Addiction is a disease affecting the brain and behaviour in which the individual cannot resist the urge to use substance(s) or partake in activities although it causes physical and psychological harm. The substances may be legal like smoking, prescription medicines, alcohol, etc, or illegal such as heroin or cocaine.
The inability to stop partaking in activities like gambling, eating or working is termed behavioural addiction.
Drug addicts have altered brain structure and function. There is a strong relationship between the addict’s compulsive behaviour and brain changes occurring over time with repeated use of drugs. Genetics is associated with an individual’s predisposition to develop drug addiction.
The goal of social policy is to reduce potential harms. However, punitive enforcement drug policies have made it difficult to see potentially dangerous drugs with the same lens as potentially dangerous foods, tobacco and alcohol. Evidence-based treatment for drug addiction reduces health and social consequences e.g. crime, HIV/AIDS and economic burden.
According to the World Health Organization, there is a cost savings of US$7 (RM29) for every US$1 (RM4.14) spent on treatment.
Treatment is cost-effective in developed and developing countries.
Various reviews over the years have reported the lack of success in addressing the drug problem in Malaysia. The use of punitive laws with incarceration as a control measure and lengthy custodial sentences for minor drug offences have led to over-representation of drug users in prisons. Various reviews have also reported drug use and injections in prisons although their occurrence is often denied.
Billions have been spent over the years on incarceration and rehabilitation centres. It was reported that in 2017 alone, Malaysia spent RM643mil on incarceration for minor drug offences and an another RM200mil for rehabilitation centres. The returns were paltry with relapse rates of 70% to 90%.
Decriminalisation and legalisation
Decriminalisation does not mean legalisation.
Decriminalisation refers to drug use and possession offences, and not the sale or supply of drugs. It focuses on drug users, not drug suppliers. The objective is to provide users with a more humane and healthcare response to their drug use.
Whilst there is no universal definition of decriminalisation, and even confusion sometimes, in essence it means the removal of criminal penalties for drug use or possession either by law or by practice. The penalties could be civil e.g. fines or diversion of offenders to educational or treatment options.
In the case of Malaysia, decriminalisation would mean changes to some laws as our drug laws are one of the most punitive globally.
On the other hand, legalisation is akin to that of the currently legal drugs e.g. tobacco and alcohol which have limitations on their sale.
Evidence for decriminalisation
Policies should be based on evidence.
Numerous studies have concluded that the “war on drugs” failed to deter drug addiction but instead deterred drug addicts from seeking treatment and inhibited harm reduction efforts.
The global research evidence on the impact of decriminalisation of drug use include:
♦ Reduction in costs to society, especially the criminal justice system
♦ Reduction in social costs to individuals, including improvement to education and employment prospects
♦ Does not increase drug use
♦ Does not increase other crime
♦ May, in some jurisdictions, widen contact with the criminal justice system.
In 2001, Portugal decriminalised the use of all drugs. Whilst the possession and use of drugs remained illegal, the offence changed from criminal, in which the offender could be sent to prison, to an administrative one.
The Health Ministry had oversight over treatments for drug addiction, which are accessible to everyone free-of-charge with substantial aftercare to reintegrate addicts back into society.
Decriminalisation reduced the heroin abuse with the Health Ministry’s estimate that heroin users numbered about 25,000 in 2017 compared to 100,000 in 2001. The reported rate of drug-related deaths is the second lowest in the European Union together.
There was also a continuous decrease in the numbers of drug-related HIV/AIDS.
However, there has been criticisms of stagnation and inaction since decriminalisation with delays in the establishment of mechanisms for ensuring effective implementation of policy e.g. failure to make available medicines for treatment; needle-exchange programmes, etc.
It is crucial to ensure that the Government’s announcement is not facile commitments to health approaches that are largely rhetorical or that mask policies and activities, which are not in keeping with good public health practice. Mandatory detention and abuse in the name of treatment have to be rejected.
The amendments to some laws have to be accompanied by appropriate measures, some of which are stated below. Otherwise, the policy change which has been termed a game-changer (www.thestar.com.my/news/nation/2019/06/27/dzulkefly-govt-to-decriminalise-drug-possession-for-personal-use) would only be a flash in the pan.
There has to be easy access to harm-reduction services for all who need them especially access to buprenorphine, methadone and naloxone, particularly in prison and detention centres as well as those with HIV, hepatitis and tuberculosis, needle and syringe exchange and condom usage. Treatment has to be humane and scientifically sound.
There has to be appropriate health and social support, including gender-appropriate treatment. In this respect, there is considerable room for improvement on education and employment opportunities for drug addicts.
Decriminalisation has to be monitored with regular reports and updates to parliament so that its success or otherwise can be measured. The United Nations Development Programme has suggested that indicators like access to treatment, frequency of overdose deaths and access to social welfare programmes would be useful.
It would not be an exaggeration to state that general practitioners can contribute considerably to the success of this policy change.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.