Just a few puffs away from drug addiction

A National Anti-Drug Agency officer testing urine samples for drugs during a police raid. However, etomidate is one drug that does not have a rapid test kit and that also rapidly disappears from the urine, making it very difficult to detect. — Photos: Filepic

Just like nicotine, some substances make people dependent on them to get through the day.

But with Kpods – vape liquids laced with drugs – there can also be far more severe consequences.

These compounds act quickly, cause rapid addiction and can impair the brain’s ability to function normally with long-term use.

Monash University Malaysia consultant addiction psychiatrist Assoc Prof Dr Anne Yee says users are often drawn to etomidate-laced vape products because of their fast-acting effects.

“With etomidate-based compounds, users can feel detached from reality after just one puff,” she explains.

“They may experience drowsiness, muscle spasms, loss of control, sedation, altered perception, and even psychosis.

“These effects appear within seconds – that’s what makes these products so addictive and dangerous.”

Some, unaware of how fast it acts, take repeated puffs, causing them to eventually lose consciousness.

Rapidly addictive

“Frozen” bodies, loss of movement control and sudden collapses in public spaces – these are some of the unsettling scenes linked to so-called “zombie vapes” or “zombie oils”.

Users commonly describe the sensation as their brain “riding a roller coaster” while their body is either unable to move or not fully under their control.

“There have been reports of young users collapsing or freezing in strange postures for minutes, or even hours, in public spaces like corridors or MRT stations,” says Assoc Prof Yee.

“They often lose coordination, experience psychosis and suffer severe withdrawal symptoms when they stop using the substance.”

Withdrawal can be intense for Kpod users.

They may become agitated, restless, or even violent.

“While high, they are often unaware of their surroundings, almost as though they’ve lost consciousness,” adds the adjunct professor at the Universiti Malaya Centre of Addiction Sciences.

Despite the risks, many continue vaping in public.

As Assoc Prof Yee notes, the behaviour is similar to a smoker craving a cigarette after a meal, even when they are fully aware of the health and legal consequences.

“Etomidate-based vapes can create both psychological and physical dependence, and dependence itself is one of the most significant long-term effects,” she says.

She adds that prolonged use may also lead to seizures and a serious condition known as adrenal suppression, where the adrenal glands fail to produce adequate hormones.

If left untreated, this can progress into an adrenal crisis, where the body is unable to produce the hormones needed to respond to stress – a potentially fatal emergency.

Beyond the physical risk, the psychological toll is equally worrying.

“Chronic use is strongly associated with psychosis, erratic behaviour, emotional instability and long-lasting mental health issues,” she says.

Several viral videos from Malaysia and Singapore show individuals behaving irrationally or attempting to harm themselves, believed to be under the influence of drug-laced vape products.

“In one case, a mother reported her son trying to jump from a building; in another, a father said his daughter fell from a height during a psychotic episode,” says Assoc Prof Yee.

Ultimately, dependence remains the most dangerous consequence.

Even when users recognise the harm, many struggle to stop, affecting their relationships, work and daily functioning.

This exhibition panel at the Malaysian Crime Prevention Foundation shows some of the illegal drugs that are listed under the DDA and are regularly tested for.

Individualised management

Treatment for drug dependence varies from person to person.

Clinicians tailor care based on the substance involved, the severity of dependence and each patient’s individual needs.

The first and most critical step is a proper assessment by a trained professional.

Assoc Prof Yee, who also practices at a private hospital in Johor Baru, says assessments are essential because many patients are unsure what they have taken.

“Patients often don’t know the substance involved,” she explains.

“Sometimes they give the wrong information – they may say it’s a magic mushroom when it isn’t.

“Dealers will tell them anything to sell their products.

“That’s why we’re trained to assess patients properly so we can deduce what substance is involved.”

Most patients she sees are polysubstance users, switching from one drug to another depending on what they can afford or what is trending.

“Eventually, they stick to one main substance, whether it’s cannabis, heroin, methamphetamine or etomidate,” she says.

Etomidate poses a challenge because it is short-acting and difficult to detect.

“You can’t detect it in urine after just two voids – once they’ve gone to the toilet twice, it’s no longer traceable.

“And currently, we don’t have a rapid urine drug test for etomidate.”

Most patients who visit her clinic are already seeking help and are honest about their use.

“They’re afraid that if I don’t know what drug it is, I might treat them wrongly,” she shares.

Urine tests are done only when confirmation is necessary.

When drug-laced vapes are suspected, samples must be sent to a toxicology centre.

However, the testing process may take up to three to six months.

“But I can’t wait that long to start treatment, so I base my decisions on symptoms.

“If it’s just nicotine, you won’t see dissociation.

“Anything beyond that, we consider drug-laced,” says Assoc Prof Yee.

When treating drug dependence, there is no single medication that fits every case.

“Once we identify the primary substance, we manage it like any other substance-use case.

“We may prescribe medication to help the brain recover because etomidate alters receptor response – that’s why users experience both psychological and physical effects,” she explains.

Detoxification process

Once the drug effects have stabilised, patients can begin detoxification.

“Detox without medication is quite cruel, which is why we rely on medication-assisted treatment,” says Assoc Prof Yee.

Without medication, withdrawal can cause unnecessary suffering, including agitation, pain and seizures.

For severe withdrawal or complications, such as adrenal suppression, loss of balance or seizures, she recommends hospital admission.

If symptoms are mild and family support is strong, detox can be done on an outpatient basis.

Detox typically takes one to two weeks, followed by continued outpatient treatment.

Counselling and psychosocial therapy only begin after detoxification.

“When patients are intoxicated or in withdrawal, their brains can’t think clearly or focus.

“You can’t do cognitive behavioural therapy (CBT) when you’re sick, you need medication first,” she says.

CBT is a form of psychological treatment that helps people identify and change unhelpful thought patterns and behaviours.

In addition to seeking help at private hospitals with the right specialists, users can turn to the National Anti-Drug Agency, which offers free rehabilitation programmes, counselling, detoxification support and community-based treatment via the National Narcotics Rehabilitation Centre (also known by its Malay acronym Puspen).

Over the past three years, police have handled more than 360,000 drug-related cases, with around 90,000 individuals referred to Puspen for institutional treatment.

Those who voluntarily seek help will not be arrested – the focus is on recovery, not punishment.

Gaps in law and testing

Kpod and other drug-laced vape liquids are classified under Malaysian law based on their chemical contents.

Narcotic Crime Investigation Department (NCID) Legal and Investigation assistant director ACP Chandra Segaran Subramaniam, explains that enforcement depends on whether a substance is listed under existing drug laws.

“If there are no controlled substances, then there is no offence,” he says.

“But if the liquid contains a drug listed under the schedule, it falls under the Dangerous Drugs Act (DDA).”

The challenge, however, lies in the rapid emergence of new synthetic compounds.

Many are not yet listed under the official schedule, and some cannot be detected using current testing equipment.

“We send samples to the Chemistry Department for confirmation, but sometimes, the report shows no drugs because the substance isn’t listed in the chemistry report,” he says.

This gap creates delays not only in prosecution, but also in medical intervention.

“Doctors cannot officially classify someone as drug-dependent without confirmation.

“Waiting months for pathology results delays treatment and increases costs.

“We want early intervention, but the system slows us down,” he explains.

According to National Poison Centre (NPC) science officer Dr Normaliza Abdul Manaf, testing vape liquids is not a quick process.

“A full laboratory analysis, which checks for nicotine, base ingredients, flavourings, additives and possible drug content, usually takes seven to 10 working days,” she explains.

“This allows time for samples to be prepared, tested and properly analysed.”

However, the process can take even longer when laboratories encounter synthetic drugs that are not yet listed.

Identifying these substances may take two to four weeks, depending on how complex they are and whether reference materials are available.

In such cases, laboratory experts rely on advanced testing methods, international databases, and at times, input from overseas experts.

At present, the NPC laboratory has internal databases covering more than 500 substances, including common controlled drugs and newer psychoactive substances such as synthetic cannabinoids.

Police data shows that most drug-laced vape liquids seized contain synthetic cannabinoids, not etomidate.

In 2023, about 65% of seized vape liquids and devices tested positive for substances such as 3,4-methylenedioxymethamphetamine (MDMA, commonly known as Ecstasy) or ADB-Butinaca, a synthetic cannabinoid compound.

Etomidate, however, is likely to be undercounted, as it is not yet widely listed as a controlled drug and can slip through routine enforcement and testing processes unless targeted laboratory analysis is conducted.