Take a compassionate approach

I TAKE heart in the recent news that the Permatang Pauh MP has put her political will behind a pilot project trialling naltrexone to treat opioid addiction in her constituency.

Nurul Izzah Anwar is not new to such harm reduction programmes, having placed her support behind

a similar study using methadone when she was Lembah Pantai MP previously.

Such programmes are part of the larger harm reduction initiative in Malaysia that has been running since 2005.

Opioid addiction affected around 25,267 Malaysians in 2018, according to statistics provided by the National Anti-Drug Agency (AADK) (https://www.adk.gov.my/orang-awam/statistik-dadah/).

Of this number, 69.2% were newly reported cases with addicts who were predominantly Malay (81.8%), male (96%) and addicted to opioids heroine and morphine (30.7%). Based on these statistics, it comes as no surprise that the harm reduction initiatives backed by Nurul Izzah utilises mosques as a centre to treat opioid addiction.

Such approaches can be said to be holistic, where the issue of addiction is treated based on science and supplemented with psychological and community support.

However, the stigma against drug users remains. The War on Drugs has embedded in public psyche that drug users are criminals and “good for nothing”, focusing on a punitive approach to “cure” persons with addiction.

It must be said that this policy

has not worked. Instead of solving addiction and the social ills related to it, it has aggravated the problem.

Drug users who have a criminal record for possessing drugs are often forced to steal or become involved in selling drugs because their criminal record prevents them from securing employment.

Stigma from the public then places blame and shame on them for being dependent on opioids, while many started their addictive habits due to stress, social pressures and mental health issues.

A case in point is the recently reported story of 17-year-old Ahmad (pseudonym), who achieved 7As in his SPM examinations. Instead of pursuing tertiary studies, Ahmad has a criminal record for possession of ketum.

His story is tragic, as he comes from a family environment of drug abuse. His 42-year-old father is imprisoned in Machang while

his elder sister, 21, did time in the Pengkalan Chepa jail in Kelantan, both for drug abuse.

Ahmad’s story is one of many. Incarceration not only risks exacerbating negative habits including finding new ways to remain addicted, but also creates a psychological barrier to overcome addiction, with many cases of recidivism when released from jail.

And the cycle continues.

While Nurul Izzah has commented that she thinks it is too soon to be talking about decriminalising drug use, I beg to differ.

We need a drug policy reform that focuses on treatment, not being punitive. There are sufficient evidence-based policy programmes in countries like Portugal to show that Malaysia can adapt.

There is enough national-level data to show that harm reduction works and should be scaled up.

All it requires is political will. What we need is commitment by more MPs, especially in constituencies that are most affected.

It is interesting to note that such a harm reduction approach has now moved beyond opioid addiction and to other addictive behaviours including alcohol, sex and gambling addiction.

Furthermore, there are global conversations and a push for tobacco harm reduction, where combustible cigarettes are replaced with devices designed to provide a nicotine hit without the toxic side effects of cigarette smoke, as well as to encourage smokers to give up their habit.

The move by the Ministry of Health to ban smoking within the parameters of eateries was a great approach to nudge many to quit smoking and ensure a smoke-free environment for most of the public. However, such moves do not “solve” addiction to smoking.

Maybe the time is ripe for local policy conversations that see a harm reduction approach to tobacco use in addition to opioid abuse. After all, such issues are often interrelated, with many drug users also smokers.

Policies impacting such sensitive issues like addiction, be it for opioid, smoking or any of the substances or behaviours mentioned above, must not only be backed by substantive science but approached with evidence from lived realities.

Most important of all, they must come with compassion and political will in implementing the regulations required.

Solving addiction is not easy. Yet often we are so focused on solving the issues on the surface that we miss the fundamental causes of those issues.

Mental health support and access are crucial to preventing and managing addiction.

I would also further argue the need to ensure a robust local economy and that inspiring many young Malay men to have ambition and be empowered to better themselves would reduce risk of them being addicted.

It can start with a national drug policy reform that is health-based, data-backed and with a holistic approach. It can start by viewing addiction as a health issue, rather than a morale one.

Lyana Khairuddin is a virologist turned policy nerd living in Kuala Lumpur. The views expressed here are entirely her own.

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