Harm reduction the way to go

  • Letters
  • Tuesday, 22 Jan 2019

LET’S be frank: Malaysia’s war on drugs is not working. The numbers are telling.

In 2010, there were reportedly 23,642 people who were dependent on drugs in Malaysia. By 2016, this had risen to 30,844. By 2017, a total of 163,931 drug-related arrests were made, clogging up our ­prisons.

This has created a subset of Malaysians who have been incarcerated for what is basically a health condition, namely addiction.

A June 14, 2017 Astro Awani report noted that 33,500 out of the 59,600 convicts in the country at the time were in prison because of drug offences, or 56% out of the total number of inmates nationwide. Of this, 71.35% were Malay and 66% were between 22 and 40 years of age.

In 2018, a Malaysian Prisons Department report revealed that while the capacity for prisons is around 52,000 inmates, there are currently 64,000 incarcerated.

Many of the men and women on death row in Malaysia today are there because of drug-related offences. In November 2018, Al Jazeera reported that out of 1,279 inmates on Malaysia’s death row, 932 were there because of drug offences.

And yet, decades of sentencing people to death for drug trafficking do not seem to have reduced the scourge of drug addiction in our country.

Former Home Minister Datuk Seri Dr Ahmad Zahid Hamidi had admitted in December 2017 that Malaysia’s war on drugs was unsuccessful as it has failed to curb addiction. Other countries around the world are rapidly coming to similar conclusions.

Clearly, our hard-line approach to the problem is not working. It has not worked because it is not purely a law enforcement or security problem, but also a health and social crisis.

What we ought to be doing is looking for alternatives – for holistic solutions.

Locking up drug users in overcrowded, often deplorable conditions will not help them beat their addiction. Nor, as the recidivism rate mounts, will mass incarceration make our streets safer as people who are dependent on drugs get caught in a vicious cycle.

At the start of the new year, among other new beginnings, I launched a methadone harm reduction programme for people dependent on opioids in my constituency, Permatang Pauh, in collaboration with dedicated medical practitioners from Universiti Malaya and the Health Ministry.

This will soon be augmented by a naltrexone-based programme, which will be the subject matter of the very first study ever done glo­bally, comparing between the use of methadone and naltrexone in addressing polysubstance users.

Why am I backing harm reduction? It admittedly can be a hard sell in Malaysia sometimes.Harm reduction is often and wrongly confused with tacit support for the legalisation of marijuana or other drugs.

That is not the case. What harm reduction seeks to do is to shift the focus from penalising drug users further and to instead help them overcome their afflictions.

Albert Einstein once said: “The definition of insanity is doing the same thing over and over again and expecting different results.”

It would be better to instead strengthen our harm reduction programmes such as the one in Permatang Pauh, alongside 900 other centres across the country.

Run by the Health Ministry, these centres work to provide methadone treatment to individuals addicted to opioids, allowing them to wean off their addictions.

Patients come to the centres weekly for treatment and are cared for as well as managed by healthcare professionals, helping their rehabilitation and reintegration back into society.

Via Medication Assisted Therapy (MAT), the harm reduction programme has proven successful in reducing HIV infections while treating opioid addiction.

The HIV infection rate through the sharing of needles has fallen from 79.6% in 2001 to 4% in 2017 and has been given recognition by international bodies like the WHO, UNAIDS, United Nations Office on Drug and Crime (UNODC) and International Drug Policy Consortium (IDPC).

Previous harm reduction programmes used methadone as the primary measure. The trend now is to expand to naltrexone implants, which are more effective for treating addiction to mind-­altering drugs, including nicotine and alcohol as well as heroin, syabu, ice and the like.

Methadone was effective for treating opioid-based substance users, but now over half of drug users in Malaysia are polysubstance users.

The study in Permatang Pauh is crucial in ascertaining the efficacy of different treatments. But one thing remains clear – harm reduction is certainly more cost-effective than incarceration in prison.

As of 2013, keeping a prisoner behind bars cost Malaysian tax­payers on average RM35 per day, which adds up to RM12,775 per year.

Naltrexone is admittedly expensive – it costs A$2,000 (RM5,896) per patient. This, however, includes the cost of rehabilitation and suppliers have apparently quoted around RM3,000 per implant, which usually lasts for three months. This is still, in the long-run, cheaper than just locking people up.

Under Section 39 (a) of the Dangerous Drugs Act 1952 (Act 234), offenders convicted of possession of drugs but not sentenced to death get jail sentences of between two and five years. This costs the country anywhere between RM25,550 and RM63,875 per ­prisoner.

This is significantly higher than naltrexone, which would average around RM10,000 per patient for the six-month rehabilitation and treatment plan.

But vulnerable drug users must also receive constant support in order to prepare them for social reintegration. They need a holistic, community-oriented approach that will ensure these individuals are not treated and then left to their own devices, which often leads to relapses. This is certainly easier to do via harm reduction programmes rather than prisons.

As such, the relevant authorities should take steps to ensure that non-violent drug addicts under­going harm reduction treatment are not unnecessarily arrested.

Families of those receiving treatment must also get the appropriate support to help them welcome their loved ones back into their fold. Again, this is easier done if the addicts were in harm reduction instead of prison.

Pivoting towards helping individuals instead of brutalising them, as well as increasing funding for and expanding the programmes, will go a long way towards making Malaysia drug-free and safer.And like it or not, Malaysia needs to give serious consideration to drug reclassification, assigning more harmful drugs to an appropriate schedule.

Problematic drug use is a serious health and social condition that negatively affects Malaysian families. Imprisonment further destabilises these families by preventing individuals from getting regular work, accessing healthcare they need, and supporting their children – the next generation of Malaysians.

Harm reduction is a workable, holistic and inclusive solution that can help people who have made bad decisions to get back on their feet again and become productive members of society. It is something that all Malaysians ought to get behind.

NURUL IZZAH ANWAR MP for Permatang Pauh

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