Human Writes: Finally ‘an addict shall be treated as a patient’


  • Living
  • Sunday, 14 Jul 2019

Sometimes, revolutions happen so quietly that we barely notice them. Did many people even realise we just had one? It involved a radical U-turn in policy, a brave measure of any government.

From having some of the harshest, most unforgiving drug laws on the planet, we are now decriminalising drugs. Anyone caught with a small amount of drugs will now not be thrown in jail.

Health Minister Datuk Seri Dr Dzulkefly Ahmad announced the policy recently as a “game changer” (“Govt to decriminalise drug possession for personal use”, The Star, June 27).

“An addict shall be treated as a patient, not as a criminal,” he said, adding jail does not cure addiction, which is a complex medical condition. He stressed this was not “legalising drugs”. Trafficking remains a crime.

This is a drastic turnaround. We’ve had four decades of tough, punitive policies. We hung drug traffickers. We caned drug users. We had brutally tough drug rehabilitation centres, where military- style marching, exercises such as duck squats and physical labour were once routine.

In fact, I took up this issue in the early 1990s, because conditions in these centres seemed so inhumane. In Rawang, Selangor, I saw 15 inmates squashed into a tiny, windowless cell (about 3m by 5m) to withdraw, with just one bucket for the toilet and barely enough room to lie down. Some were in agony undergoing gian (heroin withdrawal), which is incredibly painful without medication.

Until now, people got imprisoned on the basis of random urine tests, following police raids. (Note that poppy seeds and some medicines cause positive urine tests.) Our prisons are stuffed full with 70,000 prisoners, double the number from 20 years ago.

“We’re still arresting thousands of people – 60% of prisoners are in there for minor and personal drug use,” says Prof Datuk Dr Adeeba Kamarulzaman, dean of Universiti Malaya’s Faculty of Medicine. “It has all been very unproductive and ineffective.”

Incarceration bleeds millions of ringgit every day. In 2017, it cost a staggering RM640mil to jail people for minor drug offences, it was reported. A further RM200mil was spent on Puspem (rehabilitation centres). The outcome? High relapse rates, broken families, widespread tuberculosis in prisons and other problems.

Fears of a backlash in public opinion hindered change. But now, says Dr Adeeba, the government is looking towards evidence for drug policy rather than “misguided ideology”.

Our drug policy is fraught with flaws. A key failing is the lack of distinction between drugs and the harms they cause.

“We also didn’t make a distinction between recreational drug use and addiction. A first-time user could land in the same situation as someone using drugs regularly,” points out Dr Adeeba.

A recent report by the Global Commission on Drug Policy noted the international drug classification system was never based on science but arbitrary choices and historical precedents. Some drugs were never properly evaluated.

In 2009, a British government drug expert, Prof David Nutt, was sacked after he wrote that horse riding caused more accidents than ecstasy-use among youth, under the satirical title “Equasy”. Yet no one would ever ban riding. Prof Nutt also noted how the media favours “scare stories” on drugs.

A 2010 British study analysed personal and social harms of intoxicating substances. The most harmful? Alcohol (partly because many people drink). The least harmful/most benign? Psychedelics and party drugs such as ecstasy. Also, medical marijuana is now increasingly recognised. Yet last year, a 29-year-old father, Muhammad Lukman, was sentenced to death for providing cannabis oil to cancer patients.

Globally, the trend is towards decriminalisation. This is not legalisation, but a focus on treatment rather than imprisonment.

In Portugal, a model for decriminalisation, anyone caught with a small amount of drugs has to meet a “dissuasion panel” of legal and psychological experts. Treatment, if needed, involves counselling and medication such as methadone. Traffickers still face the law.

Now, two decades on, overdose deaths and HIV infections have plummeted in Portugal. The heroin epidemic is under control and drug use among youth has dropped.

It is hoped that with decriminalisation, drug users won’t be driven underground and treatment not delayed, Dr Adeeba explains.

“Importantly, people heavily addicted can be channelled to people able to help them, such as counsellors and addiction psychiatrists.”

Dr Adeeba points out that the path ahead requires collaboration from many sectors, including civil society and religious leaders. Training and treatment needs to be expanded, monitoring and evaluation must be conducted, and support programmes established.

“Portugal’s success was because they expanded treatment, care and support,” she notes.

“Many things need to happen. In the past, we just locked people up and forgot about them.”

The “war” against drugs can never be won. Opium production has risen by almost 170% in Afghanistan and 30% in Myanmar in the last 10 years, the United Nation reports. Amphetamine use has also skyrocketed.

Far better, then, we look for the best strategies for treatment, prevention and reducing the harms.


Human Writes columnist Mangai Balasegaram writes mostly on health, but also delves into anything on being human. She has worked with international public health bodies and has a Masters in public health. Write to her at star2@thestar.com.my. The views expressed here are entirely the writer’s own.


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