exudates and Heroin-Dependence

Clandestine heroin laboratories have been a feature of the Malaysian illicit drug scene since soon after the abuse of heroin emerged in 1972. The first few clandestine heroin laboratories which synthesised heroin via the acetylation of imported morphine were uncovered in 1973 and 1977. By the mid-1980s, this type of laboratory was replaced by heroin-cutting laboratories whereby imported high-grade heroin was cut to street heroin. This was to meet the rising demand for the drug owing to the rapid escalation of the number of drug users. Over the years, the most significant change in the composition of the street heroin is the decrease in its purity from 30%-50% to 3%-5%. Caffeine has remained the major adulterant and chloroquine is detected in virtually all recent seizures.

Topics: Drug Contamination; Heroin; Heroin Dependence; Humans; Illicit Drugs; Malaysia; Singapore

This paper describes the rationale, implementation and operation of a "world first" Islamic inspired methadone maintenance treatment project delivered in a mosque setting and presents the outcome for the first group of participants. The project explored the viability of expanding addiction recovery services through the network of mosques in Muslim communities.. The project combined methadone maintenance with peer and religious counseling. Participants consisted of 36 male Muslim heroin users who went through the project. Urine tests and self-reported measures on various dimensions relevant to drug use and quality of life were collected at baseline and 12 months.. The project had a 12 month retention rate of 80%. At 12 months all but one participant tested negative for opioids and other substances. Self-report measures showed significant reductions in the degree and variety of drug use, improvements in general health, and psychological and social functioning of participants. Qualitative data showed that availability of methadone, convenient location and religion were the main reasons drawing participants to the program.. Mosques are viable venues for offering medication assisted recovery services and offer an alternative approach for managing addiction in Muslim communities. The prospect of mobilizing community resources to offer community-oriented long-term recovery management programs in mosques and other places of worship deserves consideration.

Topics: Adolescent; Adult; Combined Modality Therapy; Counseling; Heroin Dependence; Humans; Islam; Malaysia; Male; Methadone; Middle Aged; Opiate Substitution Treatment; Pilot Projects; Program Development; Quality of Life; Treatment Outcome; Young Adult

To aid public health policymaking, we studied the cost-effectiveness of buprenorphine, naltrexone, and placebo interventions for heroin dependence in Malaysia.. We estimated the cost-effectiveness ratios of three treatments for heroin dependence. We used a microcosting methodology to determine fixed, variable, and societal costs of each intervention. Cost data were collected from investigators, staff, and project records on the number and type of resources used and unit costs; societal costs for participants' time were estimated using Malaysia's minimum wage. Costs were estimated from a provider and societal perspective and reported in 2004 US dollars.. Muar, Malaysia.. 126 patients enrolled in a randomized, double-blind, placebo-controlled clinical trial in Malaysia (2003-2005) receiving counseling and buprenorphine, naltrexone, or placebo for treatment of heroin dependence.. Primary outcome measures included days in treatment, maximum consecutive days of heroin abstinence, days to first heroin use, and days to heroin relapse. Secondary outcome measures included treatment retention, injection drug use, illicit opiate use, AIDS Risk Inventory total score, and drug risk and sex risk subscores.. Buprenorphine was more effective and more costly than naltrexone for all primary and most secondary outcomes. Incremental cost-effectiveness ratios were below $50 for primary outcomes, mostly below $350 for secondary outcomes. Naltrexone was dominated by placebo for all secondary outcomes at almost all endpoints. Incremental treatment costs were driven mainly by medication costs, especially the price of buprenorphine.. Buprenorphine appears to be a cost-effective alternative to naltrexone that might enhance economic productivity and reduce drug use over a longer term.

Topics: Acquired Immunodeficiency Syndrome; Buprenorphine; Cost-Benefit Analysis; Heroin Dependence; Humans; Malaysia; Naltrexone; Risk Factors; Risk-Taking; Treatment Outcome

Expansion of access to effective treatments for heroin dependence is a worldwide health priority that will also reduce HIV transmission. We compared the efficacy of naltrexone, buprenorphine, and no additional treatment, in patients receiving detoxification and subsequent drug counselling, for maintenance of heroin abstinence, prevention of relapse, and reduction of HIV risk behaviours.. 126 detoxified heroin-dependent patients, from an outpatient research clinic and detoxification programme in Malaysia, were randomly assigned by a computer-generated randomisation sequence to 24 weeks of manual-guided drug counselling and maintenance with naltrexone (n=43), buprenorphine (n=44), or placebo (n=39). Medications were administered on a double-blind and double-dummy basis. Primary outcomes, assessed by urine testing three times per week, were days to first heroin use, days to heroin relapse (three consecutive opioid-positive urine tests), maximum consecutive days of heroin abstinence, and reductions in HIV risk behaviours over 6 months. The study was terminated after 22 months of enrolment because buprenorphine was shown to have greater efficacy in an interim safety analysis. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00383045.. We observed consistent, linear contrasts in days to first heroin use (p=0.0009), days to heroin relapse (p=0.009), and maximum consecutive days abstinent (p=0.0007), with all results best for buprenorphine and worst for placebo. Buprenorphine was associated with greater time to first heroin use than were naltrexone (hazard ratio 1.87 [95% CI 1.21-2.88]) or placebo (2.02 [1.29-3.16]). With buprenorphine, we also recorded significantly greater time to heroin relapse (2.17 [1.38-3.42]), and maximum consecutive days abstinent than with placebo (mean days 59 [95% CI 43-76] vs 24 [13-35]; p=0.003); however, for these outcomes, differences between buprenorphine and naltrexone were not significant. Differences between naltrexone and placebo were not significant for any outcomes. HIV risk behaviours were significantly reduced from baseline across all three treatments (p=0.003), but the reductions did not differ significantly between the three groups.. Our findings lend support to the widespread dissemination of maintenance treatment with buprenorphine as an effective public-health approach to reduce problems associated with heroin dependence.

Topics: Adult; Buprenorphine; Counseling; Double-Blind Method; Heroin Dependence; HIV Infections; Humans; Malaysia; Naltrexone; Narcotic Antagonists; Recurrence; Risk-Taking; Treatment Outcome

Thirty-eight, adult, male, detoxified, Malaysian opiate addicts participated in this double-blind clinical evaluation of naltrexone. Addicts from three ethnic groups: Chinese, Malays, and Indians received a weekly regimen of naltrexone (100 mg on Days 1 and 3, and 150 mg on Day 5). Subjects were randomly assigned to receive intravenous challenge with either 25 mg heroin or placebo 12, 24, 48, and 72 h after the third naltrexone dose. Physiological and subjective parameters were measured at each challenge interval. Results indicated that naltrexone was effective in blocking the physiological and psychological effects of heroin for at least 48 and 72 h, respectively, in detoxified Malaysian opiate addicts. The efficacy of naltrexone did not differ among the three ethnic groups evaluated in this study.

Topics: Adult; Arousal; Cross-Cultural Comparison; Dose-Response Relationship, Drug; Double-Blind Method; Heroin; Heroin Dependence; Humans; Malaysia; Male; Naltrexone; Neurologic Examination; Receptors, Opioid; Substance Abuse, Intravenous

Methadone maintenance therapy has been found to be an effective harm reduction treatment for opioid use disorder. However evidence of its benefits over a longer duration of treatment is limited as most studies focus on its short term benefits. As methadone maintenance therapy reaches a decade since its implementation in Malaysia, this study sought to examine the effectiveness of methadone treatment, change in quality of life among patients since entry to methadone treatment, as well as factors predicting the magnitude of change in quality of life. This study found that methadone maintenance therapy was effective in reducing heroin use, injecting practices and crime, and in improving in social functioning and physical symptoms, but not in reducing sex-related HIV risk-taking behavior. Though patients had a significantly better quality of life at follow-up than at entry to methadone maintenance therapy, the improvement in quality of life was not significantly greater as the duration of treatment increased. Age above 50 years old, human immunodeficiency virus (HIV) positive status and physical symptoms predicted a poorer improvement in quality of life between baseline and follow-up. On the other hand, patients with hepatitis B showed a greater improvement in quality of life in the social relationships domain compared to patients without hepatitis B. In conclusion, methadone maintenance therapy is an effective treatment for opioid use disorder and improves quality of life but its benefits in further improving quality of life beyond a decade of treatment need further evaluation.

Topics: Adult; Follow-Up Studies; Hepatitis B; Heroin Dependence; HIV Infections; Humans; Interpersonal Relations; Malaysia; Male; Methadone; Middle Aged; Opiate Substitution Treatment; Opioid-Related Disorders; Quality of Life; Risk-Taking; Substance Abuse, Intravenous; Time Factors; Treatment Outcome

Topics: Heroin Dependence; Humans; Malaysia; Methadone; Narcotics; Opiate Substitution Treatment

The commencement of methadone maintenance therapy (MMT) in 2005 represents a quantum leap in the management of heroin dependence in Malaysia.. To examine the 2-year outcomes of this modality in the treatment of heroin dependence with respect to the quality of life (QOL), heroin abstinence, and rate of employment among heroin dependants attending the Tengku Ampuan Afzan Hospital (HTAA) MMT clinic.. This was an experimental study in which the second QOL assessment was conducted 2 years after treatment initiation.. A total of 172 patients enrolled at the point of entry to the MMT program. The authors examined 107 patients who remained in the program 2 years later (62.6% retention rate). A paired t test demonstrated significant improvements in all 4 domains of QOL (physical, psychological, social relationships, and environment; P < .001). The most marked improvement was noted in the psychological domain.. The MMT program at HTAA is effective in improving the QOL among heroin dependants.

Topics: Adult; Employment; Female; Follow-Up Studies; Health Facilities; Heroin Dependence; Humans; Malaysia; Male; Methadone; Middle Aged; Program Evaluation; Quality of Life; Time Factors; Treatment Outcome; Young Adult

Develop and apply new costing methodologies to estimate costs of opioid dependence treatment in countries worldwide.. Micro-costing methodology developed and data collected during randomized controlled trial (RCT) involving 126 patients (July 2003-May 2005) in Malaysia. Gross-costing methodology developed to estimate costs of treatment replication in 32 countries with data collected from publicly available sources.. Fixed, variable, and societal cost components of Malaysian RCT micro-costed and analytical framework created and employed for gross-costing in 32 countries selected by three criteria relative to Malaysia: major heroin problem, geographic proximity, and comparable gross domestic product (GDP) per capita.. Medication, and urine and blood testing accounted for the greatest percentage of total costs for both naltrexone (29-53 percent) and buprenorphine (33-72 percent) interventions. In 13 countries, buprenorphine treatment could be provided for under $2,000 per patient. For all countries except United Kingdom and Singapore, incremental costs per person were below $1,000 when comparing buprenorphine to naltrexone. An estimated 100 percent of opiate users in Cambodia and Lao People's Democratic Republic could be treated for $8 and $30 million, respectively.. Buprenorphine treatment can be provided at low cost in countries across the world. This study's new costing methodologies provide tools for health systems worldwide to determine the feasibility and cost of similar interventions.

Topics: Buprenorphine; Cambodia; Cost of Illness; Drug Costs; Gross Domestic Product; Health Care Costs; Heroin Dependence; Humans; Laos; Malaysia; Naltrexone; Narcotic Antagonists

The prevalence of hepatitis C virus (HCV) among heroin dependants in treatment was estimated at 89.9%; however, virtually no information exists on the prevalence or risk behaviour among the larger population of drug users not in treatment. This study assessed the prevalence of HCV and associated risk factors among this group with a view to designing more effective intervention programs.. A cross-sectional survey of 552 not-in-treatment drug users recruited from five key urban centres across peninsular Malaysia with on-site serological testing for HCV and HIV seropositivity was conducted.. HCV prevalence was 65.4% for the overall sample, but higher among injecting drug users (67.1%) relative to non-injecting drug users (30.8%). Bivariate analysis suggested seven risk factors though only sharing injecting paraphernalia and lifetime homosexual/bisexual behaviour remained significant in multivariate analysis.. With the majority (65.9%) sharing injecting equipment and about the same proportion (65.4%) being HCV positive, the risk of further transmission to new drug users is high. It is imperative that the nascent needle and syringe exchange and condom distribution program and its ancillary services--launched in 2005 to fight HIV--be fine tuned, as a first step, to control HCV. With its greater infectivity and non-symptomatic character, HCV is more insidious. Given the shared risk factors of HCV and HIV, routine screening of drug users for HCV--currently non-existent--should be instituted. This, with other intervention measures, will help detect and control HCV at an earlier stage while also checking the spread of HIV.

Topics: Adolescent; Adult; Bisexuality; Cross-Sectional Studies; Data Collection; Female; Hepatitis C; Heroin Dependence; HIV Infections; Homosexuality; Humans; Malaysia; Male; Needle Sharing; Needle-Exchange Programs; Prevalence; Risk Factors; Risk-Taking; Sexual Behavior; Substance Abuse, Intravenous; Substance-Related Disorders; Urban Population; Young Adult

Topics: Buprenorphine; Drug Utilization; Heroin Dependence; Humans; Malaysia; Methadone; Naltrexone; Patient Compliance; Pilot Projects; Policy Making

The study explores how data collated from rapid assessment can enhance those produced by national level surveillance systems, in this case the national drug information (NADI) system in Malaysia. Qualitative data were collected in keeping with internationally accepted guidance on rapid assessment methods in the field of substance use. An inductive research strategy was employed. The rapid assessment produced multiple data on local drug use practices and how these were influenced by the contexts of use. The assessment points to the importance of collecting data not only on patterns of drug use but also on the health and social consequences of drug use. We suggest that the current national drug information system places greater emphasis on behavioural and health-related variables in order to better understand the potential relationships between drug use and health-related risk, including HIV/AIDS.

Topics: Epidemiologic Research Design; Heroin Dependence; Humans; Malaysia; Opioid-Related Disorders; Population Surveillance; Qualitative Research; Substance Abuse, Intravenous

The prevalence of HIV/AIDS among drug addicts in Malaysia is high, especially among intravenous drug users. The present treatment and rehabilitation of drug addiction is considered as a failure. The government finally decided to start on Drug Substitution Therapy in early 2005 as an effort to prevent the spread of HIV/AIDS in the country.

Topics: Anti-HIV Agents; Female; Government Programs; Harm Reduction; Heroin Dependence; HIV Infections; Humans; Malaysia; Male; Methadone; National Health Programs; Needle-Exchange Programs; Substance Abuse, Intravenous

In Malaysia the response to illicit drug use has been largely punitive with the current goal of the Malaysian government being to achieve a drug-free society by 2015. This paper outlines the results of a desk-based situation assessment conducted over a 3-week period in 2004. Additional events, examined in 2005, were also included to describe more recent policy developments and examine how these came about. Despite punitive drug policy there has been a substantial rise in the number of drug users in the country. Over two-thirds of HIV/AIDS cases are among injecting drug users (IDUs) and there has been an exponential rise in the number of cases reported. Further, data suggest high risk drug use practices are widespread. Harm reduction initiatives have only recently been introduced in Malaysia. The successful piloting of substitution therapies, in particular methadone and buprenorphine, is cause for genuine hope for the rapid development of such interventions. In 2005 the government announced it will allow methadone maintenance programmes to operate beyond the pilot phase and needle and syringe exchange programmes will be established to serve the needs of IDUs.

Topics: Acquired Immunodeficiency Syndrome; Anti-HIV Agents; Data Collection; Drug and Narcotic Control; Government Programs; Harm Reduction; Health Policy; Heroin Dependence; HIV Infections; Humans; Illicit Drugs; Malaysia; Needle-Exchange Programs; Organizations, Nonprofit; Risk Factors; Substance Abuse, Intravenous

Malaysia is experiencing severe problems with heroin dependence and HIV infection. This, study evaluated drug use and other HIV risk behaviors and their association with HIV and other infectious diseases in heroin-dependent subjects enrolled in a clinical trial of drug abuse treatment in Muar, Malaysia.. Baseline assessment of treatment-seeking subjects (n=177) included the Addiction Severity Index; AIDS Risk Inventory; serological tests for HIV, hepatitis B, and hepatitis C; and chest X-ray.. All of the subjects were male; 67.8% were Malays, 28.8% Chinese, and 2.3%. Indian. Subjects had a mean (SD) age of 37.2 (9.1) years and 14.4 (8.5) years of using heroin; 76.3% reported lifetime injection drug use (IDU), and 41.5% reported current IDU; 30 of 156 (19.2%) tested HIV positive, 143 of 159 (89.9%) tested hepatitis C positive, and 25 of 159 (15.7%) had radiological evidence of pulmonary tuberbulosis. Malay subjects had a significantly higher prevalence of current IDU, needle sharing (p<0.01), and HIV infection (p<0.05) compared with Chinese subjects. Lifetime IDU, needle sharing, lack of consistent condom use, and Malay ethnicity were significantly associated with HIV infection.. The high prevalence of HIV infection among heroin-dependent individuals, in Malaysia supports the important of interventions to reduce the major risk factors for HIV, including IDU, needle sharing, and unprotected sex.

Topics: Adult; Buprenorphine; Demography; Female; Heroin Dependence; HIV Infections; Humans; Malaysia; Male; Naltrexone; Narcotic Antagonists; Prevalence; Risk-Taking

Human immunodeficiency virus (HIV) has spread widely among injecting drug users (IDUs) in countries to the north and west of the 'Golden Triangle' region of South-East Asia; it is likely to have spread southwards to Malaysia as well. In order to assess HIV seroprevalence among IDUs in north-east Malaysia and describe risk factors for HIV infection in this population, we performed a cross-sectional seroepidemiological study among 210 IDUs recruited at the detoxification ward of the General Hospital in the capital city of the north-eastern Malaysian state, Kelantan. Subjects were sequential entrants to the detoxification ward, interviewed about HIV risk behaviour, and tested for antibody to HIV and to syphilis. Nearly a third (62/210, 30%) of these IDUs were HIV seropositive. Three-quarters (159/210) had travelled to Thailand in the preceding 5 years, of whom 32% (51/159) were HIV seropositive; this was associated with injecting in Thailand, but not with sexual contact there. Of those who had not left Malaysia in the preceding 5 years, 26% (11/43) were HIV seropositive, a rate not significantly different from those who had travelled. Travel within Malaysia was common (144/210, 69%) among IDUs interviewed, as was unsafe injecting and unsafe sexual behaviour (20% had shared injecting equipment and 21% had had unprotected intercourse) in other states. In every locale, rates of unsafe injecting behaviour were high (55% sharing in last month), even among those who knew they were HIV infected, and rates of condom usage were low (93% of 160 sexually active IDUs had never used a condom). Syphilis was not associated with HIV infection, but with contact with Thai prostitutes.(ABSTRACT TRUNCATED AT 250 WORDS). 210 intravenous drug users (IVDU) recruited in the detoxification ward of the general hospital in the capital city of the northeastern Malaysian state of Kelantan were interviewed about their HIV risk behavior and tested for antibodies to HIV and syphilis. The study was conducted to assess HIV seroprevalence among IVDUs in northeast Malaysia and describe risk factors for HIV infection in that population. 62 of the individuals were HIV-seropositive (HIV+). 159 of the 210 had travelled to Thailand in the preceding 5 years, of whom 51 were HIV+. Their serostatus was associated with injecting in Thailand, but not with sexual contact there. Of the 43 who had not left Malaysia in the preceding 5 years, 11 were HIV+; this 26% rate is not significantly different from the rate among those who had travelled. 69% of the sample had travelled within Malaysia; 20% had shared injecting equipment; and 21% had had unprotected sexual intercourse in other states. 55% had shared injecting equipment in the previous month, even among those who knew they were infected with HIV. 93% of sexually active IVDUs had never used a condom. Syphilis was not associated with HIV infection, but with contact with Thai prostitutes. Multivariate analysis found that the major predictors of HIV seropositivity were multiple sharing partners, low income, and few years of education. These findings support the notion that HIV is widespread among IVDUs in northeast Malaysia and that it is associated with low socioeconomic status. HIV is spreading endogenously within Kelantan and probably in other states. The frequent risk behavior in this high prevalence population suggests that transmission rates will probably stay high and that large-scale prevention efforts are urgently needed.

Topics: Adolescent; Adult; Cross-Sectional Studies; Disease Outbreaks; Health Knowledge, Attitudes, Practice; Heroin Dependence; HIV Infections; Humans; Incidence; Malaysia; Male; Morphine Dependence; Needle Sharing; Sexual Behavior; Substance Abuse Treatment Centers; Substance Abuse, Intravenous

In a recent epidemiological study of 249 opiate addicts in the State of Penang, Malaysia, the use of benzodiazepines, its temporal relationship to opiate addiction and the reasons for use of benzodiazepines were examined. Just over a half of the opiate addicts indicated use of benzodiazepines in their lifetime. Use of 7 different benzodiazepines was reported, among them flunitrazepam most frequently. A substantial proportion had discontinued the use of benzodiazepines after initial experimentation. Just over a quarter had used them in the last 24 hours. Benzodiazepine use starts on average 3 to 6 years later than heroin use. The most common reason cited for benzodiazepine use was to enhance the feeling of 'high' from the opiates. These findings can be explained, at least partly, by economic factors. Reasons that could be qualified as attempts to autotherapy did not exceed 20%. None of the opiate addicts had reported isolated benzodiazepine use for fun and pleasure. From the time course of use as well as from the reasons given by the addicts, it is evident that benzodiazepines are not primary drugs of abuse. Comparing their figures from Malaysia with figures from Germany and England the authors cannot explain the preferred use of flunitrazepam by Malaysian addicts by the existence of special properties of this substance.

Topics: Adult; Anti-Anxiety Agents; Benzodiazepines; Heroin Dependence; Humans; Malaysia; Substance-Related Disorders; Surveys and Questionnaires

In a study of 249 opiate (mainly heroin) addicts special attention was paid to adjunctive drug use. Generally, nicotine (cigarette smoking), alcohol and cannabis preceded the use of heroin, and continued to be used as adjunctive drugs after the establishment of heroin addiction. Nicotine was the most common substance used together with opiates. Alcohol and cannabis were used as adjunctive drugs in about two-thirds of the cases. In the late stages of heroin addiction, benzodiazepines were also used concomitantly with opiates. The most frequently reported reason for the use of adjunctive drugs was to intensify the effect of the opiate. Three-quarters or more of the addicts had used different adjunctive drugs to boost the euphoric feeling derived from the primary drug, i.e. heroin. Attempt at self-treatment of withdrawal symptoms was a less frequently reported reason for adjunctive drug use. The findings show that heroin addiction is the major problem. The use of adjunctive drugs, especially benzodiazepines, can be partly explained on economic grounds. They must be clearly distinguished from the primary drug of abuse, heroin. For policy-making decisions, it is important that the elimination of heroin abuse through effective prevention measures would ultimately wipe out the problem of adjunctive drug use, while reduction of the overall supply of heroin without reduction in actual demand might result in an increasing trend to adjunctive drug use.

Topics: Alcohol Drinking; Cross-Sectional Studies; Heroin Dependence; Humans; Malaysia; Male; Marijuana Smoking; Smoking; Surveys and Questionnaires

The temporal sequence of drug use should reveal which drugs are precursors to heroin and which drugs are used subsequent to the establishment of heroin addiction as adjunctive drugs. This temporal sequence was examined in an epidemiological study. Out of 249 opiate addicts interviewed in the area of Penang, Malaysia, this sequence of drugs could be obtained in 248 cases. The mean (median) age for first use of nicotine is 15.5 (15) years, alcohol 18.4 (18) years, cannabis 17.8 (17) years, heroin 21.8 (21) years, opium 22.8 (22) years, and benzodiazepines 25.8 (25) years. The age of first use of different drug types is presented in some detail. The patterns of sequence of drug use was analyzed for the five major and most frequently reported drugs, i.e. alcohol, cannabis, heroin, opium and benzodiazepines. Nicotine, used as first drug in almost all cases, was omitted in this analysis. A clear trend to multiple drug abuse emerges from this analysis; the biggest number of cases were users of 4 drugs (81 cases), followed by 3 drugs (59 cases) and 5 drugs (58 cases). Thus, nicotine, alcohol and cannabis are precursors of heroin addiction. Other adjunctive drugs become important only after heroin addiction. Among these substances, opium and benzodiazepines are numerically preponderant.

Topics: Adult; Age Factors; Cross-Sectional Studies; Heroin Dependence; Humans; Malaysia; Male; Substance-Related Disorders

Information from the national drug abuse monitoring system was analysed to determine the trends in extent and pattern of drug dependence in Malaysia over the period 1970 to 1986. The annual incidence and prevalence rates of reported drug dependents increased by many folds when compared to the early seventies. Generally, the profile of drug dependents identified has remained relatively stable throughout the years. A stable pattern of drug abuse was also noted over this period. Factors influencing the trend patterns are discussed, as well as the implications of these findings for policy purposes.

Topics: Adolescent; Adult; Aged; Heroin Dependence; Humans; Incidence; Malaysia; Middle Aged; Public Policy; Substance-Related Disorders

This paper examines four drug rehabilitation systems in Malaysia from an organizational perspective. It focuses on authority structures in rehabilitation centres and their impact on rehabilitees' identities. The findings show that there are important differences between government-run and private centres in terms of administration and approach to therapy. Some policy implications are derived from a comparison of these systems.

Topics: Combined Modality Therapy; Community Mental Health Services; Heroin Dependence; Humans; Malaysia; Medicine, Traditional; Social Environment; Social Support

The purpose of this paper is to compare two forms of treatment for heroin abusers in Malaysia--traditional medicine and institutional--and to evaluate which form of treatment the drug abusers consider more effective. The study involved interviewing 100 male drug abusers in Malaysia who had had treatment from an institution and from a traditional healer. The data revealed that traditional medicine was better for some abusers, but institutional treatment was better for others, depending upon an individual's own needs and personality. Advantages and disadvantages of both forms of treatment were given by those interviewed. The data can be used as guidelines for the development of a more flexible, individualized program within an institutional setting in Malaysia.

Topics: Acupuncture Therapy; Adolescent; Adult; Attitude to Health; Heroin Dependence; Humans; Malaysia; Male; Medicine, Ayurvedic; Medicine, East Asian Traditional; Surveys and Questionnaires

Topics: Developing Countries; Evaluation Studies as Topic; Heroin Dependence; Humans; Malaysia; Myanmar; Thailand; World Health Organization

Topics: Adolescent; Adult; Child; Female; Heroin Dependence; Humans; Malaysia; Male; Middle Aged; Morphine Dependence; Substance-Related Disorders