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Fulltext Attitudes toward medication-assisted treatment among fishermen in Kuantan, Malaysia, who inject drugs

Brown SE, Wickersham JA, Pelletier AR, Marcus RM, Erenrich R, Kamarulzaman A, et al.

J Ethn Subst Abuse, 2016 07 12;16(3):363-379.
PMID: 27404914 DOI: 10.1080/15332640.2016.1196632

Fishermen who inject drugs represent an understudied group at high risk for HIV in Malaysia. This study describes fishing, drug use, and attitudes toward medication-assisted treatment (MAT) for opioid use disorders. Thirty-four male ethnic Malay fishermen completed semistructured interviews analyzed by content analysis. Analysis revealed four themes surrounding opioids, which they called ubat ("medicine"): (a) the fishing lifestyle facilitating substance use, (b) previous unsuccessful attempts to quit, (c) categorizing substances as haram or halal, and (d) attitudes toward MAT. Fishermen's environment permits substance use, including injecting drugs on boats. Fishermen expressed more positive attitudes toward methadone and negative attitudes toward buprenorphine.
Exploring adolescents' practice and perspective on the use and misuse of kratom in northwest Malaysia

Khalid K, Ku Md Saad S, Soelar SA, Mohamed Yusof Z, Warijo O

J Ethn Subst Abuse, 2023;22(1):121-132.
PMID: 33784945 DOI: 10.1080/15332640.2021.1906816

Kratom is a plant homogenous to Southeast Asia with a long history of traditional use as medicinal herbs. However, recent years have witnessed its pervasive infiltration into international audience with growing public health concern. This cross-sectional study was conducted from 1 August 2017 till 31 August 2018 aiming to explore the practice and perspectives of kratom use and misuse among adolescents in northwest Malaysia. The study involved a self-administered questionnaire that was designed for the purpose of the study. The instrument had undergone prior validation process with a good overall internal reliability for the knowledge domain (Cronbach's alpha = 0.728) and attitude domain (Cronbach's alpha = 0.700). The questionnaire was distributed to 135 respondents involving adolescents aged 13 to 19 years old via convenience (non-kratom user) and snowball sampling (kratom users). There were 65 (47.8%) kratom users, while 70 (51.5%) were kratom-naïve. Among the kratom users, peer influence was the most common reason for them to be first involved with kratom, 26 (41.3%) whereas the reasons for kratom use quoted were to improve physical stamina, 10 (16.4%), as painkiller, 9 (14.8%), and to be accepted by peers, 7 (11.5%). Multiple logistic regression found that older age (95% CI: 0.13, 0.58; p = 0.001) and being active smokers (95% CI: 39.33, 980.63; p
Continuity of illicit drug use among Malay patients attending methadone clinics in Kelantan, Malaysia

Ab Lloh S, Mohamad N, Badrin S, Abu Bakar R, Ahmad I

J Ethn Subst Abuse, 2023;22(1):45-59.
PMID: 33472556 DOI: 10.1080/15332640.2021.1871696

The study aimed to determine the prevalence of continuity of illicit drug use and its associated factors among Malay opioid users receiving methadone treatment in Kelantan, Malaysia. This cross-sectional study involved a total of 150 respondents. Sociodemographic characteristic of participants, level of religiosity, and quality of life were collected using the self-administered questionnaires. The prevalence of continuity illicit drug use was 38.7% (n = 58) by self-report and 40.7% (n = 61) by positive urine test result for drugs. Positive hepatitis C status and high quality of life in the psychological health domain were associated with low continuity of illicit drug use by self-reported data and urine drug test results. In conclusion, the continuity of illicit drug use among methadone program users is still high, especially among those on methadone therapy for less than 2 years.
Factors associated with drug use during pregnancy and breastfeeding among females who use drugs (FWUDs) in Malaysia

Anandan A, Athirah Daud NA, Vicknasingam B, Narayanan S, Azman A, Singh D

J Ethn Subst Abuse, 2023;22(4):766-781.
PMID: 34965841 DOI: 10.1080/15332640.2021.2019162

Females who use drugs (FWUDs) are at risk of continuing illicit substance use during pregnancy and breastfeeding. We investigated the prevalence rates and factors associated with these practices in a sample of 200 FWUDs recruited from a publicly-run drug rehabilitation center. A semi-structured questionnaire was used to collect the data. The majority (86%) was Malay (n = 171/200), currently single (71%, n = 141/200), and 51% had nine years of education. The mean age of respondents was 32.2 years (SD = 8.61). Thirty-eight percent (n = 75/200) reported ever using illicit substances during pregnancy, while 15% (n = 30/200) had used them during breastfeeding. Higher odds of using drugs during pregnancy were associated with having an intimate male drug-using partner and with persons who reported abandoning an infant in the past. Lower odds were linked with women who used heroin with ATS (relative to those who used only ATS), and shorter-term ATS (≤3 years) relative to long term ATS users. At a lower level of significance (p = 0.054), being married also lowered the odds. Higher odds of drug use during breastfeeding were associated with having an intimate male drug-using partner, and previous methadone use history, while lower odds were associated with short-term ATS use and being employed. The findings highlight the need for timely and targeted interventions to inform, engage and promote the participation of FWUDs in pre- and post-natal care services.
Kratom (Mitragyna speciosa) use in a sample of drug-dependent adolescents in rehabilitation for drug use in Malaysia

Singh D, Azuan MA, Narayanan S

J Ethn Subst Abuse, 2023 Dec 23.
PMID: 38142274 DOI: 10.1080/15332640.2023.2293941

BACKGROUND: Leaves derived from the Kratom (Mitragyna speciosa) tree have been traditionally ingested for their curative properties by diverse groups of the population including people who use drugs (PWUDs) in Southeast Asia. This study investigated the motives for using kratom among drug-dependent adolescents.
METHODS: Eighty adolescents who were undergoing mandatory drug rehabilitation volunteered to participate in this mixed-method, cross-sectional study. All respondents answered a semi-structured questionnaire while a few were interviewed in-depth.
RESULTS: The majority were males (70%, n = 56/80). The respondents' mean age at admission was 18.2 years (SD = 1.40), and 65% were between 14 and 18 years old. Sixty-three percent (n = 50/80) had used crystal methamphetamine alone, while the rest had co-used crystal methamphetamine with heroin. About three-fifths (60%, n = 48/80) had a history of kratom use. Kratom was commonly used for many perceived benefits such as increasing energy, reducing crystal methamphetamine intake, intensifying euphoria, easing heroin withdrawal, as a heroin substitute and reducing heroin use. In addition, the multivariate analysis indicated that higher odds of kratom use were associated with those who were employed, used only crystal methamphetamine, were recent drug users, and had no prior incarceration history.
CONCLUSION: While kratom was being used for its multifold perceived benefits, it also functions as a means to self-treat withdrawal from illicit drug use among drug-dependent adolescents.
Effects of kratom (Mitragyna speciosa Korth.) in reducing risk-behaviors among a small sample of HIV positive opiate users in Malaysia

Singh D, Narayanan S, Abdullah MFIL, Vicknasingam B

J Ethn Subst Abuse, 2020 Nov 16.
PMID: 33190622 DOI: 10.1080/15332640.2020.1845899

Out-of-treatment HIV positive opiate users often engage in risky injecting and sexual behaviors. We sought the self-reported experiences on whether or not kratom (Mitragyna speciosa Korth.) use was associated with a reduction in HIV risk behaviors among them. A convenience sample consisting of thirty-two HIV positive opiate users participated in the study. Of this, three-fifths (n = 20/32) used kratom to suppress opiate withdrawal, increase energy, as a heroin substitute, to reduce heroin dependence and self-treat psychological problems. More than one-third (38%) in the sample claimed that kratom use reduced their risky injecting and sexual behaviors. Given the small sample size, the perceived association between kratom use and the reduction in HIV risk behaviors could not be established more convincingly. However, the findings provide the basis for a broader-based study to evaluate the potential of kratom in curtailing HIV risk behaviors among HIV positive opiate users.
Barriers to enrolling in voluntary treatment programs in Malaysia: a study of women who use methamphetamine (WWUM)

Singh D, Anandan A, Narayanan S, Athirah Daud NA, Azman A, Vicknasingam B

J Ethn Subst Abuse, 2022 Nov 21.
PMID: 36409777 DOI: 10.1080/15332640.2022.2147116

Women with substance use disorders (SUDs) have been widely reported to face barriers in seeking treatment. We sought to identify barriers that prevented women who use methamphetamine (WWUM) from accessing the decade-old Voluntary Treatment Centers (VTCs) in Malaysia. A total of 153 WWUM who were undergoing rehabilitation for methamphetamine use at a compulsory drug detention center (CDDC) were recruited for this cross-sectional study. Data were collected by canvasing a structured questionnaire through face-to-face meetings. Of the total sample, 131 (86%) were Malays, with a mean age of 32.1 years. The commonly cited treatment barriers were the belief that methamphetamine use was not problematic (42%), not knowing how to seek treatment (38%), feeling embarrassed to seek treatment (33%), the lack of family support (24%), and the long waiting time for enrollment (23%). Logistic analyses indicated that a longer duration of use increased the odds of not acknowledging methamphetamine use as a problem while older participants had lower odds of holding a similar view. A longer duration of use also increased the odds of claiming treatment was not needed but lowered the odds of asserting a lack of confidence in treatment. Furthermore, Malays had higher odds of lacking family support in seeking treatment while being employed lowered the odds of not wanting treatment. Addressing these concerns will hopefully encourage higher participation of WWUM in voluntary treatment programs.
Are smoking restrictions at public venues and psychosocial beliefs associated with intentions to quit smoking among smokers in Malaysia?

Subramaniyan M, Yee A, Hairi FM, Kaai SC, Nordin ASA, Danaee M, et al.

J Ethn Subst Abuse, 2022 Sep 21.
PMID: 36129734 DOI: 10.1080/15332640.2022.2123421

The Malaysian government reinforced smoking restrictions at public venues to protect nonsmokers from secondhand smoke (SHS) exposure. This study examined whether smokers' reports about smoking restrictions and psychosocial beliefs were associated with quit intentions among Malaysian smokers. Data from 1047 cigarette smokers (103 females and 944 males) aged 18 and older from the 2020 International Tobacco Control (ITC) Malaysia Wave 1 Survey were analyzed with bivariate and multivariable logistic regression models. Most Malaysian smokers (85.2%) reported having quit intentions. Smoking was completely restricted in 34.8% of the nighttime venues, 85.3% of air-conditioned (AC) food and beverage (F&B) venues (restaurants, food courts, coffee shops), 87.3% of non-AC F&B, and 69.4% of indoor workplaces. Smokers who visited nighttime entertainment venues where smoking was fully restricted were less likely to have quit intentions. There was no significant association found with quit intentions for smokers who visited AC and non-AC F&B venues and indoor workplaces where smoking was fully restricted. All five psychosocial beliefs assessed, age, and education were positively associated with quit intentions. Malaysian smokers are interested in quitting and psychosocial beliefs were positively associated with quit intentions. There is a need for the Malaysian government to implement and reinforce comprehensive smoking restrictions in all public venues and indoor workplaces to protect nonsmokers from SHS exposure and to encourage smokers to think about quitting, which may influence their quit intentions.
Drug addictions in Malaysia: a mini-review on drug types, rehabilitation centers and therapeutic programs

Mohd Nawawi NAA, Othman EA, Mohd Nasir F, Abdullah KA, Baharudin MN

J Ethn Subst Abuse, 2024 Apr 08.
PMID: 38588590 DOI: 10.1080/15332640.2024.2336495

Drug addiction remains one of the most complex social problems worldwide that has yet to be resolved. In Malaysia, abuse of various types of drugs has been reported which warrants the government to take immediate strategies in managing drug addicts. Despite implementing various strategies to treat drug addiction, statistics show the number of relapses continues to skyrocket over the years. This calls for urgent attention to improve the effectiveness of substance abuse treatment services in Malaysia. Moreover, emerging evidence shows a change in trend in the type of drug being abused. This factor could potentially contribute to the ineffectiveness of the strategies employed in the treatment of substance abuse. Therefore, this review provides an overview of the major types of drugs commonly abused in Malaysia. Additionally, in an effort to search for ways to improve the effectiveness of substance abuse treatment services, we identified the public institutions responsible for managing drug addicts in Malaysia and discussed the therapeutic programs offered at the institutions. Review findings support the need for future research on the effectiveness of these therapeutic programs and recommend the implementation of evidence-based programs to improve the effectiveness of substance abuse treatments in Malaysia.