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The Narcotics Division ND of the Security Bureau is tasked with coordinating policies and ways to fight drug abuse, money laundering and terrorism financing. The Government adopts a five-pronged approach to fighting drug abuse. The strategy involves legislation and law enforcement, education and publicity, treatment and rehabilitation, research, and international cooperation. It is a non-statutory body composed of professionals in the medical, youth service, educational and anti-drug fields. Headed by a chairman, it has 16 unofficial members and two official members. The officials are the Commissioner for Narcotics and a representative from the Department of Health. Regular reviews are conducted to see whether amendments or revision to the existing ordinances are needed to deal with changes in the illicit drugs world. Hong Kong provides a variety of treatment and rehabilitation services to help drug abusers from different backgrounds kick the habit. The major drug treatment and rehabilitation services include a compulsory drug treatment programme run by the Correctional Services Department, a voluntary methadone out-patient treatment programme provided by the Department of Health, and voluntary residential programmes run by non-governmental organisations NGOs. Medical and psychiatric treatment for psychotropic substance abusers is provided by five substance abuse clinics under the Hospital Authority. In addition, five Counselling Centres for Psychotropic Substance Abusers operated by NGOs are subvented by the Social Welfare Department to provide community-based treatment services to psychotropic substance abusers. Under the Drug Dependent Persons Treatment and Rehabilitation Centres Licensing Ordinance, centres offering in-house voluntary treatment to four or more people need to be licensed by the Social Welfare Department to make sure that the centres meet present-day safety and management requirements. By year-end, 28 Certificates of Exemption were issued to centres that were operating before the ordinance came into effect, and 11 centres that were already operating with a valid licence. The course ran from February to July with 68 participants being given the certificate on completion of the course. A pilot service information system was also launched in July to gather data for drawing up standards for local drug treatment services to follow. This is also part of the recommendations made in the plan. Its key recommendations include promoting reintegration of ex-drug abusers into the community and strengthening cooperation between medical practitioners and NGOs to address the medical needs of drug abusers and to extend the scope for early intervention. In , the ND provided anti-drug talks to 79 students attending Primary 4, 5, and 6 schools, secondary level schools and students at the English Schools Foundation and international schools. This was the first year that anti-drug talks were given to Primary 4 students. Workshops and seminars were also organised for teachers, social workers and parents. In , four workshops were held for teachers and school social workers. Since parents play a vital role in drugs prevention education, the ND, for the first time, organised two seminars for parents in April and September in the Sha Tin Town Hall and Yuen Long Theatre respectively. About parents attended. In collaboration with Hong Kong Commercial Broadcasting Co Ltd, two radio programmes were broadcast during the period between December and March to give parents a better understanding of the drug problem so that they may communicate more effectively with their children. A television docu-drama series entitled Anti-Drug Files jointly produced with RTHK was broadcast in July to increase public awareness of drug issues, including those occurring on the other side of the boundary. During the year, about 28 visitors, comprising 15 students, 3 members of youth groups, community organisations, and rehabilitation centres, principals, teachers and school social workers, 1 group and 7 walk-in visitors, made use of the centre. Two new TV and radio Announcements in the Public Interest APIs were launched during the Christmas and New Year holidays to remind young people of the detrimental effects of abusing ketamine and ecstasy, the two drugs commonly used by young people. Posters were put up in public places and advertisements were carried on buses to drive home the message that ketamine and ecstasy damage the brain. The statistics compiled on drug abuse trends are based on the Central Registry of Drug Abuse. The registry collates information on drug abusers through a wide network of reporting agencies, including law enforcement departments, treatment and welfare agencies, tertiary institutions, hospitals and clinics. In , a total of 13 drug abusers were recorded in the registry. Of these, 26 per cent were new cases, 19 per cent were aged under 21, and 81 per cent were males. Heroin remained the most commonly abused drug in Hong Kong, with 62 per cent of drug abusers in the registry being heroin abusers. The number of psychotropic substance abusers has increased noticeably over the years and reached 56 per cent in About 32 per cent of drug abusers were reported to have abused more than one drug. About 64 cent of young people who abused drugs did it at discos and karaokes. Findings from drug-related research studies provide useful reference material to facilitate the Government's formulation of anti-drug strategies and programmes. Three studies carried forward from previous years — on the harmful effects of cough mixture abuse; the drug abuse situation among ethnic minorities; and developing a supplementary drug abuse monitoring system — were completed during the year. The cough mixture study confirmed that there was a definite association between cough mixture abuse and folate deficiency. Folate deficiency would in turn cause severe damage to one's brain and nervous system and may even lead to severe permanent disabilities. Pregnant mothers who indulged in cough mixture abuse would cause severe brain damage to the foetus. Heroin was the most common drug abused by ethnic minorities, followed by cannabis and cough syrup. The abusers encountered different problems such as difficulty in handling relationship with family members and in job seeking. Language training was the most desired service provided to drug abusers to distract them from their problems, followed by outpatient service, community integration and employment services. The supplementary system drew together drug-related statistics that were compiled currently and kept by different departments and agencies in Hong Kong. With the system, policy-makers could more readily identify problems and formulate corresponding programmes and measures to tackle them. One ongoing study on meta-analysis of acupuncture therapy in treatment of heroin dependence was carried over from the previous year. A study on parents' participation in anti-drug work was launched recently. The Government continued to participate actively in international forums against drug abuse, drug trafficking and money laundering. Apart from fulfilling its obligations under the three major United Nations UN conventions concerning narcotic drugs and psychotropic substances, it also maintains close links with the UN, the World Health Organisation WHO , the International Criminal Police Organisation Interpol , and the World Customs Organisation, to ensure that Hong Kong's anti-drug and anti-money laundering work remains in step with current international standards and requirements. The Government keeps in touch with various jurisdictions to share Hong Kong's experience with them and to foster closer working ties. The Police Force and Customs and Excise Department have also established cooperative arrangements with their Mainland and overseas counterparts on intelligence exchange, joint operations and experience-sharing. To promote better communication and cooperation among Hong Kong, Guangdong and Macao in tackling drug abuse and trafficking, tripartite activities in the form of conference and thematic workshops were organised. In Hong Kong drew up an exchange programme and formed a forum at which the three parties discussed and shared their experiences. Guangdong, Macao and Hong Kong took turns to host a five-day meeting on the exchange programme between December and January Participants met and shared experience with anti-drug workers from government departments and treatment centres, enhancing their understanding of the daily operations and underlying philosophies of the departments and centres concerned. The sharing session-cum-discussion forum was scheduled for the summer of in Hong Kong. These included a programme for teaching parents to get the anti-drug messages across to their children through story-telling. Another project was funded to assist psychotropic substance abusers of South Asian origin to seek treatment. The Anti-drug Volunteer Group comprised members of the public and 91 company representatives in They participated in 20 anti-drug community and publicity activities, including district carnivals, visits to treatment and rehabilitation centres, exhibitions and seminars. During the year, they helped promote the anti-drug message during a jamboree organised by the Boy Scouts Association of Hong Kong. The event was attended by 4 local and overseas scouts. The group also organised a football competition in December to promote healthy living style and the anti-drug message. As an international financial centre, it is important for Hong Kong to maintain an effective anti-money laundering and counter-terrorist financing regime. The Government adopts a five-pronged approach to combating money laundering and terrorist financing. It includes legislation, law enforcement, regulation by the financial regulators, publicity and education, and international cooperation. To fulfil its international obligations under the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, Hong Kong enacted the Drug Trafficking Recovery of Proceeds Ordinance in and the Organised and Serious Crimes Ordinance in which provide for the tracing, freezing, confiscation and recovery of proceeds from drug trafficking and other serious crimes. It provides for, among other things, the power to freeze the non-fund property of terrorists and terrorist organisations. In September, they organised a series of seminars for banks, insurance, securities, trust and company service providers, money lenders, remittance and money changing companies, precious metals and stones dealers, and estate agents. The ND was also preparing an interactive training kit to assist these sectors in identifying suspicious transactions. International cooperation is vital in combating transnational crimes such as money laundering. In addition, various government departments continued to facilitate the granting of legal assistance to other jurisdictions in accordance with bilateral agreements. By year-end, Hong Kong had concluded 21 mutual legal assistance agreements and 16 surrender-of-fugitive-offenders agreements. Narcotics Division. Overall Strategy and Coordination The Government adopts a five-pronged approach to fighting drug abuse. Legislation Regular reviews are conducted to see whether amendments or revision to the existing ordinances are needed to deal with changes in the illicit drugs world. Treatment and Rehabilitation Hong Kong provides a variety of treatment and rehabilitation services to help drug abusers from different backgrounds kick the habit. Preventive Education and Publicity In , the ND provided anti-drug talks to 79 students attending Primary 4, 5, and 6 schools, secondary level schools and students at the English Schools Foundation and international schools. Research Findings from drug-related research studies provide useful reference material to facilitate the Government's formulation of anti-drug strategies and programmes. International Action and Regional Cooperation The Government continued to participate actively in international forums against drug abuse, drug trafficking and money laundering. Volunteer Scheme The Anti-drug Volunteer Group comprised members of the public and 91 company representatives in Action Against Money Laundering and the Financing of Terrorism As an international financial centre, it is important for Hong Kong to maintain an effective anti-money laundering and counter-terrorist financing regime. Commissioner on Interception of Communications and Surveillance.

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Skip to main content. Current Issue. Past Issues. Online First. For Authors. Submit an Article. Corresponding author: Dr CH Yee yeechihang surgery. Introduction: Ketamine is known to cause urinary tract dysfunction. Recently, methamphetamine MA abuse has become a growing problem in Asia. We investigated the symptomatology and voiding function in patients who abused MA and ketamine and compared their urinary tract toxicity profiles. Methods: In the period of 23 months from 1 October , all consecutive new cases of patients presenting with MA- or ketamine-related urological disorder were recruited into a prospective cohort. Polysubstance abuse patients were excluded. Data were analysed by comparison between patients with ketamine abuse and MA abuse. Basic demographic data and initial symptomatology were recorded, and questionnaires on urinary symptoms and the Montreal Cognitive Assessment MoCA were used as assessment tools. Results: Thirty-eight patients were included for analysis. There was a statistically significant difference in mean age between patients with MA and ketamine abuse Urinary frequency was the most common urological symptom in our cohort of patients. There was a significant difference in the prevalence of dysuria ketamine Overall, questionnaires assessing urinary storage symptoms and voiding symptoms did not find a statistically significant difference between the two groups. The MoCA revealed that both groups had cognitive impairment ketamine Conclusions: Abuse of MA caused urinary tract dysfunction, predominantly storage symptoms. Compared with ketamine abuse, MA abuse was not commonly associated with dysuria or pelvic pain. New knowledge added by this study Conventionally, methamphetamine has mainly been implicated for its neurological impact. Our study illustrated the impact of methamphetamine on the urinary tract, ie, an increase in storage symptoms. Cognitive impairment from ketamine abuse was also documented in our study with a valid assessment. Implications for clinical practice or policy Management of methamphetamine and ketamine abuse should involve multiple disciplines to improve the comprehensiveness of assessment and treatment. Both the range of available drugs and the scope of drug markets are expanding and diversifying. Abuse of substances such as amphetamine-type stimulants, cannabis, and cocaine are major global health concerns. According to World Health Organization statistics, the number of cannabis users increased from million in to million in worldwide, whereas 34 million people abuse amphetamines and prescription stimulants. While the spectrum of substance abuse can be wide, many forms of illicit drug use inevitably induce toxicity and detrimental effects on the urinary tract. Smoking cannabis was found to have a significant association with bladder cancer in a hospital-based case-control study, 2 attributed to the common carcinogens present in cannabis and tobacco smoke. In recent years, methamphetamine MA abuse has also become a serious and growing problem in Asia. We investigated the symptomatology and voiding function in a cohort of patients who abused the two most common psychotropic substances in our locality, namely MA and ketamine, and compared their urinary tract toxicity profiles. In the period of 23 months from 1 October , all consecutive new cases of patients who attended our centre for MA- or ketamine-related urological disorders were seen in a dedicated clinic and were recruited into a prospective cohort. Written informed consent was given by all participants before entering the study. Basic demographic data were recorded before clinic attendance, including age, sex, employment status, drinking habits, and smoking history. Habits of substance abuse were characterised. Serum creatinine levels, urine microscopy and culture, and uroflowmetry were measured. Initial symptomatology enquiry included the presence and characteristics of frequency, urgency, suprapubic pain, haematuria, hesitancy, intermittency, and incomplete emptying. Functional bladder capacity was calculated by adding the voided volume to post-void urine residuals during the uroflowmetry assessment. The Chinese version of the PUF symptom scale is a validated assessment tool for cystitis. Chu et al 14 proved the validity and reliability of the Cantonese Chinese MoCA as a brief screening tool for cognitive impairment. Data were analysed by comparison between two groups of patients, namely those with ketamine abuse only and those with MA abuse only. Descriptive statistics were used to characterise the clinical characteristics of the study cohort. Chi squared tests were used for categorical data, and Mann-Whitney U tests were used for continuous data. From October to August , 66 new patients attended our clinic for urological problems secondary to substance abuse. After excluding patients with substance abuse other than ketamine and MA, 38 patients were included for analysis Table 1. Both genders contributed 19 patients. There was a statistically significant difference in mean age between the two groups of patients with MA and ketamine abuse Most patients were not active substance abusers upon presentation to the clinic. While all patients had a history of substance abuse, only two 5. Table 1. Urinary frequency was the single most common urological symptom in our patient cohort. Regardless of whether the patient was consuming ketamine alone, MA alone, or a combination of ketamine and MA, urinary frequency was found in Other symptoms that shared similar distributions between both groups were urgency, suprapubic pain, intermittent stream, and sensation of incomplete emptying. There was a statistically significant difference in the prevalence of dysuria between the two groups ketamine A trend was observed in the difference in prevalence of hesitancy ketamine 4. Table 2. Presenting symptoms of patients. To summarise the results of questionnaires that assess urinary storage symptoms and voiding symptoms as a whole, neither OABSS nor IPSS revealed a statistically significant difference between the two patient groups Table 3. The mean IPSS score of the ketamine only group was No significant differences in maximal voiding velocity, voided volume, post-void residual, or bladder capacity were observed between the two groups. Similarly, no significant difference was observed in sexual function between the male patients of these three groups, as assessed by IIEF. Table 3. Renal function, symptom scores, and uroflowmetry of patients. Pelvic pain assessment with the PUF symptom scale revealed higher scores in the ketamine group, especially in the Bother score domain ketamine 6. Cognitive assessment using MoCA revealed that both groups had impairment, but there was no significant difference between the MA group and the ketamine group ketamine Serum creatinine did not differ significantly between the groups ketamine Substance abuse is a significant public health problem, with approximately 5. Methamphetamine belongs to the class of amphetamines that also includes other drugs such as MDMA 3,4-methylenedioxy-N-methylamphetamine. The stimulant, euphoric, anorectic, empathogenic, entactogenic, and hallucinogenic properties of MA drive its popularity for abuse. Kolbrich et al 15 demonstrated the fast, widespread, and long-lasting distribution of MA in the human brain, paralleling the long-lasting behavioural and neurological effects of the drug. Our data on cognitive impairment in MA users echoed this finding, demonstrating impaired function in this group by MoCA assessment. Much of the focus on MA in the literature has been placed on its neurological and behavioural aspects. Unlike ketamine, whose effects on the urinary tract and treatment modalities have been more commonly discussed, 16 similar research endeavours have not been undertaken in the area of MA, even though it is a more widely abused drug. Thus, our study was an effort to investigate the clinical presentation of MA abuse on the urinary tract and compare it with ketamine abuse, another common drug of illicit use. As illustrated by our findings in the cohort, patients who used MA reported at least moderate severity of urinary symptoms by IPSS assessment. Because we studied a group of young patients with mean age In the current study, storage symptoms particularly urinary frequency had similar prevalence between patients who used MA and ketamine Table 2. On assessment of storage symptoms by OABSS, patients in both groups attained similar scores to patients with overactive bladder syndrome. It also promotes dopamine release from storage vesicles. All these effects increase cytoplasmic dopamine concentrations and enhance reverse transport. An animal study showed that a selective D1 antagonist decreased bladder capacity in rats. In our cohort, Case reports in the literature have drawn an association between amphetamines and urinary retention. This observation could be employed as a reference for treatment options. Patients with ketamine abuse more commonly experienced dysuria and pelvic pain. In our previous report of patients with ketamine abuse, the mean PUF score was This could be because the effects of MA on the urinary tract were more on neurology rather than local tissue destruction, resulting in less local nociceptor stimulation. Currently, there are no reports on histological assessment of urinary tract tissues in people who use MA. This would be useful to facilitate a more comprehensive investigation on the impact on MA on the urinary tract. The relatively small sample size of our cohort limited our statistical analysis. As MA abuse has only gained popularity in recent years in our locality, and the urological sequelae of such abuse might take years before it becomes prominent and severe, the current study could act as an initial assessment highlighting the early observation of urological presentation. One of the potential limitations of our study is that the majority of the patients presenting to our clinic were not active substance abusers. At the time point of assessment, the use of a heterogeneous group of active and former abusers may introduce bias into our evaluation. However, our cohort included mostly patients with long abuse duration. Studies have demonstrated the persistent effects of drug abuse even after a period of abstinence, namely dysfunctional dopamine metabolism in patients who had used MA 27 and urinary tract damage in patients who had used ketamine. In conclusion, MA is a common drug of choice for abuse in Asia. It causes urinary tract dysfunction, predominantly in the form of storage symptoms. Compared with ketamine, MA abuse was not commonly associated with dysuria or pelvic pain. In addition to the behavioural impacts of MA abuse, its urinary tract implications should not be neglected. All authors had full access to the data, contributed to the study, approved the final version for publication, and take responsibility for its accuracy and integrity. As an editor of the journal, CF Ng was not involved in the peer review process of the article. Other authors have no conflicts of interest to disclose. United Nations Office on Drugs and Crime. World drug report. Accessed 10 May Association between marijuana use and transitional cell carcinoma. Urology ; The intersection between cannabis and cancer in the United States. Crit Rev Oncol Hematol ; Acute bilateral renal infarction secondary to cocaine-induced vasospasm. Kidney Int ; Ketamine-associated uropathy: from presentation to management. Curr Bladder Dysfunct Rep ; Yiu-Cheung C. Acute and chronic toxicity pattern in ketamine abusers in Hong Kong. J Med Toxicol ; Current status of substance abuse in East Asia and therapeutic prospects. East Asian Arch Psychiatry ; The new pattern of drug abuse in China. Curr Opin Psychiatry ; Current status of substance abuse and HIV infection in Japan. J Food Drug Anal ;S Kwon NJ, Han E. A commentary on the effects of methamphetamine and the status of methamphetamine abuse among youths in South Korea, Japan, and China. Forensic Sci Int ; Symptom assessment tool for overactive bladder syndrome—overactive bladder symptom score. Hong Kong Med J ; Geriatr Gerontol Int ; Plasma pharmacokinetics of 3,4-methylenedioxymethamphetamine after controlled oral administration to young adults. Ther Drug Monit ; Clinical outcome of a prospective case series of patients with ketamine cystitis who underwent standardized treatment protocol. J Formos Med Assoc ; Toxicity of amphetamines: an update. Arch Toxicol ; Striatal dopamine nerve terminal markers in human, chronic methamphetamine users. Nat Med ; Decreased striatal dopamine D1 receptor-stimulated adenylyl cyclase activity in human methamphetamine users. Am J Psychiatry ; Role of dopamine D1 and D2 receptors in the micturition reflex in conscious rats. Neurourol Urodyn ; Parkinsonism Relat Disord ; Bladder outflow obstruction secondary to intravenous amphetamine abuse. Br J Urol ; Acute, transient urinary retention from combined ecstasy and methamphetamine use. J Emerg Med ; Urological complications of illicit drug use. Nat Rev Urol ; Prevalence and management of lower urinary tract symptoms in methamphetamine abusers: an under-recognized clinical identity. J Urol ; The role of dopamine receptors in the neurotoxicity of methamphetamine. J Intern Med ;

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