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Official websites use. Share sensitive information only on official, secure websites. Correspondence should be addressed to Archana Krishnan, Ph. Drug use in Malaysia remains a significant public health and social problem despite implementation of harsh punitive drug policies such as forcibly placing suspected drug users into compulsory drug detention centers CDDCs. Survey results showed Evidence points to the need for integration of social support-oriented practices and behavioral interventions into the rehabilitation of drug users in this region. Keywords: Substance abuse treatment, harm reduction, compulsory drug detention centers, drug policy, amphetamine, Malaysia. As per the Dangerous Drugs Act and Drug Dependence Treatment and Rehabilitation Act, people who test positive for drugs are detained in CDDCs for a mandatory two-year period without legal due process and forcibly detained in these facilities against their will. The increasing number of PWUD in Malaysia and the insufficient scalability of harm reduction programs like needle and syringe exchange programs NSEPs and opioid agonist therapies OAT like buprenorphine and methadone, which were introduced in and respectively, have thwarted HIV prevention efforts. Drug use in Malaysia, however, is not uniform throughout the country and there is emerging evidence of a growing amphetamine-type substance ATS epidemic in other parts of Malaysia, 18 including in the Kelantan region. The implementation of semi-structured interviews in addition to a quantitative survey was deemed to be the most appropriate methodology because of the lack of any systematic research on drug use in this region of Southeast Asia. The eventual purpose of this two-pronged approach is to help guide treatment strategies based on both empirical and particularized drug use characteristics, behaviors and experiences. Additionally, patients can participate in optional group physical activities that include games, hiking, artistic activities, musical therapy, and vocational training. Data were collected over six weeks from June to July , using a mixed methods approach - quantitative surveys and qualitative in-depth interviews. The survey was conducted first; a convenience sample of individuals who participated in the survey was then approached to partake in the in-depth interview. Institutional review boards at both the University of Malaya and Yale University approved the study. Those individuals expressing interest were then referred to trained research assistants affiliated with SAHABAT, a local non-governmental organization that operates harm reduction programs in Kota Bharu. Inclusion criteria included being 18 years or older and having been an inpatient or outpatient at the facility for at least one month. The median duration of treatment for this study sample was days, i. Eligible clients underwent informed consent procedures by research staff for the survey portion of the study and a medical chart review. Among the 96 patients 47 inpatients and 49 outpatients participating in the survey, 77 agreed to participate in the qualitative interview. Trained research assistants conducted the surveys and the interviews in a confidential, on-site private room and all communication was in Bahasa Malaysia, the local language. Additionally, questions on experiences with methadone and HIV treatment were asked to patients who had received methadone or were HIV-infected, respectively. The survey was constructed in English, translated into Bahasa Malaysia and then back-translated to ensure face validity of all study measures. This research assistant introduced himself and the study, and completed informed consent procedures before proceeding with the interview. The interviews ranged from minutes. They were audio-recorded and later transcribed and translated into English. Additionally, tests of significance t-test and chi-square test were conducted to assess differences in drug use characteristics between inpatients and outpatients. Qualitative interviews were analyzed through a conventional content analysis approach 30 wherein participant responses were first used to develop codes and the relationships between the codes were then analyzed using Atlas. While half the patients were employed, employment was represented only among the outpatient clients. Medical and psychiatric comorbidities were not highly prevalent in this sample — Psychiatric comorbidities were also relatively low, with Overall, half had been previously detained There were no significant differences in the socio-demographic characteristics of the qualitative interviewees and the overall sample from where this subset was enrolled. Results from the quantitative survey showed that ATS Stratifying by patient status, there were no significant differences in drug of choice or lifetime drug use except for ketum; more inpatients reported having used ketum at least once in their lifetime compared to outpatients. Cough syrup, presumably with codeine opioids , was not assessed in the survey; however, multiple quotes from the in-depth interviews explicitly mentioned cough syrup as a drug used for relieving withdrawal symptoms:. At that time, cough syrup was very popular among addicts and it was cheaper than heroin. After taking the cough syrup, I took it again with the methamphetamine and it felt good so I took more. After that I took cough syrup. When I was 16, I went to Kuala Lumpur to work. At that time, I only took drugs for fun. Overall, Of these, a fifth acknowledged using a syringe or needle that had been used by someone else. Again, there were no significant differences in injecting behaviors between inpatients and outpatients. Some participants described progressing to injecting drugs as an economic strategy to make their purchase last longer:. Injecting one pill would last till the afternoon if I took it in the morning. In the interviews, participants described previous failed attempts to stop using drugs, including when detained, and explained why they relapsed. After I left, I met my friends and immediately started staking drugs again. Participants described the powerful influence of their friends over their drug use and attempted to avoid substance-using friends by isolating themselves futilely at home. I locked myself in my room for a week, I withstood the withdrawals and I managed to get over it. But once I got out of the house, there were too many challenges, especially from my friends who would always ask me to take drugs with them. They knew that I stopped but they kept pestering me. Some even offered to buy the drugs for me. After a while, I gave in to my friends and I started taking drugs again. Some activities like watching TV, playing games can make me not think about the thing. But if we think about it, we will want it. Better to be locked at home. A third participant directly attributed his periodic drug use to his friends and avoided interactions with them since he considered them as a the trigger to his drug relapse. I have a friend living in Kuala Lumpur. Even if just my friends walk past my house the aura will trigger. So now I avoid my friends. Table 3 shows the various structured responses from the quantitative survey. The top three reasons were: wanting to quit drugs because it was hurting relationships with family and friends In fact, when participants discussed relapse, their major concerns were not physical withdrawal symptoms that might facilitate relapse, but the pressure from friends to start using drugs again. Let me be healthy till I am old. I hope to stop. I hope to not see my old friends. I worry that I might fall into becoming an addict again. I hope my intentions come true. Outside I have so many problems, like problems with friends. We are going to fall get involved again with drugs. Living here there is no problem. My hope, I want to live happily with my family, have a normal life like other people… If I have any problem, I will come here, sometime with my wife. My friends outside, I will give advice. I need friends who can support me and I also need support from my family. I need counseling here to help me with this. I am ready to face the temptations outside. I always have to be careful and remember. And always fill my time with sports and things. Demographic characteristics of this sample is similar to those of participants from another study in the region that examined attitudes towards OAT among HIV-infected prisoners, 32 suggesting that these new voluntary centers serve a similarly vulnerable population, but with higher ATS use. Importantly, the high prevalence of ATS use among this group may reflect that those individuals with primarily opioid use disorders may have enrolled in OAT elsewhere. From a contextual perspective, this analysis provides important insights into the transformation of CDDCs for Malaysia and elsewhere. This is especially important since many OAT programs do not provide these additional services. From a broader perspective, both in Malaysia and elsewhere in the region, it may be important to integrate OAT with additional treatment services where both opioid and amphetamine use disorders need simultaneous treatment. Unlike the HIV prisoners previously surveyed, the proportion in this study with HIV and other medical and psychiatric comorbidities was relatively low. For those who were CJS-involved, relapse rates were high, regardless of the type of incarceration. Results indicate high ATS use in this region, likely due to their availability in close proximity to the Thai border, but could also reflect that this treatment facility served an important addiction treatment need for those without opioid use disorders who may have sought treatment elsewhere. This suggests that cough syrup might be an important proxy for drug use and for easing withdrawal pain. This needs further investigation especially since cough syrup use has not been empirically observed in any other drug behavior studies in Malaysia and may not be perceived as a treatable condition since cough syrup is traditionally seen as medicinal. The surveys and in-depth interviews both indicate a high degree of polysubstance use. They recognized that peer networks were strong influencers not only for drug initiation, but also as relapse triggers. It was apparent that many chose to become inpatients in order to remove themselves from community-based peer networks, and for those who received non-inpatient care, they had to remain involved in day-long activities to reduce contact with the community. Participants attributed their initiation into drug use and subsequent failed attempts to stop their drug use behaviors to peer pressure. The pressure to remain drug-free was mainly influenced by family support. Overall, the findings from this study show that drug use behaviors vary even within the regions of Malaysia. However, in order to address the multitude of polysubstance abuse and to utilize family support, intervention strategies ought to be augmented so as to positively influence recovery. The participants in this study were recruited from a convenience sample. In order to examine the long-term effect of these innovative harm reduction programs on treatment outcomes, future studies should attempt to incorporate a longitudinal design. Important here is that it serves an important unmet need for ATS users who otherwise may not have access to treatment. In the absence of such treatment programs, these individuals may not have had any access to treatment for amphetamine use disorders, which until medications are documented to be effective, is often treated using psychosocial and therapeutic community strategies. It is in the best interests of drug users, policy makers and society to adopt evidence-based intervention strategies to combat drug addiction. Insights from this study may have far-reaching policy implications regarding drug rehabilitation that are provided in voluntary rather than compulsory detention settings. This study was funded through multiple grants. Data analysis and interpretation, and manuscript preparation were facilitated through salary support provided by the following - National Institute on Drug Abuse R01 AA , a diversity supplement R01 DA and a career development grant K24 DA None of the above funding organizations played a role in manuscript preparation, review, or approval nor were they influential in the decision to submit the manuscript for publication. AK conducted the quantitative analysis, interpreted the results and wrote the manuscript. SB analyzed and interpreted the qualitative findings and assisted in writing the results section. FK and MG collected the data and assisted in content analysis. As a library, NLM provides access to scientific literature. Subst Abus. Published in final edited form as: Subst Abus. Find articles by Archana Krishnan. Find articles by Shan-Estelle Brown. Find articles by Mansur Ghani. Find articles by Farrah Khan. Find articles by Adeeba Kamarulzaman. Find articles by Frederick L Altice. Issue date Oct-Dec. PMC Copyright notice. The publisher's version of this article is available at Subst Abus. Open in a new tab. The authors declare that they have no conflicts of interest. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Having unprotected sex in the previous 30 days. Self-Reported Medical Comorbidities. Opioids heroin, opium, codeine, pethadine, morphine. Injection Behaviors c. Used syringe or needle that participant knew had been used by someone else last 30 days. Injected by pulling drugs into the syringe from a container other people were using last 30 days. I wanted to quit drug use because it was hurting my relationships with family and friends. I wanted to quit drug use because it was hurting my health. I wanted to quit drug use because it was hurting my job or occupation. I was able to stop my drug use, and I came here to prevent relapse. My family, friends or employers told or brought me to get treatment here. The workers from the community service shelter or NGO I lived in before suggested me to come here. I needed medical care because I was sick from my drug use. I needed methadone treatment, and could not get it anywhere else.
Risk and protective factors of drug abuse among adolescents: a systematic review
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Decades of harsh laws that punish and stigmatize people who use drugs and others involved in the drug trade have led to mass incarceration, disease, suffering and violence. Criminalizing drugs does not decrease their use or supply. Instead, it drives the trade underground, increases the harms of using drugs and fuels organized crime, corruption and violence. The prohibition of drugs directly impacts our right to health. People who use drugs are denied access to medical treatment or are deterred from seeking medical assistance for fear of being reported to the authorities. This increases the risk of overdose and other threats to their life and health. Drug policies designed to punish people exacerbate the risks and harms associated with drug use. These policies can lead to increased transmissions of HIV and other diseases. They also obstruct access to drugs for medical purposes, including for pain relief and palliative care, resulting in further harm and suffering for millions of patients. Since then, it has been used by many governments around the world to launch crackdowns on people who use drugs and reduce the trafficking of drugs. These campaigns rely on harsh punishments to deter people from using or selling drugs. Instead, it undermines the rights of millions of people, exacerbates the harms of using drugs, and intensifies the violence associated with illicit markets. It disproportionately affects the poorest and most marginalized communities, who carry the burden of this failed strategy. It traps entire communities in cycles of incarceration, violence and poverty. In June , then-President Rodrigo Duterte launched a brutal campaign against drugs in the Philippines. Since then, thousands of people, the vast majority from poor and marginalized communities, were killed over suspected links to the drug trade. The government acknowledged at least 6, killings at the hands of police or other people with links to the police. Human rights groups report that the real figure could be as high as 30, people killed by anti-drug operations. There remains no genuine accountability for these human rights violations nor justice for families of victims. In fact, the International Criminal Court is currently conducting an investigation into these crimes. The killings continue under the new Marcos administration , with drug-related killings reported during his first year in office. Latin America has seen a particularly sharp growth in prison populations in the last decades, where the population detained for drug-related offences has grown at a faster pace than the overall prison population. Globally, women are imprisoned for drug-related offences more than for any other crime and face harsher obstacles to access non-custodial sanctions and other alternatives to detention than men. The US imprisons more people than any other country. One in five people in US prisons is serving time for a non-violent drug offence. Thousands of other people who use or are suspected of using drugs have been arbitrarily detained and forcibly subjected to mandatory treatment, often without their consent. These centres have been infamous for their deplorable conditions and reports of torture and other ill-treatment. An Amnesty International investigation revealed the punitive and abusive nature of drug-detention centres in Cambodia, where medical facilities and properly trained staff is utterly lacking. Rather than receiving evidence-based treatment, people are detained against their will and face systematic abuse. The use of the death penalty for drug-related offences is perhaps the most extreme manifestation of the punitive approach favoured by many countries. Those sentenced to death for drug-related offences are mostly at the low-end of the drug chain, and often from disadvantaged socio-economic backgrounds. Using the death penalty for drug-related offences is a clear violation of international law. Yet, drug-related offences can still be punished by death in more than 30 countries. Amnesty has continued to document people executed for drug-related charges in a handful of countries, namely China, Iran, Saudi Arabia and Singapore. Vietnam was likely to have carried out such executions as well, although it is difficult to say for sure. Sexual violence used as a form of torture has become a regular part of interrogations, particularly in the context of drug-related operations. Some countries also have in place punishments for drug-related offences that amount to torture and other ill-treatment. In Singapore , for example, drug laws allow for the penalty of life imprisonment and 15 strokes of the cane as the only alternative punishment to a death sentence for people convicted of drug trafficking. In Mexico, drug cartels often recruit women and girls from marginalized backgrounds to carry out dangerous tasks as they are considered expendable if arrested. As a result, young, poorly educated and low-paid women and girls are at particular risk of suffering abuses at the hands of criminal groups. Women are also at risk of being picked up by the police or the military since they are often seen as the weakest link in the trafficking chain and an easy target for arrest. Authorities often attempt to boost figures to show they are tackling organized crime, which leads to group arrests and accusations without evidence. This specifically affects women, who are often unfoundedly accused of being girlfriends, and thus accomplices of people involved in organized crime. This allows them to boost figures in an attempt to show they are tackling organized crime, without targeting those at the top of the drug chain. States have a particular obligation to protect children and adolescents from the risks and harms of drugs, including those stemming from the use of drugs by children or their parents as well as from policing and other law enforcement efforts. While data relating to the use of drugs by children and young people is poor in many countries, evidence suggests that punitive responses to drugs do not deter children from using drugs nor significantly restrict their access to them. Instead, punitive drug policies have produced additional and particular harms to children, including physical and mental health consequences. The UN Special Rapporteur on Belarus estimates that hundreds of children and young people in Belarus are serving lengthy sentences for minor, non-violent drug-related offences. All too often, children and young people in Belarus fall victim to deceptive practices by anonymous individuals who sell drugs online via couriers. Children that are caught by the police have reported being coerced into admitting their guilt and often face multiple human rights violations while in detention. Drug laws are often enforced in a discriminatory way against marginalized groups , including racial and ethnic minorities and the poorest sectors of society. The ACLU found in that Black people across the US are over three times more likely to be arrested for cannabis possession than white people, despite roughly equal rates of use. In the UK, Black people are stopped and searched for drugs at almost nine times the rate of white people. Indigenous young people in Australia were 26 times more likely to be in detention than non-indigenous young people, and Aboriginal and Torres Strait Islander women are more likely to be convicted of a drug-related offence. In Bangladesh, police drug raids which often lead to extrajudicial executions frequently target low-income neighbourhoods. Women have also been disproportionately affected by drug laws , facing increased risks as their participation in the drug trade is on the rise worldwide — especially among women who lack education and economic opportunities. Women who use drugs are also at particular risk of criminalization, especially if they become pregnant. Some US states have laws that are used to arrest and prosecute pregnant women who use drugs based on a belief that they are harming their foetus. Fear of these laws deters pregnant people from accessing healthcare and drug treatment. Governments and civil society organizations are designing new models for regulating and decriminalizing drugs in many places around the world. While some alternatives to current prohibitionist policies have yet to be tested, the evidence available so far shows that decriminalizing the use, possession and cultivation of drugs for personal use, if combined with an expansion of health and social services, does not lead to higher rates of use. Instead, countries where drugs have been decriminalized have seen a beneficial impact on public health, public security and human rights. A few other places are moving away from prohibition and towards better regulation of drugs within legal markets, based on the premise that bringing illicit markets under the control of the government can better protect public health and human rights. Decriminalisation means removing laws that make it a criminal offence, for example around the use or possession of drugs. Decriminalization does not mean that drugs are legal; rather, it means that people who are caught with them will not get a criminal record or face jail time. On the other hand, regulation means adopting a range of legislative and regulatory frameworks to allow drugs to be legally available, but with a level of state control that differs according to the health risks of each substance. Regulation does not mean to allow for the unrestricted access for all people to all drugs. Instead, it sets out rules to allow for the adequate control of specific substances and provide the legal channels for those permitted to access them. This is similar to the way governments regulate alcohol and tobacco. In Portugal, the use and possession of all drugs has been decriminalized since Drugs are still not legally available, but the national strategy focuses on increasing access to drug treatment rather than criminalizing drugs. Instead, people might be sent to a committee made up of legal, health and social work professionals tasked with determining whether there is a problematic use of drugs or if some underlying social or health problem needs to be addressed. They offer services to those in need instead of throwing them in jail. Levels of drug have decreased since , especially for heroin-use. And even with new synthetic drugs and consumption habits growing, they remain below the European average. There has also been a dramatic decrease in new HIV diagnoses among people who inject drugs. Amnesty International is calling for states to shift away from policies based on prohibition and criminalization, in favour of evidence-based alternatives that protect public health and the human rights of people who use drugs and other affected communities. This should include decriminalizing the use, possession, cultivation and purchase of all drugs for personal use , and the effective regulation of drugs to provide legal and safe channels for those permitted to access them. Such policies must be accompanied by an expansion of health and other social services to address drug-related problems as well as other measures to address the underlying socio-economic causes that increase the risks of using drugs and that lead people to engage in the illicit drug trade. Drugs can certainly pose some risks to individuals and societies, and therefore states have an obligation to adopt adequate measures to protect people from the harmful effects of drugs. But it is precisely because of these risks that governments need to take control and regulate how these substances are produced, sold and used. Back to What We Do. Overview Drug control policies are failing. Read our Drug Reform Policy. The use of the death penalty for drug-related offences The use of the death penalty for drug-related offences is perhaps the most extreme manifestation of the punitive approach favoured by many countries. Case Study: Women in Mexico In Mexico, drug cartels often recruit women and girls from marginalized backgrounds to carry out dangerous tasks as they are considered expendable if arrested. The harm of punitive drug policies on young people States have a particular obligation to protect children and adolescents from the risks and harms of drugs, including those stemming from the use of drugs by children or their parents as well as from policing and other law enforcement efforts. Case Study: Children and young people lured to distribute drugs in Belarus The UN Special Rapporteur on Belarus estimates that hundreds of children and young people in Belarus are serving lengthy sentences for minor, non-violent drug-related offences. Drug laws and discrimination Drug laws are often enforced in a discriminatory way against marginalized groups , including racial and ethnic minorities and the poorest sectors of society. Racism is deeply embedded in drug policies in many countries. Alternatives to the prohibition and criminalization of drugs Governments and civil society organizations are designing new models for regulating and decriminalizing drugs in many places around the world. Case Study: Decriminalization of drugs in Portugal In Portugal, the use and possession of all drugs has been decriminalized since What is Amnesty doing to address drug policy reform? Among other things, Amnesty is calling for governments to: Move away from punishing and stigmatizing people who use drugs and instead adopt laws and policies focused on protecting health and human rights to minimize risks and stop the violence associated with illicit markets. Decriminalize the use, possession cultivation, and purchase of all drugs for personal use. Decriminalization policies must be accompanied by an expansion of health and other social services to address the risks related to drug use. Expand evidence-based prevention, harm reduction and treatment programmes and address the root causes that may increase the risks of using drugs or that lead people to become involved in the drug trade, including ill-health, denial of education, unemployment, lack of housing, poverty and discrimination. Regain control and reduce violence by moving towards the effective regulation of drugs , based on a scientific and evidence-based assessment of the risks and harms of each drug, to effectively control substances and provide legal channels for those permitted to access them. Put in place measures that tackle social inequalities and promote social justice , including a wide set of gender-sensitive and holistic socio-economic protection measures tackling the different stages of the drug trade, from cultivation and production to distribution and use.
Buying Heroin Kuala Lumpur
Risk and protective factors of drug abuse among adolescents: a systematic review
Buying Heroin Kuala Lumpur
Buying Heroin Kuala Lumpur
Risk and protective factors of drug abuse among adolescents: a systematic review
Buying Heroin Kuala Lumpur
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Buying Heroin Kuala Lumpur