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At the nondescript entrance of Poliklinik Khafidz, the clinic to treat addiction in Kajang that has been around since , there are two arrows drawn with tape on the tiled floor. The one on the right points inwards to a patterned wooden door, while the other arrow points outwards from a plain door. Through here is salvation, the arrow on the right seems to say. For Muhammad, 31, it certainly does. He and hundreds of patients go through that door daily for their methadone, an opioid used to help heroin addicts manage their addiction and hopefully, help them stop using altogether. Muhammad told Bernama that he has been taking heroin since he was 15, perhaps unsurprisingly as his parents were also drug addicts. He had tried quitting heroin and meth numerous times, to no avail. Finally, he sought treatment at the clinic after his friend, a former addict who worked as an addiction outreach official for a non-governmental organisation NGO , referred him. Muhammad is a success story in more than one way. Despite being an intravenous IV drug-user for more than a decade, he has never tested positive for human immunodeficiency virus HIV even as about 30 per cent of needle-users in tested positive, according to data from the Ministry of Health. The first pebbles off the mountain have been cast with the abolishment of mandatory death penalty for drug cases last year. Members of the Task Force for Drug Decriminalisation under the auspices of the Ministry of Health hailed the move towards drug decriminalisation, but added there were several issues the government must address to ensure successful implementation. Malaysia made a commitment to decriminalise drugs last year, acknowledging that the war on drugs with its zero tolerance approach has failed as the number of drug arrests remain high with no visible dent in drug trafficking. For example, your child wants ice cream. He wants it five times a day. But you cannot stop him taking the ice cream completely. Five times is not good for his health. Proponents argue that decriminalising drugs will reduce prison overcrowding, reduce overdose deaths, reduce healthcare costs and crime, and help addicts and users become contributing members of society, among others. They were quick to stress that drug decriminalisation does not mean legalisation of all drugs. Rather, sale and distribution of narcotics will still be illegal with drug decriminalisation. However, people will not be arrested for possessing small amounts of drugs that are for personal use. This means addicts will be able to carry enough drugs to satisfy their craving and help them function. Individuals who experiment with drugs or use drugs recreationally will not be caught in a criminal trap either. A harm reduction approach also means changing the approach in dealing with users and addicts. The government is expected to table the amendments before the end of the current parliamentary session. Addiction experts told Bernama that focusing on harm reduction and decriminalising drugs will encourage more people to come forward and seek help, as they are less likely to be arrested. Another point the experts made was that drug addiction was a complicated issue, and policies decriminalising drugs should reflect that. All agreed treating addicts as patients instead of criminals was a move in the right direction. Dr Khafidz, who is also the chief executive officer of Universiti Malaya Centre for Addiction Science Studies UMCAS , said decriminalisation should require police officers to refer addicts to doctors and treatment centres, rather than sending them to prison. If law enforcement officers stop people from getting their treatment, how can the doctor do their job? He wondered how the amendments would classify drug-users and the various degrees of drug use, saying not all users were addicts who needed treatment. They may need counselling, they may need guidance. He added that the public needs to know where to get help, be it at the hospital, private clinics or NGOs. The golden standard for harm reduction is Portugal, which decriminalised drugs in The tiny European nation replaced punishment-focused policies with policies that allow people to possess drugs including heroin, cocaine and marijuana in amounts just enough for 10 days of use. Although consumption of the drugs is still illegal, people who misuse them get a citation and referral to treatment centres. Attendance is voluntary, however. Until recently, the numbers were encouraging. Prison population went down, so did overdoses and, like Malaysia, the number of HIV cases among syringe drug-users has also seen a decline. Drug use remained at about the same levels. But the gold seems to be flaking off. Some policymakers in Portugal are questioning whether they should continue with these policies as overdose rates have increased from a decade ago, as well as property crime blamed on drug addicts. Other than funding, experts said good data was crucial. Currently, Malaysia only has data of people who have been arrested on drug-related charges and those sent for rehabilitation. There is no data on the number of drug-users or the scope of drug usage in Malaysia. Dr Khafidz said the number of drug users in Malaysia is likely severely undercounted, adding that the actual number may be in the millions. Palani, who is also a member of the Task Force, pointed to Thailand, saying Malaysia should learn from its failure to manage the legalisation of recreational marijuana properly. When they legalised recreational marijuana, as well as the sale, distribution and cultivation of cannabis, two years ago, they did it without the necessary data. There were no pilot sites, not a great monitoring and evaluation system to catch the challenges and the problems. The country is back to prohibiting recreational marijuana again, which will take effect at the end of the year. Medical cannabis - which is primarily hemp and not psychoactive - remains legal. Dr Fadzli, who is also the head of the Psychiatry Addiction Unit at HKL, urged the government to engage stakeholders in the treatment and rehabilitation sector, especially community-based organisations and former drug users, before tabling the amendments. Follow us on social media : Facebook : bernamaofficial , bernamatv , bernamaradio Twitter : bernama. From Nina Muslim.
Availability and Utilization of Opioids for Pain Management: Global Issues
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Official websites use. Share sensitive information only on official, secure websites. Reviewed by: Giovanni Martinotti, University G. Specialty section: This article was submitted to Addictive Disorders and Behavioral Dyscontrol, a section of the journal Frontiers in Psychiatry. The use, distribution or reproduction in other forums is permitted, provided the original author s or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. In recent years, there have been increasing accounts of illegal substance abuse among university students and professional groups in Malaysia. Students from Malaysian universities were asked for their impressions about drug availability and abuse, as well as factors contributing to drug abuse and relapse. The questionnaire also inquired into their knowledge and views regarding government versus private rehabilitation centers, as well as their exposure to, and views about, school-based drug-prevention education. Results showed gender differences in perceptions of relapse prevention strategies, as well as factors leading to drug abuse and relapse. Implications of student perceptions for the improvement of current interventions and educational programs are discussed. Keywords: drug abuse, contributory factors, drug knowledge, prevention education, higher education. Drug abuse continues to be a major problem in Malaysia 1 , with almost half of the Malaysian prison population of 30, having been indicted for various drug-related offenses 2. Acknowledging the importance of drug abuse and relapse as a public health issue, the Malaysian government has implemented a number of programs aimed at curtailing drug distribution as well as improving drug-treatment programs. Starting from , the National Anti-Drug Agency NADA undertook efforts to transform their existing rehabilitation programs to a so-called open-concept approach. Rather than focusing solely on compulsory rehabilitative treatment for convicted drug offenders 3 , the open-concept approach provides drug users with the opportunity to receive treatment voluntarily at local community service centers without facing legal judgment or prosecution 4. This new approach was aimed at allowing relapsed users to seek treatment while continuing with their life and career 5 , while also encouraging drug users with the motivation to change, to seek treatment voluntarily with no legal consequences. Moving forward, to effectively deal with drug abuse, it will be important to get a clearer picture of the problem as it stands in the current social context. The transformation of Malaysian society to a more modern and globalized culture has caused much of the existing research on drug abuse to become out-dated. Past research studies and national statistics showed the highest proportion of drug users among general laborers, followed by workers from service industries, agriculture, fisheries, and sales. The unemployed came in fifth place, in terms of occupational hierarchy among drug users 6 — 9. Drug users, in other words, were portrayed as from lower socioeconomic strata, often resorting to crime to fund their habit. Recent reports, however, suggest that drug users come from many different backgrounds, with white collar workers, civil servants, college students, and adolescents all represented in significant numbers Findings from the longitudinal College Life Study CLS conducted in the University of Maryland found that there was widespread use of illegal substance with Working professionals with high-stress jobs and burnout such as social workers, doctors, and nurses are at equally, if not greater risk of engaging in drug use to relax or maintain punishing work schedules Such trends among Malaysian drug users warrant investigation. Global analytical reports from the years to suggest drug use starting at younger ages pre-teens in countries such as the United States, New Zealand, and Australia While statistics on drug use among Australians has consistently pointed to ages 18—24 as the years of most widespread use 14 , similar statistics for Malaysia have fluctuated since 6. It is not clear what the root of these changes is, but it does appear either that the pattern of drug use in Malaysia are shifting or that, since the legal changes in rehab availability, many users from different walks of life are seeking help who might not have done so in the past. The latest available statistics on drug types, which were commonly misused by Malaysian drug users in , cited opiates The possibility that people from many different, non-criminal backgrounds are engaging in drug use is also illustrated by recent research showing individual differences in the ability to use drugs without developing dependence Ersche et al. Non-dependent, recreational users were able to engage in drug use in social situations without affecting their daily functioning i. Understanding drug use and abuse, thus, is probably more complicated than previous Malaysian statistics suggested, with a much greater number of casual or recreational users among the educated and higher social strata than was previously assumed. This study thus aimed to broaden our understanding of the issues by taking a different approach. Rather than just looking at users or those who have been admitted to drug treatment programs, we chose to look at the views and opinions of the general public and non-users about the availability and use of illicit substances in Malaysia. Although previous research involving non-user populations has looked at reasons for non-use of illicit drugs 17 as well as perceptions of risk in Latin American countries 18 , this kind of research has not been conducted in Malaysia. Understanding the mind-set of the non-user population, their conceptions and misconceptions about drug use, as well as related attitudes is, we feel, important for evaluating the effectiveness of existing drug education programs as well as for designing government health programs A second goal of this study was to understand the impression among university students, who are generally understood to be at high risk for drug use 20 , of existing educational programs. However, there is little information available on the effectiveness of these and other programs conducted at various universities. Thus, this study also obtained qualitative feedback from students on their past experiences with drug education and prevention programs. Are there gender differences in this perception? Do gender differences exist in this perception? What are the preferred media for sharing information and learning about drug abuse issues? How much awareness do students have about drug rehabilitation programs and what is their perception of the relative effectiveness of government and private rehab centers? Do the students have past exposure to school-based prevention education? What is their perception of the appropriate timing for prevention education? Purposive sampling was used to recruit participants for this study. An online advertisement to recruit participants was posted on university websites and social networking sites. The advertisement contained a brief summary of the research and the web link for the questionnaire. A wider age criterion was set to obtain participants within the at-risk age group but not excluding mature students. Mature students in this sample consist of individuals who were studying while juggling professional careers. The online-administered Student Perception Questionnaire SPQ consisted of 26 items and was designed with a mixture of close-ended and open-ended questions. The questionnaire begins with basic demographic items to obtain basic background information such as gender, age, ethnicity, religion, and educational status. Items in the SPQ cover seven research scopes: a the types of drugs commonly abused and easily available, b reasons for drug abuse and relapse, c strategies to overcome drug addiction and relapse, d prior knowledge about drug rehabilitation programs and treatment effectiveness, e information resource on drug abuse, f age appropriate for drug-prevention education, and g suggestions for improving drug education. Students who were interested in participating clicked on the web link provided. Subsequently, an in-depth explanatory statement detailing the purpose, procedure, risks, benefits, and contact details of the researcher was provided. Information on professional help services was also included for students who experienced any form of discomfort or required assistance. After students indicated their consent to participate, the questionnaire items appeared in their browser window. Participation was voluntary and anonymous. Students who wished to withdraw from the study could do so without consequences by simply closing their web browser. A pilot study involving 50 students from Monash University Malaysia was conducted to test the reliability of the five constructs developed. Four out of five constructs were within acceptable to good reliability range 0. Further examination of this construct brought to the conclusion that these items could not be removed, as most questions were contingency response items. In addition, the content validity of the questionnaire was performed by a panel of two experts who have done extensive work using the qualitative or mixed methods research approach and were previously engaged in research projects related to drug misuse and relapse. Both experts evaluated the clarity and representativeness of the questions. Several items on drug rehab programs were rephrased and open-ended questions about the appropriate medium for sharing information on drug misuse and prevention education were extended. Of the respondents, 40 were excluded because they did not completely fill out the questionnaire. Thus, data from students were included in the analysis. There were more female participants There were Malaysians Most of the participants were from undergraduate Bachelor degree programs Students were asked which drugs were most frequently or commonly used as well as which were most accessible or available. To determine the highest proportion of rankings for each drug type, mode values were obtained as shown in Table 1. Ecstasy and cannabis were most often rated as 1, indicating that they were perceived as the two substances, which were most commonly used and easily available. Heroin was also ranked as most commonly used and second most easily available substance. Ketum leaves, a type of herbal drug that is more customary in Southeast Asian countries, was also ranked as most easily available but least commonly used. Methamphetamines were ranked third in terms of commonality but only obtained a rank of 6 in availability. Morphine was mid-rank in both commonality and availability, with a score of 5. Opiates received a rank of 7 in commonality and availability, while psychoactive pills and ketamine were perceived as the most difficult substances to obtain with a ranking of Ketamine was also ranked as the least commonly used substance, together with ketum leaves. The students rated the extent to which they agree or disagree with the given statements on reasons for drugs abuse, on a 5-point Likertscale. The Mann—Whitney examines the differences in ranked positions and scores are ranked from the lowest to the highest. The highest mean rank indicates that there are a greater number of high scores within it and vice versa. Based on mean rankings, more female students rated significantly higher scores for unemployment as a reason for drug use in comparison to male students. Students were given the option to select as many reasons as they felt applicable. A chi-square test was also run to determine gender differences in ratings of relapse factors. The results demonstrate that there were no significant gender differences in ratings of relapse factors. Students were required to rate the extent in which they agree or disagree with statements on strategies in overcoming drug relapse according to a 5-point Likert scale. Analysis from the Mann—Whitney U test shows gender differences for four strategies see Table 4. Mode values were obtained to determine the highest proportion of rankings for each resource see Table 5. Internet websites and blogs were ranked in first place by This was followed by newspaper and magazine articles Both social sites The students were encouraged to provide opinions on what would be the best medium to share information. A tier system to rank the medium was developed based on range of citations by students. The classification of the tier system are as follows: a Tier 1: medium, which received the highest range of references i. As shown in Figure 1 , social media and internet websites were the most highly cited resource for sharing information Tier 1. The ease of sharing information to a wider audience and the wide accessibility of social network accounts were among the reasons cited by students for using social media. Many students reported that their knowledge had been greatly improved with social media sites. Informational websites and group forums were also popular among students who cited the ease of searching for information and perceived anonymity as reasons for using these resources. People tend to share information around and this would be a great time for them to share out information about drug abuse. This is because nowadays people used to make a research by doing online and the internet is the easiest way to access the drug matters. Make it serious but in a comedic way because it might make people remember the info better. Prevention education was the third most commonly cited source of information. The students acknowledged that prevention programs are important for providing early awareness of and exposure to the dangers of drug abuse. According to some students, many do not have the desire to read, learn, or investigate on their own. Thus, they felt that conducting compulsory programs would be beneficial. It is rather unlikely that a heavy drug abuser would take the initiative to search for drug related abuse information on the internet. Plus a person involved in such activities would be more likely than others to have friends that also abuse drugs. The fourth most commonly cited source of information Tier 4 consisted of printed materials such as brochures, pamphlets, and posters, as well as newspaper, books, and magazines. Brochures, pamphlets, and posters were cited as easy to read, with important facts briefly summarized and information presented creatively. Students suggested that brochures, pamphlets, and posters be given out in conjunction with drug-prevention seminars, to reinforce the knowledge gained. Some also suggested having committed columns in popular newspapers and magazines dedicated to substance abuse and other related mental health topics as a way of increasing awareness among the public. Newspaper and magazine articles by field experts and established columnists were seen as more influential and their messages easily acceptable to the public. However, the students highlighted a need for more books on psychiatry and substance abuse in bookstores and local libraries. A slightly higher proportion of students Fifty-six students Findings on the effectiveness of rehabilitation centers demonstrated that a higher proportion of students One respondent 0. Some respondents As demonstrated in Table 6 , the mean age in which students received prevention education was Descriptive statistics and paired-sample t -test comparing differences between age of exposure and perceived age of initiation. Most responses indicated that in-depth knowledge based on drug abuse causes, consequences, and its effects are required. The students were of the opinion that educating students through subjects such as chemistry, biology, and science would provide them with more exposure toward drug knowledge, how it is produced, and its effect on the body system. This would lead to a deep awareness of the consequences of drug use. Moreover, they were interested in having more knowledge about health conditions associated with drug abuse such as AIDS and psychological conditions like bipolar disorders, eating disorders, schizophrenia, and anxiety disorders. The students felt that by truly comprehending the effects of drug use on their health, lifestyle, family, friends, as well as the legal consequences, this would help school children and youths make rational decisions regarding drug use. In-depth information on prevention strategies was also suggested as it could help students be more aware of the various situations in which accidental drug use could occur, help identify the symptoms of addiction, the resources to help friends and family members who are abusing drugs and positive attitudes that should be applied when dealing with drug users. Field visits and phenomenological experience were also mentioned as important for drug prevention. They would be motivated to avoid similar experiences for themselves. No amount of motivational speeches tailored for students would dent the problem except real life first-hand experience. Students also suggested learning through research. Some suggested class assignments, which would help increase their awareness and understanding of the effect of drugs on their body. Using interactive learning styles incorporating experiments related to the chemical behavior of various drugs in the body was suggested as a way to increase interest and awareness among students. Messages on drug abuse prevention, it was suggested, could also be presented to students in a creative manner using theater, music performances, and game applications. Opportunities for mentorship with health professionals involved in rehabilitating drug abuse patients as well as speaking to former drug users to obtain guidance on how to avoid getting involved in drugs was also suggested. This concept could be incorporated through a short-term social work experience during the weekends or school holidays. By helping out at the rehab centers or volunteer in community activities conducted in conjunction with the rehab patients, it was suggested that students would be able to see for themselves how treatment is conducted, the issues faced and what facilities and services are available. For example, hands-on workshops for example, analysing how drugs affect our brain in the lab or something like that. Students made multiple suggestions for coping skills training as well. Teaching stress management using healthy methods such as exercise, meditation, breathing techniques, having a balanced diet, and proper time management was suggested as well as exposure to alternative methods to deal with life stresses, academic pressure, and peer pressure would help them cope more effectively without the need for using performance-enhancing drugs. Students also suggested encouraging healthy lifestyles by introducing a myriad of healthy activities. Simple exercise routines, extra-curricular activities, as well green events could play a part in getting students to incorporate more outdoor activities, learn about indoor games, and activities that would encourage positive socialization as well as how to live healthily without drugs. It was suggested that introducing students to healthy activities and adaptive skills would also lead to positive socialization as being with a group of like-minded peers will encourage them to stay away from negative influences and make better decisions in choosing the right crowd of friends. At the same time, the students felt that teaching assertiveness skills would encourage them to think independently and logically in resolving their problems rather than being easily influenced by their peers. Assertiveness should go hand-in-hand with instilling self-confidence. Learning to build self-confidence and the belief that the decision they made is the right one after careful deliberation was equally important to the students. Lacking self-confidence will push them into taking the lead from others and result in undesirable actions. Regardless of the consequences of their life decisions, the students felt that early intervention on responsibility toward their own actions would be greatly beneficial to school children and college students. The students felt that the scope on rehabilitative treatment information could be widened. Information on available treatment services, treatment approaches, and how to seek help should be publicized so that family members and friends of drug users could provide help where needed. In addition, the students viewed a strong support network with non-judgmental support and advice from health professionals to be important in encouraging young drug users to seek help. The role of family support during and after drug rehab treatment also requires greater emphasis. It was suggested that confidential one-to-one counseling sessions should be made easily available to students so that root problems to stress issues can be resolved. As drugs provide only a temporary escape, facing the issue directly and working it out with a counselor could help find an alternative solution with longer-lasting effects. Get to know the root of their problems and make them understand why drugs is bad for them. Teachers have an important role in prevention efforts. As the students perceive teachers as role models that primary school children look up to, teachers can educate them about how to solve problems, choosing the right friends, identifying the different types of drugs, and the danger of using drugs. Based on their past experience, the students were aware that some secondary school students tend to assume that they know it all about drugs and may not give their full focus toward health programs conducted by external facilitators. Thus, it was suggested that teachers who have a good rapport with students work closely with this group of students to provide a greater impact. In addition, the organization of open forums and debates on how to prevent drug use and what schools can do to promote drug-free lifestyles, was proposed with the cooperation of parents, teachers, and students. Besides teachers, parents play a pivotal role in educating their children about drugs. The students generally felt that it would be beneficial to have parental input on how drug abuse cases i. In addition, clearer guidelines on how parents should explain about drugs were needed as most parents may not be as well-versed on this issue too. Similarly, the students felt that the society should have a greater role in drug prevention by ensuring that information on prevention strategies is spread throughout their respective communities. Community and youth leaders should also be well-educated on the topic of drug abuse and be available as a source of advice for troubled members within their community. While external regulators may conduct the programs in school, not many students actually absorb the information. Most secondary school students think they already know enough about drug abuse and prevention, and do not have the heart to focus for sessions of speeches given by facilitators they do not know. Thus, teachers whom students look up to would make the most impact. A change in the program focus was also proposed. Moreover, prevention activities should be conducted periodically using different approaches to reinforce their knowledge. An area that was often cited for improvement was the public health programs. In particular, it was suggested that programs widen the education scope to include other health and social issues that correlate with drug abuse such as domestic violence and sex education. In addition, the programs should be tailored to address drug use trends such as how to avoid being duped into using drugs unknowingly. Public health activities should also progress with technology and be made available to the public through social media besides the conventional display exhibitions and talks. Reports and articles about drug abuse should be widely published to increase awareness on this topic. Additionally, the students felt that public health programs should be made as part of the early intervention practice. As prevention is often touted as better than cure, students should be educated on drug abuse and situations that they should avoid from an early age, such as not taking food or candy from an unknown individual. Children need to understand the dangers of drugs to the self and how it will worry their parents if they get involved in drug use. The overall objective of this study was to investigate the perceptions of university students related to drug use and availability as well as drug abuse and treatment services. In particular, this study was interested in getting non-user opinions on drug abuse to determine what areas might require more attention when implementing drug education and prevention programs. Although heroin was also ranked by students as most commonly used and in the second tier of easily available substances, morphine was mid-rank in both commonality and availability and opium received a rank of 7 in commonality and availability. This was similar to the current finding, in which methamphetamines were ranked third in terms of commonality but obtained a rank of 6 in availability. While ketamine has been popular in party circles since the s, nimetazepam is another designer substance that has been increasingly popular since entering the market in Nimetazepam is also known as Erimin, and is a benzodiazepine derivative, which possesses sedative, hypnotic, and anxiolytic properties. Originally, it was prescribed to patients suffering from severe insomnia but is commonly misused by Malaysian drug users as an alternative to opiates and amphetamines Psychoactive pills and ketamine were perceived as the most difficult substances to obtain, with a ranking of In addition, ketamine was also ranked as the least commonly used substance, together with ketum leaves. Although there were differences in perception, this does not reflect that students have inaccurate perceptions in any way. Instead, their perceptions could reflect the actual situation within their surroundings i. As the statistics by NADA were based on substance use profiles obtained from drug users who were admitted for rehabilitative treatment, there should be caution in using this data for interpreting the actual availability and commonality of substances. This research has subsequently highlighted another limitation to previous research, which is a lack of information about the availability and commonality of substances within the community. While findings from past research on drug user populations such as Vento et al. Additional qualitative feedback from the pilot study indicated that the students viewed these substances differently in its context of use. The students perceived ecstasy or MDMA as a recreational drug because it was more often associated with its role as party drugs, while psychoactive pills were viewed as substances that were used to treat psychological disorders. Findings on factors contributing to drug abuse demonstrated that female students generally rated personal sufferings, problems with family, coping with life, curiosity, associations with drug-dependent peers, and influence of media portrayals as important reasons for drug use. However, only unemployment was rated significantly higher by female students in comparison to male students. The view of unemployment as a cause of substance abuse is supported by Henkel 25 , whose comprehensive review concluded that unemployment plays a dual role as a significant risk factor and an outcome of drug use. The perceptions of our Malaysian sample partially coincided with those reported by Cirakoglu and Isin 21 , who found in a Turkish sample that females tend to attribute drug use to problem coping. However, in their study, males tended to attribute drug use to sensation seeking i. Responses on relapse factors showed that students perceived lack of family support as a major reason for relapse, followed by lack of self-efficacy and peer influence in importance. Research from the United States generally concurs with these perceptions, providing evidence that loss of support from family as well as encountering peers still involved in drugs are significant risk factors for relapse Ibrahim et al. Patients who are released from treatment with inadequate preparation for re-integrating into society, such as lacking the necessary job and self-sufficiency skills, are more likely to experience low self-efficacy and a resultant higher risk of falling back into substance abuse. Cirakoglu and Isin 21 , by contrast, found that males were more likely to view avoidance as instrumental in preventing relapse. The students in this sample preferred using internet websites and blogs as their primary resource to search for information, followed by newspaper and magazine articles, as well as brochures, pamphlets, or posters. This finding was similar to a study by Stetina et al. It was interesting to note that social sites and books were the least preferred resource for university students. This can be attributed to the reason that it is difficult to identify the reliability and credibility of information in social media, since rumors and misinformation can be spread quickly. The need for quick information at their fingertips, however, is making books less popular. Moreover, books on substance abuse are often scarce in libraries and are costly to buy. Findings such as these further emphasize the important role of the Internet as a resource for information on substance types and drug abuse patterns. With this in mind, Schifano and colleagues 29 created a web tool called the Psychonaut Project. The objective of this project was to provide professionals from the field of substance abuse with updated and reliable information on drug scenarios within European countries. Nevertheless, it is equally important that this information be disseminated to the public, as they are the target population who requires awareness about new designer substances and the danger of illicit substances being sold on the net as herbal supplements, such as marijuana and ecstasy Interestingly, social media and internet websites were preferred methods for sharing information, as they are able to reach out to selected or wide circles of audience with a simple click of the mouse. Radio and television were also perceived as good educational resources due to their wide use and availability. However, our findings indicated that a large number of individuals did not seek out information on their own, so the role of prevention education should not be overlooked as a way of reaching students and young adults who do not actively search for and exchange such information. The analysis on knowledge about rehabilitative services and the differences in treatment effectiveness demonstrated that a major proportion of students perceived that they have knowledge about the drug rehab programs that are available in Malaysia. A slightly higher proportion of students also believed that there is a difference in treatment effectiveness between government and private rehab centers with As private rehab and healthcare are often associated with large funds to provide advanced treatment, engage experts and provide ample space within treatment facilities without a long wait list 32 , this has further fueled their beliefs despite high treatment costs Precisely, Although efforts were made by NADA to introduce drug education early since pre-school through the TUNAS program 4 , the views of students on when it should be initiated should also be taken in full consideration. It is around this age that children begin to show great increases in their ability to think abstractly, to plan logically, and to understand the long-term consequences of their actions It is also a time when children begin seriously considering their identity and how they would like to fit into society as a whole. Qualitative feedback from students about drug education and prevention programs revealed that there is much improvement needed in the existing programs. Besides increasing the depth and scope of drug information, the students preferred the use of interactive teaching and learning methods rather than talks and exhibitions, which have the tendency to be rather dry. In addition, the students were also interested in having realistic examples through experience-sharing or an opportunity to do volunteer work at rehab centers. Besides drug prevention, drug education should be tailored to address medical conditions and social issues that are related to drug abuse. Drug prevention would be more effective with access to help resources such as help lines, the contacts of health professionals and the dissemination of coping skills. Parents, teachers, and society need to play a more active role in drug prevention and develop prompt procedures to detect, identify, and seek treatment for underage children and youths who abuse drugs. There are several points within this study that requires further discussion. This study utilized purposive sampling to recruit participants although this sampling method is synonymously associated with qualitative research. Purposive sampling is a non-probability method, which views sampling as a strategic series of choice about whom, where, and how the study is done Decisions were made by the researchers in regards to the participants, which are to be included in the sample based on a variety of research criteria such as specialist knowledge or unique perspective of the research issue or the capacity and willingness to participate Thus, the method of sampling needs to be tied to the research objective and the working context of the research. Purposive sampling was chosen because this study had specific objectives in examining the perceptions of drug abuse issues among university students who have not engaged in drug use. Thus, participants who fulfilled the recruitment criteria were sought, as they would be able to contribute appropriate data, both in terms of relevance and depth. Although the data from this study, coming from five different states in both Peninsular and East Malaysia, comprise a wide geographical representation of Malaysia, the study has several limitations. First, as with all self-report-based research is the possibility of response bias. The SPQ is a self-report measure, thus there is a probability that some students may have responded in a way that would reflect well on them, despite the fact that the SPQ is administered anonymously. Second, students may be providing their opinions on drug types without a good deal of knowledge, as this was not a test of knowledge, per se , but essentially an opinion survey. There was a possibility that some students lacked familiarity with the legal names of substances, and studies such as Corazza et al. Nevertheless, the drug types were listed according to their legal names in the SPQ due to the reason that a majority of students in Malaysia do have awareness about the legal names of illicit substances, as they have been exposed to this knowledge through drug-prevention programs in school. In addition, the numerous commercial or street names for each substance, which consequently varies based on location and country, could equally posed an issue in which students may have been exposed to different street or brand names, depending on the media, which they were frequently exposed to i. Third, the students were mostly sampled from higher education institutions in urban areas. There could be slight differences in relation to drug types that are commonly used and easily accessible in rural areas. Future research could further expand on this area by including students and working professionals from both rural and urban areas to gain a more comprehensive understanding of non-user perceptions across the population of Malaysia. Furthermore, this study has a higher proportion of responses from female students as compared to males. It could be argued that males may have greater awareness about drug abuse issues since a higher proportion of drug users are males and were more likely to have experimented with new psychoactive substances and used recreational drugs, as compared to female drug users However, this does highlight the question of whether females really lack awareness about new psychoactive substance. There is a possibility that females may choose not to use particular substances despite their awareness about it, as they are motivated by different reasons for drug use. Several studies have demonstrated that males were more likely to use substances for experimentation as compared to females 38 , whose drug use was more highly associated with mood and anxiety disorders 39 , eating disorders 40 , as well as severe premenstrual syndrome or premenstrual dysphoric disorder Although the findings related to gender differences may not be representative of the academic population, gender differences in perception, related to reasons for drug use and relapse prevention strategies should be taken seriously in developing gender-sensitive drug prevention. Future studies should consider increasing the sample size and width of participant demographics, in addition to examining how diverse beliefs, culture, and prior exposure to drug information in the media could influence perceptions about drug abuse. This research has important implications toward the evaluation of drug education and prevention programs. Understanding the perceptions of non-user populations is essential toward identifying misconceptions and knowledge gaps about illicit drugs, effective prevention strategies, and factors of drug abuse and relapse so that remedial steps can be taken to prevent them from experimenting or misusing drugs. Getting public feedback on drug-prevention programs and including their opinions into future planning is the way forward in efforts to obtain active participation from school children, young adults, parents, teachers, and the community. The qualitative responses on how current drug education and prevention programs could be improved in particular suggest that an active community role is increasingly important toward effective prevention. Prevention activities in school and higher education institutions only are no longer sufficient, and students would like to see greater cooperation and contributions across the community. Media outlets, for example, can ensure that appropriate and accurate educational messages are adequately circulated. Training the community to identify specific drugs and underlying issues that could lead to drug use will encourage greater monitoring of young children and adolescents who at-risk. The community can also play a greater role in drug prevention by providing feedback in assessments to evaluate the effectiveness of prevention programs to weed out ineffective strategies, and focus time and effort on those who do work. It was unsurprising to find that the students in this sample perceived that treatment facilities and services provided by private rehabilitation centers were more effective. These beliefs about public and private rehabilitative services have long existed. Dissemination of help information during drug-prevention activities was an aspect that required more emphasis to students. Responses on contributory factors and relapse prevention strategies do show the influence of gender on the attribution of triggers for drug misuse and drug relapse prevention. However, more research is needed to understand gender roles on drug use perceptions and translating its influence into tailoring effective drug-prevention messages. The overall data collection of student and public perceptions on drug abuse has significant implications toward the creation of learning materials to educate the community as a whole. An example would be the creation of an online educational database to provide the public with updated information about new substance types that they should be wary of, latest research findings, who and where to seek help for drug users, coping skill modules as well as guidelines on how to identify drug use. This blog is currently being conceptualized and developed by the researchers. In the future, it is hoped that such feedback from non-user populations can be factored into drug prevention and other public health programs. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. As a library, NLM provides access to scientific literature. Front Psychiatry. Find articles by Qiu Ting Chie. Find articles by Cai Lian Tam. Find articles by Gregory Bonn. Find articles by Chee Piau Wong. Find articles by Hoang Minh Dang. Find articles by Rozainee Khairuddin. Received Jan 20; Accepted Apr 13; Collection date Commonality and ease of availability of substances according to mode rankings. Open in a new tab. Gender differences in the perception of contributory factors. Gender comparisons of contributory factors of drug relapse. Gender differences in the perception of strategies to overcome drug relapse. 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