MyMedR

Malaysia and Singapore: new export centers for the Southeast Asian heroin trade

Solomon R

J Psychedelic Drugs, 1979 10 1;11(4):283-8.

PMID: 522169

Matched MeSH terms: Heroin/supply & distribution*; Heroin Dependence/etiology

Heroin in Malaysia and Singapore

Sulaiman M, Kunalan V, Yap ATW, Lim WJL, Ng JJY, Loh SWX, et al.

Drug Test Anal, 2018 Jan;10(1):109-119.

PMID: 28670869 DOI: 10.1002/dta.2238

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.

Matched MeSH terms: Heroin/adverse effects; Heroin/analysis; Heroin/chemical synthesis*; Heroin Dependence/diagnosis; Heroin Dependence/epidemiology*

Aspects of opiate dependence and its management in Malaysia

Deva MP

Family Practitioner, 1978;3:23-27.

The result of the opiate (notably heroin) epidemic in Malaysia has been one of an excessive overload on existing medical and social services. The immediate problem of detoxification and rehabilitation is likely to continue for a while before planned and purpose-built and staffed centres take over to bring the problem, hopefully, to manageable proportions.

Matched MeSH terms: Heroin

Fulltext Heroin addiction: the past and future

Noor Zurani, M.H.R., Hussain, H., Rusdi, A.R., Muhammad Muhsin, A.Z.

Malaysian Journal of Psychiatry, 2008;17(2):1-6.

MyJurnal

Substance misuse, in particular heroin addiction contributes to health and social problems. Although effective medical treatment was available, earlier efforts confined the treatment of heroin addicts to in-house rehabilitation which required them to be estranged from the community and their families for 2 years. The in-house rehabilitative programme, implemented for at least three decades has produced low abstinence rates. On the other hand, being ‘away’ meant that many heroin addicts faced employment problems and family relationship difficulties upon completing the in-house rehabilitation. However, recently, the concerted efforts by various government and non-government organisations, and the acknowledgement that heroin addiction is a medical illness has resulted in a revamp to approaching treatment of heroin addiction. At present, methadone substitution programmes have been offered as part of treatment programme for heroin addicts in Malaysia. This new programme has been shown to be effective in treating heroin addiction and would need support and cooperation from all groups involved.

Matched MeSH terms: Heroin; Heroin Dependence

Morinda citrifolia Linn. fruit extract mitigates heroin seeking behavior in mice

Pandy V, Khan Y, Yarlagadda DP, Tatinada SP

Acta Neurobiol Exp (Wars), 2021;81(4):328-334.

PMID: 35014982

Methanolic extract of Morinda citrifolia unripe fruit (MMC) was tested against heroin addiction using a mouse modified runway model of drug‑seeking. Habituation sessions were carried out for 10 min/d for 3 days. On day 0, the total run time of each mouse was noted (the start box to goal box) during the preconditioning test. This was followed by the conditioning session (30 min), in which the animals were conditioned with escalating doses of heroin hydrochloride (5, 10, 20, 40 and 40 mg/kg) for 5 days upon entry into the goal box. On day 6, the run time of each mouse, from start to goal box, was recorded during the post conditioning test. Extinction trials were performed for the next 5 days, in which no drug/saline was injected upon goal box entry. On day 13, a priming dose of heroin (8 mg/kg) was given to reinstate drug seeking in the mice. MMC given as oral doses (1, 3 and 5 g/kg) dose‑dependently prolonged the run time to reach the goal box, indicating MMC attenuated heroin reinforcement. Moreover, MMC (5 g/kg) was found to reverse the heroin‑seeking on extinction trial 1 and 2. MMC was also found to reverse heroin‑induced reinstatement in mice. This study demonstrates that MMC attenuated heroin seeking at different phases of drug self‑administration in a mouse modified runway model.

Matched MeSH terms: Heroin*

Opiate dependence--the role of benzodiazepines

Navaratnam V, Foong K

Curr Med Res Opin, 1990;11(10):620-30.

PMID: 1968829

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.

Matched MeSH terms: Heroin Dependence/complications; Heroin Dependence/epidemiology*; Heroin Dependence/psychology

A simplified clustering method for novice narcotic chemists

Chan KW, Tan GH, Wong RC

Sci Justice, 2012 Sep;52(3):136-41.

PMID: 22841136 DOI: 10.1016/j.scijus.2012.04.006

Statistical classification remains the most useful statistical tool for forensic chemists to assess the relationships between samples. Many clustering techniques such as principal component analysis and hierarchical cluster analysis have been employed to analyze chemical data for pattern recognition. Due to the feeble foundation of this statistics knowledge among novice drug chemists, a tetrahedron method was designed to simulate how advanced chemometrics operates. In this paper, the development of the graphical tetrahedron and computational matrices derived from the possible tetrahedrons are discussed. The tetrahedron method was applied to four selected parameters obtained from nine illicit heroin samples. Pattern analysis and mathematical computation of the differences in areas for assessing the dissimilarity between the nine tetrahedrons were found to be user-convenient and straightforward for novice cluster analysts.

Matched MeSH terms: Heroin

BDNF rs6265 polymorphism and drug addiction: a systematic review and meta-analysis

Haerian BS

Pharmacogenomics, 2013 Dec;14(16):2055-65.

PMID: 24279859 DOI: 10.2217/pgs.13.217

A majority of studies have shown a link between the common functional rs6265 polymorphism of the BDNF gene and susceptibility to drug dependence. However, the pattern of results is inconsistent. To precisely evaluate this association, a systematic review and meta-analysis of previous case-control reports was conducted. Data from 20 studies containing 9419 participants (4665 cases and 4754 controls) conducted between 2004 and 2013 restricted to alcohol, nicotine, heroin, substance and methamphetamine dependency were meta-analyzed. Following quality control of the results, a significant association between C allele and methamphetamine dependence remained in south Asian subjects (p = 0.004). Similar results were detected in south Asian subjects for methamphetamine dependence and in Chinese subjects for heroin dependence under an autosomal codominant genotype model (TT vs CC, p = 0.005 and p = 0.0004, respectively). In conclusion, the rs6265 polymorphism may be a risk factor for methamphetamine dependence in south Asian subjects or for heroin dependence in Chinese subjects.

Matched MeSH terms: Heroin/toxicity*; Heroin Dependence/genetics*; Heroin Dependence/pathology

Treating heroin addiction: bridging the past and future--a Malaysian experience

Robson N, Rashid R, Nazar M, Habil H

Asia Pac Psychiatry, 2015 Mar;7(1):121-5.

PMID: 23857876 DOI: 10.1111/j.1758-5872.2012.00194.x

Matched MeSH terms: Heroin Dependence/drug therapy*

Fulltext An epidemiological assessment of drug dependence in Malaysia--a trend analysis

Navaratnam V, Foong K

Med J Malaysia, 1989 Jun;44(2):92-103.

PMID: 2626130

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.

Matched MeSH terms: Heroin Dependence/epidemiology*

Alternative systems in Malaysian drug rehabilitation: organization and control in comparative perspective

Lee RL

Soc Sci Med, 1985;21(11):1289-96.

PMID: 4095582

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.

Matched MeSH terms: Heroin Dependence/rehabilitation*

An evaluation of TLC systems for opiate analysis

Rajananda V, Nair NK, Navaratnam V

Bull Narc, 1985 Jan-Mar;37(1):35-47.

PMID: 4063572

The authors selected 38 thin-layer-chromatography (TLC) systems described in the available literature published over the last 10 years and evaluated those systems with respect to their suitability for detection and identification of opiates in urine, opium and heroin, as well as adulterants in heroin. A total of 14 substances: 8 opiates (morphine, 6-monoacetylmorphine, diacetylmorphine, codeine, acetylcodeine, noscapine, papaverine and thebaine) and 6 adulterants (ephedrine, quinine, methadone, caffeine, cocaine and strychnine) were used as test samples for this research. Using laboratory-coated plates and pre-coated plates, 15 and 13 TLC systems, respectively, were found to be able to detect and identify morphine and codeine in urine without interference from the remaining 12 substances. For the detection of opiates in opium samples as well as opiates and adulterants in illicit heroin samples the TLC system: chloroform-n-hexane-triethylamine (9:9:4) which was developed by the National Drug Research Centre, Penang, Malaysia, was found to be most suitable on both laboratory-coated and pre-coated plates. In addition, the following two systems, one on laboratory-coated plates--hexane-chloroform-diethylamine (50:30:7)--and the other on pre-coated plates--benzene-dioxane-ethanol-ammonia (50:40:5:5; T-7)--were also found to be among most suitable TLC systems for the analysis of opiates in opium samples. The article also presents the relative cost of each of the 38 evaluated TLC systems.

Matched MeSH terms: Heroin/analysis

Neuroelectrophysiological approaches in heroin addiction research: A review of literatures

Motlagh F, Ibrahim F, Menke JM, Rashid R, Seghatoleslam T, Habil H

J Neurosci Res, 2016 Apr;94(4):297-309.

PMID: 26748947 DOI: 10.1002/jnr.23703

Neuroelectrophysiological properties have been used in human heroin addiction studies. These studies vary in their approach, experimental conditions, paradigms, and outcomes. However, it is essential to integrate previous findings and experimental methods for a better demonstration of current issues and challenges in designing such studies. This Review examines methodologies and experimental conditions of neuroelectrophysiological research among heroin addicts during withdrawal, abstinence, and methadone maintenance treatment and presents the findings. The results show decrements in attentional processing and dysfunctions in brain response inhibition as well as brain activity abnormalities induced by chronic heroin abuse. Chronic heroin addiction causes increased β and α2 power activity, latency of P300 and P600, and diminished P300 and P600 amplitude. Findings confirm that electroencephalography (EEG) band power and coherence are associated with craving indices and heroin abuse history. First symptoms of withdrawal can be seen in high-frequency EEG bands, and the severity of these symptoms is associated with brain functional connectivity. EEG spectral changes and event-related potential (ERP) properties have been shown to be associated with abstinence length and tend to normalize within 3-6 months of abstinence. From the conflicting criteria and confounding effects in neuroelectrophysiological studies, the authors suggest a comprehensive longitudinal study with a multimethod approach for monitoring EEG and ERP attributes of heroin addicts from early stages of withdrawal until long-term abstinence to control the confounding effects, such as nicotine abuse and other comorbid and premorbid conditions.

Matched MeSH terms: Heroin Dependence/physiopathology*

A survey of 47 opiate dependent persons who sought treatment

Deva MP

Med J Malaysia, 1977 Mar;31(3):183-7.

PMID: 904509

Matched MeSH terms: Heroin Dependence/epidemiology

Heroin dependence in developing countries: WHO collaborates in treatment evaluation studies

WHO Chron, 1980 Feb;34(2):60-2.

PMID: 6445134

Matched MeSH terms: Heroin Dependence/therapy*

Drug abuse and counter-measures in Japan

Kumagai H

Med J Malaysia, 1974 Dec;29(2):136-44.

PMID: 4282402

Matched MeSH terms: Heroin Dependence/history

Heroin dependence and HIV infection in Malaysia

Chawarski MC, Mazlan M, Schottenfeld RS

Drug Alcohol Depend, 2006 Apr;82 Suppl 1:S39-42.

PMID: 16769444

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Matched MeSH terms: Heroin Dependence/ethnology; Heroin Dependence/epidemiology*; Heroin Dependence/rehabilitation

The Use of Kratom (Mitragyna speciosa Korth.) Among People Who Co-use Heroin and Methamphetamine in Malaysia

Singh D, Narayanan S, Vicknasingam B, Prozialeck WC, Smith KE, Corazza O, et al.

J Addict Med, 2021 5 19;16(2):223-228.

PMID: 34001777 DOI: 10.1097/ADM.0000000000000876

OBJECTIVES: Kratom (Mitragyna speciosa Korth.), an indigenous medicinal plant, has been widely used as a traditional remedy in Southeast Asia. However, its combined consumption with other substances has received scarce attention. This study investigates the use of kratom among adults with a history of using heroin and methamphetamine in Malaysia.

METHODS: A total of 332 patients who were mandated to undergo drug rehabilitation participated in this cross-sectional study. The study data were collected through face-to-face interviews using a semi-structured questionnaire.

RESULTS: The majority were males (95%, n = 314/332) and Malays (98%, n = 325/332) with a mean age of 32.3 years (SD = 9.16). Over two thirds of the respondents used kratom to alleviate heroin withdrawal symptoms and to reduce methamphetamine intake; 59% used it as a substitute for heroin and methamphetamine. A similar proportion used kratom to reduce heroin intake (58%), while only 15% used it for its euphoric effects. Multivariate analysis showed that previous attendees of government rehabilitation programs had lower odds of using kratom as a heroin substitute.

CONCLUSIONS: The potential of kratom to alleviate heroin withdrawal symptoms, and to reduce methamphetamine and heroin intake, among people who co-use heroin and methamphetamine warrants further research.

Matched MeSH terms: Heroin

Itraconazole-induced torsade de pointes in a patient receiving methadone substitution therapy

NoorZurani MH, Vicknasingam B, Narayanan S

Drug Alcohol Rev, 2009 Nov;28(6):688-90.

PMID: 19930027 DOI: 10.1111/j.1465-3362.2009.00128.x

Methadone, a pharmacological agent used to treat heroin dependence is relatively safe, but may cause cardiac arrhythmias in the concurrent presence of other risk factors. APPROACH AND KEY FINDINGS: This case report highlights the risk of torsade de pointes, a life-threatening cardiac arrhythmia, in a heroin-dependent patient receiving methadone substitution therapy who was prescribed itraconazole for vaginal thrush. The patient presented to the accident and emergency department for chest discomfort and an episode of syncope following two doses of itraconazole (200 mg). Electrocardiogram monitoring at the accident and emergency department showed prolonged rate-corrected QT interval leading to torsade de pointes. The patient was admitted for cardiac monitoring, and electrocardiogram returned to normal upon discontinuation of methadone.

Matched MeSH terms: Heroin Dependence/drug therapy*; Heroin Dependence/physiopathology

Substitution treatment in Malaysia

Noordin NM, Merican MI, Rahman HA, Lee SS, Ramly R

Lancet, 2008 Sep 27;372(9644):1149-50.

PMID: 18926274 DOI: 10.1016/S0140-6736(08)61479-8

Matched MeSH terms: Heroin Dependence/drug therapy; Heroin Dependence/rehabilitation*

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