstinence is not the main aim as addiction is regarded as a neurobiological deficiency. Based on Mahmud Mazlan (2006), he said that currently the Ministry of Health is given the authority to provide medical treatment for heroin dependence in the country. This shift signals a remarkable change in Malaysian policies and approaches to addiction and an improtant opportunity to develop, implement and disseminate effective treatments. In this journal too, there discuss about Malaysian drug problem between 1988 until 2006 and there are 300,241 was registered for abusers in Malaysia. From national Drug Information System on January(2007), in 2006, there 22,811 substance abusers were detected in the country. Majority of them was males that is 97.97% the another 69.48% were from the Malay ethnic group. But the main drug abusers in the country are heroin and morphine. So, by the problems that happen, they try to look how to treat the abusers and prevent by coming out the issues about drug treatment in Malaysia. It would be useful to first look specifically what has been the treatment and rehabilitation program conducted by the government in the country. Based on the government program, there are 29 treatments center in Malaysia. Currently there are three main treatment modalities cold turkey detoxification in the institution, institutional rehabilitaion for a period of two years and aftercare supervision for a period of between one to two years. Other than that, in the institution a multi-disciplinary approach is used. This includes spiritual, vocational, military style physical training and psychosocial interventions are used in the phase system that is four phase; first is main concentration is to re-orientate, restore the physical health, counseling and spiritual rehabilitation, second is activities in phase one will be continued with the addition of vocational training, third is the additional activity would be job attachment. The last is aspects that will be strengthen are community integration and re-entry programs. Also, National Anti Drugs Agency (NADA) has come out with its own community programs, that is aim to reach out to drug users and motivate them to come for treatment voluntarily. About the institutional treatment and rehabilitation program which emphasizes a total abstinence approach prove that it is not successful. Also, Navaratnam et.al (1994) carried out a controlled clinical evaluation of the safety, tolerance and efficacy of naltrexone among opiate addicts. But at the end, subjects on naltrexone only showed slightly better results than the control group. Eventhough private medical practitioners not actively treat drug users but after three to four years of introduction of buprenorphine Malaysia seems to be confronted with the problems of misuse of beprenorphine for unsupervised use from the beginning of treatment and leading to problems of poor medication compliance and diversion. By Mahmud Mazlan (2006) he said that patients are also not provided drug counseling or other psychosocial services. Also, by using methadone was limited in Malaysia. But the problems was occured by introducing medication for drug users in the country, the medical profession has now become actively involved in treatment of drug users in the country. In this journal also discuss about the policy paradigm shift towards harm reduction. One of it is the institutional treatment and rehabilition program and moved towards using medications to treat drug users. Most of this issue discuss about the drugs and the injections to the drug users. However , it also like to state there are also other reasons why harm reduction programs were slow to be implemented in the country. But most important issues is that the use of medication to treat drug users in the country need to be monitored more carefully. Based on Institute of medicine (2006;77) suggest that countries policies and regulations regarding opioid agonist maintenance treatment should balance the potentially competing goals of increasing the accessibility and utilization of opioid agonist maintenance treatment and reducing the likelihood of diversion agonist maintenance medications. By reading and reviewing this article I found that this article quite suitable for me as to know how drug can be damaged to people and how drug also can be medication to people. Also, I prefer this article because it help me to gain knowledge about the advantages and disadvantages the drug but mostly based on this article I found that it mostly give the advantage to the people if they using it in the wrong way. But this article can be more interesting if they focus to certain people such as at the certain country or places such as at village or at the town. And also it can be studies to those students. Because nowadays, there are some issues that the students also using the drug and mostly the reason is to release the tension.

As the conclusion, I found that this article can give me more knowledge about the drug in Malaysia and how far the government find the way how to solve the problems among the drug users and how to prevent the drug will be use in the wrong way.