Prepared by

Dr Steven Chow, President, Federation of Private Medical Practitioners’ Associations, Malaysia & President, President, Addiction Medicine Association of Malaysia &

Associate Professor Dr Anne Yee, Honorary Secretary, Addiction Medicine Association of Malaysia

24^th  May 2021 (Kuala Lumpur)

The Addiction Medicine Association of Malaysia (AMAM) and the Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM) organised the 11^th National Conference on Addiction Medicine (11^th NatCAM). The first session was held on 23^rd May 2021 (Sunday) and was attended by more than 70 practitioners.  The second session is scheduled for 30^th May 2021 (Sunday) from 1100 to 1600 hrs.

Experts and practitioners working on ground zero of the addiction disease landscape shared their concerns and reservations on the many issues  which have been neglected during this COVID-19 pandemic.

 The 11^thNatCAM specifically addressed issues related to drug addiction and its treatment in the pandemic era.  A team of experts was invited to share their knowledge and experiences with our members and frontline practitioners.

METAMPHETAMINE ABUSE UPDATE

Associate Professor Dr Anne Yee (UM) and Associate Professor Dr Suzaily Wahab (UKM), delivered the plenary lectures on how to address the issues and treat methamphetamine use disorder, especially in adolescents and young adults, in the COVID-19 period which is a worrying trend.

COVID-19 PANDEMIC ASSOCIATED DEPRESSION & SUICIDE

Dr Chee Kok Yoon, Consultant Neuropsychiatrist (HKL), talked on the burdens of depression and suicidal tendency in the era of COVID-19 pandemic and how GPs can help in early diagnosis and intervention.

TOBACCO HARM REDUCTION – VAPING/E-CIGARETTES: TO BAN OR TO REGULATE

In his address, Dr Steven Chow, reiterated that in 2015, AMAM, FPMPAM and other medical NGOs  had  called for the ban on e-cigarettes and tobacco. We are concerned that to date we have not seen any update of the proposed Control of Tobacco Products Regulations 2004 which we had hoped would have led to the  ban or at least  to seriously regulate e-cigarettes and vaping.

Dr Chow reiterated the point that “It is misleading to say that the effects of electronic cigarettes and vaping on our health and society is minimal. We must learn from the mistakes made during the war against tobacco, in which it took decades for the true cost of tobacco harm to the society to be made public.  AMAM and the FPMPAM will jointly move to support access to smoking cessation service with a programme to train general practitioners to help those wishing to quit smoking. We are aware that more than 50% of current smokers in Malaysia are keen to quit, and it is our duty as doctors to help them achieve abstinence”

To date, we have approximately 300,000 students who are e-cigarette users.

The Conference was informed that the World No-Tobacco Day on 31^st  May 2021, will seek to explore what tobacco harm reduction is and how it can help smokers in quit smoking altogether. AMAM and FPMPAM will participate in this global initiative led by the World Health Organisation (WHO).

Associate Professor Dr Amer Siddiq, a smoking cessation expert, stated that e-cigarettes are clearly being targeted at the younger geneerations of the society and this could be a gateway to lifelong nicotine addiction. Although there is evidence to suggest that e-cigarettes might be able to assist smokers to quit, however it is important that we look at all factors on harm and benefits considering the available of safer alternatives to assist in smoking cessation for fear of creating another issue such dual use (using electronic cigarettes and tobacco at the same time).

Associate Professor Dr Amer presented the updated Cochrane Review on Electronic cigarettes for smoking cessation, which looked at 50 studies from the USA, UK, Italy, Australia, New Zealand, Greece, Belgium, Canada, Poland, South Korea, South Africa, Switzerland and Turkey and the key findings were that smokers were likely to stop smoking for at least six months by switching to vape with nicotine e-liquid as compared to nicotine replacement therapy, nicotine-free vape or behavioural support.

The Conference called for more intense public and professional engagement to examine the issue of  tobacco harm reduction. The evidence supports the view that tobacco harm reduction can be a pragmatic approach to reducing the harm of smoking related diseases.

AN UPDATE ON KETUM IN MALAYSIA

Associate Professor Dr Rusdi Abdul Rashid, a  Director of University of Malaya Centre for Addiction Science Studies (UMCAS), presented his data on studies on ketum users. He explained that most of the regular ketum users were found to have opioid or stimulant dependence. They mainly used ketum to reduce the withdrawal symptoms from opioids and stimulants. He concluded that ketum could be a potential alternative as compared to existing methadone assisted therapy. However, more studies should be done on ketum to explore its use. Hence, he suggested that ketum should not be put under the Dangerous Drug Act to facilitate further research activities.

UMCAS also provided training workshops for the practitioners to equip them with knowledge and skills to treat substance use patients – ASSISST BI (The Alcohol, Smoking and Substance Involvement Screening Test plus brief intervention) is one of them.

ASSIST BI was developed for the WHO by an international group of substance abuse researchers to screen for problems or risky uses of substances and to provide a brief intervention to at-risk patients in the primary health care settings. 

CHEMSEX, the Malaysian  Scenario

The use of stimulant drugs by men who have sex with men (MSM) which facilitate and enhance sexual pleasure (chemsex) has been documented. Due to the prohibition of drug use and homosexuality in Malaysia, drug treatment services tailored to the needs of MSM are therefore non-existent in this country. Associate Professor Dr Anne Yee, the principal investigator of a project developing a community-based, online intervention to address the mental health and sexual health needs among stimulant-using MSM in Malaysia, stated that this community-based, low-threshold, online intervention will provide a safe environment where MSM could access drug screening and harm-reduction materials.

Currently this project is still actively recruiting participants for its study. She called on GPs with patients who are aged 18 years or older, having engaged in ‘chemsex’ with other men in the past 12 months (defined as taking crystal methamphetamine, GBL/GHB, or ecstasy/MDMA), to contact her by email at  annyee17@um.edu.my.

Session 2, 30^th May 2021

Among other topics,  experts will discuss the current debate on medical marijuana with a plenary on Redesigning the Policy of Medicinal Hemp by Professor Dr Mohammad Hussain Habil. There will also be an interactive forum on the Drug and Substance Abuse Act 2020.

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The Addiction Medicine Association of Malaysia (AMAM)

AMAM, a sister society of the FPMPAM, was formed in 2006 and is the first addiction medicine association to be founded in Asia. Its primary objective is to develop and promote the science of addiction medicine nationally and in the region. Members of AMAM consists of GPs, specialists in addiction medicine and allied healthcare professionals with the interest or working in managing of patients with addiction. AMAM organises the National Conference on Addiction Medicine (NatCAM) together with International Conference of Addiction Medicine (ICAM) once every two years.

Federation of Private Medical Practitioners Associations, Malaysia (FPMPAM)

Founded in 1989, it has more than 5,000 members in seven state-level associations in the country. While it is primarily committed to improving the quality of private healthcare through continuing medical education, continuing professional development of its members and ethics advocacy, it has in recent years been focusing on frontier medicine, addiction medicine and a mentoring programme for trainee doctors.

For further information please contact: Dr Steven Chow,

Tel: 019 3376703 email: secretariat@fpmpam.org

PRESS STATEMENT

Kuala Lumpur, 27.11.2019

RISING TREND IN DRUG RELATED ARRESTS, DRS URGE GOVERNMENT TO AMEND LAWS

We refer to the speech by YB Dr. Lee Bon Chye, Deputy Minister of Health Malaysia in Bangi at the opening of the Asia Pacific Society for Alcohol and Addiction Research Conference incorporating the 10^th National Conference on Addiction Medicine.

The Federation of Private Medical Associations Malaysia (FPMPAM) and the Addiction Medicine Association of Malaysia (AMAM) would like to congratulate and support this important development in the on-going battle against drug addiction.

The medical fraternity have long appealed for a compassionate approach to the management of those afflicted by drug addiction and advocated for the important role of medication assisted therapy (MAT) together with psychosocial intervention at all levels of the community. The scientific evidence of addiction as a chronic brain disorder is irrefutable.

Since 2002, the FPMPAM and the AMAM (founded in 2006) have developed a community-based MAT program. More than 900 GPs have been trained in the use of MAT and they are able to offer treatment for these patients within the community setting. To date, our nation-wide community-based MAT program have taken more than more than 24,000 patients with heroin addiction off the streets. Retention treatment rates have been more than 60% when the data was last analysed in 2014. Within 2 years following the introduction of MAT in Malaysia, important parameters like HIV-associated IV drug use death rate and drug-related arrests have been shown to fall significantly. This experience have been similar in countries that have advocated this policy.

However from 2016, statistics from the NADA have shown a worrisome reversal of the trend with an increasing number of drug related arrests. This is an indication that affirmative regulatory reform is needed for maintaining and upscaling MAT.

Amendments to relevant provisions in the Drug Dependants (Treatment and Rehabilitation) Act 1983 will enable those in addiction to legally and confidently seek medical treatment are urgently needed.

We urge that political will be focussed to ensure that this policy decision be translated into administrative action to prevent condemning another generation of young Malaysians into a lifetime of addiction. On our part as medical practitioners, we offer our services and resources to the government to achieve this goal.

The 10^th National Conference on Addiction Medicine is incorporated into the APSAAR 2019 with AMAM as a co-organiser. AMAM will specifically address issues related to drug addiction and its treatment in Malaysia at this meeting

 

Dr. Steven KW Chow
President, Addiction Medicine Association of Malaysia (AMAM)
President, Federation of Private Medical Practitioners’ Associations Malaysia.

About The Addiction Medicine Association of Malaysia (AMAM)
AMAM, a sister society of the FPMPAM was formed in 2006 and is the first addiction medicine association to be founded in Asia. Its primary objective is to develop and promote the science of addiction medicine nationally and in the region. Members of AMAM consists of GPs, specialists in addiction medicine and allied healthcare professionals with the interest or working in managing of patients with addiction. AMAM organises the National Conference on Addiction Medicine (NatCAM) together with International Conference of Addiction Medicine (ICAM) once every two years.

About the Federation of Private Medical Practitioners Associations Malaysia (FPMPAM)
Founded in1989, it has more than 5,000 members in seven state-level associations in the country. While it is primarily committed to improving the quality of private healthcare through continuing medical education, continuing professional development of its members and ethics advocacy, it has in recent years been focusing on frontier medicine, addiction medicine and a mentoring programme for trainee doctors.

For further information please contact: Dr. Steven Chow,
Tel: 019 3376703 email:secretariat@fpmpam.org

KUALA LUMPUR, June 24 (Bernama) — The Federation of Private Medical Associations Malaysia (FPMPAM) and the Addiction Medicine Associations of Malaysia (AMAM) have applauded the government for its decision over the decriminalisation of drug addicts.

Dr Steven KW Chow, the president of both associations, noted that the medical fraternity had long appealed for a compassionate approach to the management of those afflicted by drug addiction and advocated for the important role of medication assisted theraphy (MAT) together with psychosocial intervention at all levels of the community.

“We fully support this policy decision and will offer our services and resources to the government to help curb the ever rising danger of addiction,” he said in a statement.

Dr Chow said the scientific evidence of addiction as a chronic brain disorder was irrefutable.

He further said that amendments to relevant provisions in the Drug Dependants (Treatment and Rehabilitation) Act 1983 would enable those in addiction to legally and confidently seek medical treatment.

Earlier today, Bernama reported that drug addicts in this country were no longer seen as criminals who must be punished but were patients in need of treatment and rehabilitation.

This follows a discussion between the Home Ministry and the Health Ministry in Putrajaya which concurred on the need to decriminalise drug addicts.

— BERNAMA

Original article:
http://health.bernama.com/news.php?id=1738746

Tan Sri Muhyiddin Yassin dan Menteri Kesihatan, Datuk Seri Dr Dzulkefly Ahmad semasa sidang media selepas mengetuai delegasi kedua-dua kementerian semasa mesyuarat berkenaan isu-isu kesihatan membabitkan Kementerian Dalam Negeri (KDN) di KDN hari ini.

 

PUTRAJAYA, 24 Jun (Bernama) — Penagih dadah di negara kini tidak lagi dilihat sebagai pesalah jenayah yang perlu dihukum sebaliknya pesakit yang memerlukan rawatan dan pemulihan.

Takrifan itu dicapai susulan perbincangan antara Kementerian Dalam Negeri (KDN) dan Kementerian Kesihatan di KDN di sini hari ini yang bersetuju untuk melaksanakan ‘decriminalization’ ke atas penagih dadah.

Bercakap kepada pemberita selepas perbincangan itu, Menteri Dalam Negeri Tan Sri Muhyiddin Yassin berkata pelaksanaan ‘decriminalization’ itu akan melibatkan program rawatan dalam komuniti dengan memperkasakan peranan ahli keluarga dan masyarakat.

“KDN akan bekerjasama dengan Kementerian Kesihatan dalam program harm reduction melalui terapi dadah gantian methadone dan joint management kes-kes dual diagnosis yang dijalankan oleh Pusat Pemulihan Penagihan Narkotik (Puspen) di Tampoi dan Hospital Permai di Johor,” katanya.

Menurut Muhyiddin, terdapat 70,000 tahanan penjara di Malaysia pada masa ini dengan sebahagian besar daripadanya adalah penagih dadah.

“Dengan proses decriminalization, tahanan penjara yang dikategorikan sebagai penagih dadah akan diberi rawatan dan pemulihan,” katanya.

KDN juga sedang mengkaji untuk mengeluarkan Seksyen 6, 8 dan 9 Akta Penagih Dadah (Rawatan dan Pemulihan) (APD) daripada didaftarkan di bawah Akta 7 (Akta Pendaftaran Penjenayah dan Orang Tidak Diingini 1969) bagi memberi peluang kedua kepada penagih yang telah pulih dan dibebaskan daripada pusat pemulihan Agensi Anti Dadah Kebangsaan (AADK), katanya.

Muhyiddin berkata, turut dibincangkan KDN dan Kementerian Kesihatan hari ini ialah isu penyakit berjangkit di penjara, lokap, pusat tahanan dan depoh tahanan KDN.

Maklumat terkini Jabatan Penjara mendapati 16,955 banduan dikesan mempunyai penyakit berjangkit.

“KDN dan Kementerian Kesihatan akan bekerjasama dalam menguruskan masalah penyakit berjangkit di tempat tahanan KDN,” katanya.

— BERNAMA

Original article:
http://health.bernama.com/newsbm.php?id=1738459

Bulan antidadah kebangsaan telah diraikan pada bulan Februari tahun ini. Sejenak dengan sambutan ini, mungkin kita perlu merenung sejenak sejauh manakah kita telah menapak kehadapan dalam usaha membasmi penyalahgunaan dadah dinegara kita. Selaras dengan perubahan masa dan pemodenan, bentuk dan corak penyalahgunaan dadah juga berbeza dan memerlukan pendekatan dan pelan perawatan  yang berbeza. Apa yang pasti, isu ini didapati semakin meruncing dengan penularan masalah ini dikalangan remaja dibangku sekolah. Sejak kebelakangan ini, isu dadah hangat diperbincangkan dan mendapat perhatian  dari pelbagai reaksi masyarakat. Hukuman mati yang diberikan kepada seorang anak muda pada September tahun lepas yang menjual minyak kanabis untuk tujuan perubatan menimbulkan spekulasi dan emosi pihak tertentu tentang kewarasan atau keperluan bentuk hukuman tersebut kepada pesalah dadah.

Masyarakat sering menyifatkan masalah penyalahgunaan dadah sebagai isu moral semata-mata. Ini sama sekali tidak benar kerana bukti kajian saintifik sejak beberapa dekad jelas menunjukkan masalah ini juga merupakan isu kesihatan kronik yang memerlukan perawatan yang sewajarnya. Perlabelan pesalah dadah sebagai ‘sampah masyarakat’  tidak membantu, malahan menyekat proses pemulihan disebabkan oleh faktor stigma yang tinggi membunuh semangat pesakit untuk pulih. Konsep ‘pencegahan lebih baik dari mengubat’ perlu dititikberatkan dan masyarakat perlu faham bahawa terdapat faktor-faktor yang boleh mendorong seseorang itu untuk jatuh ke kancah penyalahgunaan dan kebergantungan terhadap dadah. Sungguhpun demikian, masyarakat tidak seharusnya dipersalahkan serratus peratus diatas sikap ‘negatif’ terhadap pesalah-pesalah dadah. Ramai yang berasa trauma melihat akibat penyalahgunaan dadah ini sehingga mencetuskan persepsi sedemikian. Dengan itu, adalah menjadi tanggungjawab agensi-agensi professional untuk memberikan pengetahuan secukupnya kepada masyarakat tentang peranan mereka dalam menangani isu global ini.

Konsep perawatan dan pelan pemulihan dadah mememerlukan kerjasama yang erat dari semua pihak. Sungguhpun terdapat pelbagai cara perawatan yang dipraktikkan,  seharusnya konsep perawatan yang dijalankan ini perlulah berlandaskan dari bukti kajian-kajian terdahulu tentang keberkesanannya. Sudah tiba masanya satu halatuju dan pemahaman yang selari diantara agensi-agensi yang terlibat memberikan fokus kepada objektif-objektif yang sama untuk memastikan keberkesanan pelan perawatan dan pemulihan. Pelan perawatan yang diberikan seharusnya bersifat lebih komprehensif dengan mengambilkira seluruh aspek kehidupan pesakit termasuklah penerapan semula pesakit yang telah pulih ke dalam masyarakat dan isu-isu kekeluargaan yang seringkali terabai dan dianggap remeh oleh sesetengah perawat.

AMAM meyokong pendekatan berasaskan pengurangan kemudaratan (harm reduction) yang telah lama dipraktikkan dinegara ini yang merangkumi penggunaan terapi gantian seperti Methadone dan Buprenorphine serta pendekatan terapi selain ubat-ubatan seperti terapi individu dan penerapan semula pesakit dalam komuniti.   Konsep pembasmian dadah yang merujuk kepada hukuman semata-mata terbukti tidak mendatangkan hasil yang diharapkan, malahan mendatangkan beban yang tinggi kepada negara dari sudut kewangan. Masalah perlambakan pesalah penggunaan dadah yang menerima hukuman di penjara tanpa menerima rawatan yang sewajarnya untuk pemulihan dari kebergantungan terhadap dadah mencetuskan masalah “revolving door” apabila mereka dipenjarakan semula atas kesalahan yang sama setelah tamat tempoh hukuman. Justeru itu AMAM menyambut baik cadangan Menteri Undang-undang Liew Vui Kong supaya undang-undang pesalah dadah dikaji semula dan tidak berfokuskan hukuman semata-mata. Masalah pengedaran dadah perlu ditangani dengan cara yang berbeza dari masalah penggunaan dadah. Penggubalan undang-undang yang baru ini semestinya perlu mengambilkira pelan perawatan pesalah dadah bagi membantu proses pemulihan mereka.  Perbincangan yang menyeluruh dan kesepakatan diantara semua agensi yang terlibat dalam pengurusan individu dengan masalah penyalahgunaan dadah merupakan kunci utama untuk membantu pemulihan mereka.

 Profesor Madya Dr Suzaily Wahab
Pakar Perunding Psikiatri PPUKM
Ahli Jawatankuasa AMAM

I was proud to be given the honour of being an AMAM representative to present in the WPA Congress in Melbourne from 25th to 28th February 2018. My presentation was based on a study done among juvenile detainees looking at their history of substance use and other associated factors such as maltreatment and family functioning. I must congratulate all the research team members on the excellent work, especially to my former student and current colleague, Dr. Muhammad Adib Baharom who had diligently and patiently strived through the rough hours and make this research a success. Our research findings had highlighted on an essential but often neglected issue, which is, the significant association between history of maltreatment and substance use. My sincere thanks to AMAM for making the knowledge sharing process with colleagues from the other parts of the world possible.

The current issue of substance use in adolescents and young adults is worrying. Our study revealed a high percentage (about 70%) of the juvenile detainees had history of abusing drugs. Statistics from the National Anti-Drug Agency of Malaysia showed an increased trend of substance use case detections among adolescents within the past few years. This highlights the seriousness of the issue in the local population and highlights the needs for proper intervention planning in order to manage the problem. An understanding   of the substance use issues in the local community and the ability to identify both risk factors and protective factors towards substance use is unquestionably necessary for effective substance use prevention plan.

Is our community ready to make the necessary changes in preventing youth substance use and how much has been done so far? Plested (1999) described a number of readiness for change stages observed in the community; no awareness / denial / vague awareness / preplanning / preparation / initiation / stabilization / expansion / professionalization, each of which is shown by a certain community’s response. For example, at the stage of ‘denial’, the community may not believe the problem is in actual fact, occurring and even if it occurs, nothing can be done about it. This is in contrast to the community who is in ’stabilization’ phase which fully support existing programmes to address substance use issues. And so, the question remains as at what stage our community is in at this time point and whether we are contributing adequately towards the betterment of the issues.

Prevention is always better than cure. The ability to Identify the risks and protective factors in tackling the issue of adolescent substance use is undeniably crucial as the first approach in problem prevention. Labelling difficult behaviours in the young population with contempt  and as ‘always difficult’ without further analysing why it occurs brings injustice to the adolescents and leave the community stuck at the denial stage.   The stigma, rejection and demoralization brought upon by the community may further demoralize these adolescents’ self-esteem and self-worthiness hence pushing them more towards substance use.

A step back approach is probably more effective and useful in the long run. The analysis needs to encompass the whole environment    interacting with the child/ adolescent namely family, peers school and community. An adolescent who lacks parental supervision and monitoring may turn to drug use without any of the family members realizing it. A non-nurturing and chaotic home environment, substance abusing parent, or an emotionally unstable parent who cannot provide significant care to the children, all become the unseen risks to drug use. However, even in the serenity of perfect home environment, the adolescent may decide to ‘just try’ the new ‘pills’ due to peer pressure. As for school, the inadequate policy and intervention to ensure the  un availability of the drug in school area  may also pose another problem. And last, blame it on the community where there is marked poverty with increased number of school dropouts which may further increase the risk.

It is important to note that the link and pathway towards substance use is not necessarily direct, but more often interjected in between in the normal developmental and life processes of the young. There is always a strong need to be cautious of significant transitions     in life which may pose more demand in the life of the adolescent. These are the risky time point and need to be adequately addressed. For example, during the examination years, when the demand to perform with success is very high, some adolescents may just cope by finding means either by temporarily ‘escape’ or finding the perfect temporary ‘boost’ for their mental and physical performance by resorting to substance use.

Realizing the fact that the pathways towards adolescent substance use are multiple and diverse, the prevention plan may not be possible without cooperation from all stakeholders, including general practitioners and family physicians. General practitioners and family physicians have undeniably significant roles in the prevention of adolescent substance use as familial factors are also massive contributors to adolescent risky behaviours. Some general practitioners are also monitoring a number of patients on medically assisted substance abuse treatment programmes in their clinics. There are several measures that can be practiced by the attending general physicians when managing patients.

1. Understand that every adult client seeking medical treatment is a part of a family unit.
2. Spend time to talk to the client’s family members and children when the opportunity arises
3. Identify early any problem or issues which may lead to violence or abuse in the family. It is important to note that abuse and maltreatment have significant association with adolescent substance use.
4. Treat the client with their family’s well-being as an aim
5. Educate on how children can model the drug us e behaviour from parents or significant persons in their lives.
6. Educate on how any intentional or unintentional abuse has an impact on children’s lives not only current but also in future.
7. Identify any risky behaviours in the client’s children that potentially may lead to substance use and help the client manage the problem by referring them to the appropriate professionals.

The prognosis can only be made better with awareness and appropriate actions by everyone in the community.

Associate Professor Dr Suzaily Wahab
UKMMC
AMAM Council Member