KUALA LUMPUR - At the nondescript entrance of Poliklinik Khafidz, the clinic to treat addiction in Kajang that has been around since 2001, 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.
"My friend said, ‘If you’re serious about getting clean, you have to do it under a doctor’s supervision, with counselling and everything,” he said, adding he has been clean for over a year and hopes to be free from drugs forever.
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 2008 tested positive, according to data from the Ministry of Health. In this, he becomes the poster boy for the objectives of Malaysia’s HIV/AIDS approach on harm reduction rather than zero-tolerance.
With the success of harm reduction policies in tackling the HIV/AIDS playbook on drug use, experts are now taking the next step, by pushing for the decriminalisation of drugs.
The first pebbles off the mountain have been cast with the abolishment of mandatory death penalty for drug cases last year.
And now, Home Minister Datuk Seri Saifuddin Nasution Ismail announced on June 26 that the Cabinet has approved amendments to the Drug Dependants (Treatment and Rehabilitation) Act 1983.
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.
PERSONAL USE
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.
"Harm reduction is proven successful. But total abstinence has failed,” said Dr Mohd Khafidz Mohd Ishak, addiction medicine practitioner and member of the Task Force.
"What we do is (like) regulating ice cream per day. 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. So you regulate it to only once a day,” he said.
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.
Currently, Malaysian laws for possession of illicit drugs are some of the harshest in the world, carrying the possibility of death penalty or life in prison for small amounts, which addiction specialists have pointed out were enough for a week’s personal supply.
A harm reduction approach also means changing the approach in dealing with users and addicts. At the opening of the National Anti Drug Science Symposium, Saifuddin told reporters the amendments will affect 29 clauses in the Drug Dependants (Treatment and Rehabilitation) Act 1983.
One of them will be how addicts will be regarded, as people with an illness and not criminals.
"If these amendments are approved, it will help the National Anti-Drugs Agency’s (NADA) to treat addicts without encountering much bureaucratic red tape and be more effective," he said.
The government is expected to table the amendments before the end of the current parliamentary session.
TREATMENT IS NOT ONE SIZE FITS ALL
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.
Hospital Kuala Lumpur (HKL) addiction psychiatrist Dr Mohd Fadzli Mohamad Isa said decriminalisation should occur as it would provide opportunities for people to get treatment.
"So I think when decriminalisation happens, more people will want to get treatment as early as possible. Not waiting until they are severely dependent, not only after developing psychological complications like psychosis, mood disorder, you know, so that's the reason and the role of decriminalisation,” he said.
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.
"There should be a link between doctors and law enforcement. If law enforcement officers stop people from getting their treatment, how can the doctor do their job?” he said, adding that police officers used to come to his clinic to arrest his patients.
Hearing that the proposed amendments may be giving authority to NADA agents to determine who should go for treatment instead of doctors, Drug Policy Programme Director at Malaysian AIDS Foundation Palani Narayanan became concerned.
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.
"People who are experimenting or using recreational drugs do not need to be put in rehab centres. They may need counselling, they may need guidance. Putting them into treatment - it is not going to work,” he said.
Dr Mohd Fadzli agreed, saying there needs to be more options for treatment.
"But people sometimes go to the wrong door. I say it's the wrong door because sometimes they're not that severely dependent but they have to undergo a programme that is tailored for severely dependent users,” he said.
He added that the public needs to know where to get help, be it at the hospital, private clinics or NGOs.
DATA, FUNDING FOR GOLD
The golden standard for harm reduction is Portugal, which decriminalised drugs in 2001.
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.
Decriminalisation proponents attributed the recent poor showing to the lack of funding.
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 was no structured plan of implementation. There were no pilot sites, not a great monitoring and evaluation system to catch the challenges and the problems. But most importantly, there was not a nationwide consensus amongst all the different parties that this is a national issue that needs to be implemented,” Palani said via Zoom.
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 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.
"It also should prioritise medical and health intervention along the line of accepting addiction as a medical disease,” he added. - BERNAMA