By S. INDRAMALAR
In 2001, Portugal became the first European country to abolish all criminal penalties for personal possession of drugs (including marijuana, cocaine, heroin and methamphetamine). Jail time was replaced with therapy.
This was because the Portuguese realised that the fear of prison only drove addicts underground and did nothing to treat the problem. Also, incarceration was more expensive than treatment. At the time, Portugal had among the highest levels of hard-drug use in Europe.
As a result, those guilty of possessing small amounts of drugs are sent to a panel consisting of a psychologist, social worker and legal adviser for treatment, instead of jail.
Many were sceptical about the move, but a report commissioned by the Cato Institute, an American think tank, found that five years after personal possession was decriminalised, illegal drug use among teens in Portugal declined and rates of new HIV infections caused by sharing of dirty needles dropped, while the number of people seeking treatment for drug addiction more than doubled.
In the MAC report, "Everything On My Own", Malaysian AIDS Council’s Fifa Rahman and Sarah Iqbal urge Malaysia to decriminalise personal possession and use as it hasn’t proved to be effective in treating addiction, based on their interviews.
Many of the women interviewed had either been in and out of prison or rehabilitation centres at some point in their lives. However, they all say that their incarceration did nothing to treat their addiction.
“When you are in prison, you are in a closed environment where you have no access to drugs. You have activities to do and you have no choice but to be clean.
“Once you come out, you face all kinds of temptations. Anything from the past can trigger the addiction,” explains outreach worker Zulkiflee Zamri who manages Ikhlas drop-in centre in Chow Kit, KL.
Addiction, explains consultant psychiatrist (Addiction Medicine) Associate Professor Dr Amer Siddiq Amer Nordin, is a chronic medical condition which might start as a habit but may for some people, develop into an addiction.
“At some point of drug experimentation, people can choose to continue or not. But once they have taken it regularly for some time, there are certain chemicals within the drugs that lead them to be dependent and addicted,” says Dr Amer who is with Universiti Malaya’s Department of Psychological Medicine.
He explains further that addiction is a “relapsing-remitting disorder” where the symptoms are sometimes the worse (relapse) and at other times are improved or gone (remitting).
“Many service providers get frustrated because they think they may have “cured” someone who has addiction, only to find them unwell again. We need to get the message across and understand that they have a disorder that is biological,” he says.
Addiction psychiatrist Dr Anna Yee explains that some people are more prone to become addicts than others.
“Even with tobacco, studies show that there are multiple genes that may make some people more susceptible to addiction that others. These genes need certain environments to flourish. If they are in a good environment, they may not develop substance use disorder but if in a high risk environment, they are very susceptible,” explains Dr Amer.
Universiti Malaya Medical Centre’s substance abuse clinic runs a drug substitution and maintenance therapy for heroin dependency, including the government-sponsored MMT programme.
Although the clinic does not have specialised services for women users, Dr Amer says that the addiction clinic is not set apart from the other psychiatric clinics and addiction clients sit together with other patients.
“This way they don’t feel so self-conscious when they come for treatment as no one know what they are there for,” he says.
Dr Amer, however, said that the report is important in pointing out the flaws that practitioners sometimes take for granted.
“MAC’s report has resonated strongly with me. We have always looked at male issues with regards to hard drugs and perhaps we need to look at whether the services we offer may be too male-dominant. Indeed, if a woman goes to a clinic where there are 100 males and your’re the only female – it can be quite scary or daunting for some women to come out for help.
As a medical practitioner, Dr Amer doesn’t believe that incarceration alone works to help drug users get well. Instead, the harm-reduction programme has achieved tremendous success. In essence, the harm reduction programme aims to minimise the harmful effects of drug use such like HIV, Hepatitis C, addiction and incarceration.
“The incarceration method has failed and there are several studies that reconfirm what we already know: people who are incarcerated without any substitution treatment will revert back as they are back to their same environment.
“There was a study where individuals who have been abstinent for about five years are shown pictures of drug paraphernalia. Their brain lights up equally and in the same regions as those who are still taking drugs.
“What this shows is that there is something an individual who, despite being abstinent for some time, can relapse at any time, based on the cues their brain gets from their environment,” he says.