A twelve-month study of all university students with psychological problems and symptoms, referred by the Student Health Physicians of the University of Malaya, Kuala Lumpur was conducted. A total of 308 students were seen and treated. The following results were elicited:
1) The proportion of student breakdown among the different ethnic groups was in proportion with the total student population.
2) There was no significant difference in diagnosis among students of urban-rural origins or from the different faculties.
3) The majority of students were seen during the first term from the first and second year courses.
4) Fifty-six percent of students suffered from symptoms prior to their admission to the university.
5 ) Differences in language stream, especially from the Malay-medium schools, did not increase the rates of breakdown because of attenuating factors to reduce the stress among Malay students.
6) Chinese students had significantly more severe acculturation gap differences from their parents than Malay students. They also significantly came from more well-off homes, of a higher social class and from urban regions as compared to the Malay students.
7) Fifty-one percent were diagnosed as suffering from a neurosis and 13.3% from a schizophrenic psychosis. The neurotics had a much lower failure rate than the schizophrenic students.
8) Personality and family problems were significantly higher among Chinese than Malay students. On the whole, there were more personality and family problems among urban-based students of both ethnic groups.
There has been a rapid increase in the past five years in the numbers of hospitalized drug dependents. While the studied population was clearly unrepresentative of the country-wide drug using population, it illustrates how the problem is neither limited to one particular stratum of society, nor to the few "traditional" drugs. Indeed, an increasingly youthful group of individuals drawn from all backgrounds is not only becoming dependent upon opiates, but is also using a range of other drugs, all of which are available on the market at relatively low cost. The market prices of drugs have an effect on the pattern of drug use; and many individuals move directly from tobacco to heroin smoking. Drug abuse continues to be a considerable public and governmental concern, and enforcement and treatment programmes are rapidly expanding in attempts to resolve this problem.
A field survey, based on a representative sample of children aged 12 to 16 years was carried out in three different areas of Malaysia. The data derived from the study have revealed that 10.5 per cent of them used drugs for non-medical reasons. Drug use was more common among boys (11.9 per cent) than girls (8.6 per cent). The highest frequency of drug was found in the youngest group--12-year-old children (13.5 per cent). The use of barbiturate and/or non-barbiturate sedatives (5.5 per cent) ranked first. This was followed in descending order by tranquillizers (4.5 per cent), simultants/amphetamines (3.9 per cent), heroin (3.6 per cent), morphine and/or opium (3.9 per cent), the hallucinogens (3.1 per cent) and cannabis (2.7 per cent).
A representative sampling of the secondary school population of two states of Malaysia (sample size 16166) indicated that 11% of students had had experience of drug use. Use of a single drug was the common pattern, with cannabis reported most often by older students, and sedatives most often by younger students. A quarter of those who had used drugs reported experience with four or more substances and were likely to have progressed rapidly to heroin. This progression may be facilitated by the ready availability of heroin and the local tradition of smoking or inhaling rather than injecting opiates. Descriptions of drug migration patterns based on Western samples are not fully appropriate worldwide, because the youthful abuser is much influenced both by local market forces and by cultural traditions, even though the epidemic of youthful drug abuse is itself worldwide.
Although those Malaysian secondary schoolchildren who have never used drugs are consistent in their support for legal and social sanctions against drug use, it is argued that such sanctions are a relatively unimportant factor in the decision whether or not to use drugs. Non-drug users inhabit a social world separated from their drug-using contemporaries; they rely on information from public rather than direct social sources, and claim to have been little interested in information received. However, there is evidence that, for a minority of the drug-using sub-sample, public information campaigns have made them more rather than less interested in experimenting with drug substances.
A survey was conducted on three different groups of population viz. inpatients in the medical wards of General Hospital, Kuala Lumpur, the people of Kampong Pandan and two rubber estates as to their analgesic consuming habits. It is found that 0.5 to 2.0% of the people surveyed had consumed more than 2 kg of analgesics and 4.6 to 9.6% of the people surveyed had consumed more than 250g of analgesics. The commonest analgesic consumed is paracetamol followed by Chap Kaki Tiga and Chap Harimau. The commonest reason for consuming analgesic is headache. The implications of the above findings are discussed.
The article focuses on countries and areas of South-East Asia, which are seriously affected by drug abuse and the problems associated with it. Opium has traditionally been used for treating illnesses and alleviating physical and mental stress, as well as for recreational and social purposes. The prohibition of the sale and use of opium in Burma, Hong Kong, Malaysia, Singapore and Thailand forced many habitual opium users to switch to heroin. Over the past two decades there has been an increasing trend towards drug use, often involving experimentation with more than one substance, among youth in and out of school. For example, a survey of students at teachers' colleges in northern Thailand showed that at some time in their lives 30-40 per cent of the male respondents and 3-6 per cent of the female respondents had used cannabis, and that 18-20 per cent of the males and 12-27 per cent of the females had sniffed volatile solvents. The same survey showed that 5-10 per cent of both the males and females had used stimulants and nearly 2 per cent had used heroin. During the 1970s the abuse of heroin and other opiates emerged as a serious problem of epidemic nature, predominantly affecting young people in many countries of South-East Asia. While opiates, including heroin, have been abused by inhaling and by smoking, there has recently been an increasing trend towards injecting heroin of high purity (80-90 per cent pure heroin). Heroin addiction spread first to the populations of capital cities and then to other cities and towns and even to the hill tribes, as studies in Thailand have revealed. Most recent studies have shown that heroin abuse has spread further in Asia, both socially and geographically, involving such countries as India and Sri Lanka, which had no previous experience with the problem. Studies have also shown that the abuse of manufactured psychotropic substances has been increasing and that heroin addicts resort to these substances when heroin is difficult to find. The article also briefly reviews the history of opium use in China and the history of drug abuse in Japan, particularly with regard to the problem of methamphetamine abuse, which has appeared in two epidemic-like waves. The first followed the end of the Second World War and disappeared at the end of the 1950s; the second reappeared in 1975 and since then has gradually been increasing in size.
Epidemiological studies are carried out by the National Drug Research Centre, Malaysia on various aspects of drug use and abuse. One of the groups of substances studied are the opioid agonist-antagonists. The study utilised information submitted to international agencies and obtained through a questionnaire survey. The results showed that out of 28 countries studied, 18 reported existence of illicit traffic in these substances and of this, 17 indicated seizures. A majority of countries were unable to give consumption data and the limited information available did not allow any significant conclusions. The study did not demonstrate a significant problem of abuse globally.
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.
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.
Monitoring systems are useful epidemiological instruments for assessing the problem of drug abuse. The rapid growth of the drug dependence problem in Malaysia led to increased awareness of the need for a system for continuous monitoring of the situation. Preliminary work on the design of an appropriate monitoring system was initiated in 1976. A fully integrated national reporting system was established in 1978, linking all public services and agencies coming into contact with drug-dependent persons, including law enforcement agencies, drug abuse treatment and rehabilitation centres, and social and welfare institutions. The information system included a mechanism for systematic gathering, processing, analysing and presenting essential data on the prevention, control and management of drug abuse problems. It also included reporting on drug-related events, such as hospitalizations and arrests, as well as data on known drug-dependent persons and new cases of dependence. The system has been used for routine monitoring of the extent, trends, patterns and other characteristics of drug abuse problems in Malaysia, providing basic information for policy-making and programme planning. On the basis of data generated by the system, it was estimated that the prevalence rate of drug-dependent persons per 100,000 population increased from 84.3 in 1976 to 754.6 in 1986. It was estimated that there were 119,001 drug-dependent persons in Malaysia in 1986.
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.
It is a common belief that a massive effort in law enforcement, preventive education and rehabilitation will result in the elimination of a country's drug problem. Based on this premise. Malaysia in 1983 implemented such a multifaceted anti-drug strategy, and the results of a 1987 study by the author suggested that Malaysia's effort had begun to contribute to a steady decrease in the number of identified drug abusers. Although the number of drug-addicted individuals declined, the country's recidivism rates were still high. Because of this high relapse rate, Malaysia expanded their rehabilitation effort and developed a community transition program. In order to determine the impact of these changes on the country's battle against drug abuse, a follow-up study was conducted in 1990. The results of this study did not clearly demonstrate that the Malaysian effort had been successful in eliminating the problem of drug abuse, and raised some questions concerning the effectiveness of the country's drug treatment programs.
Opium has been produced and consumed since the nineteenth century in the areas of Asia currently referred to as the Golden Crescent and the Golden Triangle. In the 1970s and 1980s, most countries from Afghanistan to Japan experienced a heroin epidemic of varying degrees of severity. Opium and heroin abuse appeared to be more severe in countries and areas where those drugs were produced, an exception being Hong Kong, which has had a large population of heroin abusers for more than two decades. Drug injecting was far more common in countries of the Golden Triangle than in those of the Golden Crescent. In Myanmar and Thailand, for example, up to 90 per cent of chronic heroin abusers practised intravenous injection, which appeared to spread to heroin abusers in nearby territories such as the State of Manipur in India. Yunnan province in China, as well as Malaysia and Viet Nam. Amphetamine abuse was more frequent in Japan and the Republic of Korea for a number of years, while illicit production and consumption in the Philippines have recently shown significant increases. The injection of amphetamines was common only in the Republic of Korea. The prevalence of injecting among institutionalized methamphetamine abusers was reported at about 90 per cent. Most countries in Asia first reported cases of infection with the human immunodeficiency virus (HIV) in the mid-1980s. An extremely rapid spead of the epidemic and high prevalence, at rates of from 30 to 90 per cent, of HIV infection among the sample of intravenous heroin abusers were observed in a few countries with a high prevalence of intravenous injecting, such as India (in the State of Manipur), Myanmar and Thailand. The rest had either few reported cases or none at all, even though needle-sharing was found to be common. Great caution should be exercised in interpreting prevalence because of vast differences in methods of assessment. Given the vulnerability of intravenous drug abusers to rapid transmission of HIV infection, the prevention of drug injecting is of paramount importance in arresting the spread of the epidemic. Efforts to contain drug abuse, though difficult, are a principal means of achieving that end.
One hundred and seventy-one drug-dependent females in a drug rehabilitation centre were studied to estimate the prevalence of HIV infection among them. Twenty-four (14%) were positive on the Western Blot test. The presence of HIV infection was significantly correlated with syphilis (p < 0.03) and age (p < 0.001); 83% of those who were HIV positive were intravenous drug users. The need for harm reduction programmes to prevent spread of HIV infection among injecting drug users is stressed.