BACKGROUND: Methadone is a synthetic opiate mu receptor agonist that is widely used to substitute for illicit opiates in the management of opiate dependence. It helps prevent opiate users from injecting and sharing needles which are vehicles for the spread of HIV and other blood borne viruses. This study has the objective of determining the utility of daily methadone dose to predict retention rates and re-injecting behaviour among opiate dependents.
METHODS: Subjects comprised opiate dependent individuals who met study criteria. They took methadone based on the Malaysian guidelines and were monitored according to the study protocols. At six months, data was collected for analyses. The sensitivity and specificity daily methadone doses to predict retention rates and re-injecting behaviour were evaluated.
RESULTS: Sixty-four patients volunteered to participate but only 35 (54.69%) remained active and 29 (45.31%) were inactive at 6 months of treatment. Higher doses were significantly correlated with retention rate (p < 0.0001) and re-injecting behaviour (p < 0.001). Of those retained, 80.0% were on 80 mg or more methadone per day doses with 20.0% on receiving 40 mg -79 mg.
CONCLUSIONS: We concluded that a daily dose of at least 40 mg was required to retain patients in treatment and to prevent re-injecting behaviour. A dose of at least 80 mg per day was associated with best results.
Relapse is a common phenomenon among former addicts who has undergone a preventive and rehabilitation treatment program. Relaps is a condition of using drugs more than one times after stopping them for a certain period of time depending on one's resistance to a drug withdrawal syndrome. There are various factors that affect the former drug addicts became relaps. Hence, the focus of this study is to explain the external factors of relaps among adult male drug addicts in Cure and Care Service Centre, Kuala Pilah, Negeri Sembilan. This study is a qualitative research that has been using a phenomenology approach using face-to-face interviews and further observation among eight drug addicts who are undergoing rehabilitation programs at CCSC Kuala Pilah. Sample selection was done through purposive sampling techniques and data were analyzed using thematic analysis through an inductive approach that focused on coding to obtain some key themes. The result of the study indicates the external factors such as family, peer and environmental factors play a great role in influencing of relapse. In conclusion, these identified factors illustrate the external influences that cause drug addicts to relapse. Therefore, the researcher proposes a post-rehabilitation module or program done by the responsible agencies after the addicts completed the rehabilitation program as guidance for them to the right direction for efficient recovery.
This social psychology study sought to understand how the inability of former drug addicts controlling
interpersonal conflict that occurs in the community resulted in relapse or back to their addiction. A
qualitative phenomenological approach was taken to conduct interviews with former drug addicts that
are participating in a rehab program in Cure and Care Service Centre, Kuala Pilah, Negeri Sembilan,
Malaysia. Eight informants were consented and interviewed. Purposive sampling was used and
responses were analyzed thematically. These themes included the issue of labeling drug addicts as
convicts, isolation from the community and restricted from participating in community-based
programs. Researcher suggests related agencies to work with rehabilitation officers in restructuring the
rehabilitation learning module and improve the interpersonal conflict management module. Therefore,
it is hoped that in the future, former drug addicts would be capable to manage interpersonal conflict
and simultaneously avoid from recidivism in addiction.
Facing competing demands with limited resources following release from prison, people who inject drugs (PWID) may neglect health needs, with grave implications including relapse, overdose, and non-continuous care. We examined the relative importance of health-related tasks after release compared to tasks of everyday life among a total sample of 577 drug users incarcerated in Ukraine, Azerbaijan, and Kyrgyzstan. A proxy measure of whether participants identified a task as applicable (easy or hard) versus not applicable was used to determine the importance of each task. Correlates of the importance of health-related reentry tasks were analyzed using logistic regression, with a parsimonious model being derived using Bayesian lasso method. Despite all participants having substance use disorders and high prevalence of comorbidities, participants in all three countries prioritized finding a source of income, reconnecting with family, and staying out of prison over receiving treatment for substance use disorders, general health conditions, and initiating methadone treatment. Participants with poorer general health were more likely to prioritize treatment for substance use disorders. While prior drug injection and opioid agonist treatment (OAT) correlated with any interest in methadone in all countries, only in Ukraine did a small number of participants prioritize getting methadone as the most important post-release task. While community-based OAT is available in all three countries and prison-based OAT only in Kyrgyzstan, Kyrgyz prisoners were less likely to choose help staying off drugs and getting methadone. Overall, prisoners consider methadone treatment inapplicable to their pre-release planning. Future studies that involve patient decision-making and scale-up of OAT within prison settings are needed to better improve individual and public health.
Matched MeSH terms: Drug Users/psychology*; Drug Users/statistics & numerical data*
This case study demonstrates a 36-year-old ex-intravenous drug user (IVDU) who had been initially tested positive for human immunodeficiency virus (HIV) twice using Enzyme Immunoassay (EIA) method (Particle agglutination, PA done), but a year later he was tested HIV-negative. The patient was asymptomatic for HIV and T helper cells (CD4) count remained stable throughout this period. In light of this case, there may be a need to retest by molecular methods for high risk category patients who were initially diagnosed HIV-positive, but later showing an unexpected clinical course, such as a rising or stable CD4 titre over the years.
The problem of illicit drug use has been a long standing problem in Malaysia. It is well recognized that drug mis-use is associated with many social, economic and health problems, including mental health problems. Anxiety disorders have consistently been cited as the commonest type of psychiatric disorder in drug users. In Malaysia, many drug users are incarcerated in rehabilitation centres and prison. They form a different type of population as compared to the drug user in the general population, due to the effects of incarceration. With this in mind, a study was carried out in a rehabilitation centre, looking at anxiety disorders. Utilizing the SCID, we found current and lifetime diagnoses for anxiety disorders at 63.4% and 67.6% respectively. Suggestions are made in regards to our findings.
The scenario of drug addiction is a chain of threats to individual, families and communities. This is shown through the increasing statistics in addiction relapse causing epidemic to communities. The effects of drug relapse affect individual’s health with problems of comorbidity, psychopathology and psychosocial. After 40 years, Malaysia undertook various efforts in treatment and rehabilitation programs, but these efforts do not indicate success. This situation has led to the study of various factors that contribute towards high-risk situations in drug relapse. Hence this study aims to identify intrapersonal factors consisting of motivation to change and coping strategy as mediator of high-risk situations for drug relapse, which include negative emotions, interpersonal conflict and social pressure. This study employed a cross sectional design which utilized questionnaires administered to 600 clients in the Cure & Care Clinic, Malaysia. The questionnaires used were The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), Brief COPE and the tendency of high risk situation for drug relapse scale. Data were analyzed using multiple regression analysis and PROCESS for SPSS. Results showed significant influences of intrapersonal factors and coping strategies towards high-risk situations for drug relapse. In addition, coping strategy mediated the relationship between motivation to change and the tendency of high-risk situations for drug relapse. These findings should be taken into account in establishing treatment and rehabilitation programs for drug relapse in Malaysia.
Keywords: motivation to change, coping strategy, addiction relapse, high risk situations, mediator
The process of drug rehabilitation is an important agenda for the National Anti-Drug Agency (NADA). Various efforts have been taken to aid NADA in treating drug addicts. This study focuses on identifying the mental health status and psychological factors to design appropriate treatment strategies. Therefore, this research aims to determine the level of family functioning, cognitive distortion and resilience among clients of CCRC and C&C. A total of 495 clients from these institutions took part in this study. The instruments used were FACES III to measure family functioning, CDS to measure cognitive distortion and Resilience Scale to measure resilience. Results indicate that clientsâ€™ family functioning is at a moderate level, clientsâ€™ cognitive distortion is at a low level, whilst their resilence is at a high level. This indicates that the rehabilitation programs conducted at the institution had an impact on clientsâ€™ resiliency and cognitive distortion.The implications of the study can be attributed to the counseling intervention at NADA.
Recovering drug addict is affected by two main factors, namely internal factors (such as resilience and self-confidence) and external (support from families, employers, friends, and community). One of the internal factors that appear to influence the level of recovery of former drug addict is selfconfidence. Therefore this study aims to measure the level of self-confidence among former drug addicts, also known as Orang Kena Pengawasan (OKP) who underwent rehabilitation in 6-11 months and 12-24 months. The study was conducted using cross-sectional surveys. A total of 386 former drug addicts in Peninsular Malaysia were involved in this study with 198 respondents undergoing 6-11 months rehabilitation programme and 197 were respondents who were released within 12-24 months. The data obtained were analyzed using descriptive statistics. This analysis was used to measure the level of self-confidence between respondents who underwent the 6-11 months rehabilitation programme (Group 1) and 12-24 months (Group 2). The study found that the majority of both groups showed no signiticant difference in the level of recovery from the aspect of self-confidence. The study also found the majority of respondents of both groups showed a moderate level of confidence of 58.5 percent. However, Group 1 showed a higher percentage of self-confidence (63.5%) compared to Group 2 of (53.8%). The findings have implications for the development of strategies towards a strong self-confidence among the inmates to reduce recidivism rates in Malaysia.
Co-infection with hepatitis B and C among HIV infected patients are prevalent among high-risk populations. This meta-analysis aimed to estimate the prevalence of HIV, HCV and HBV co-infections among high-risk populations in Iran. We systematically searched the national and international electronic databases until 2016. The primary outcome was the prevalence of HIV, HBV, HCV and HIV co-infections in different high-risk populations in Iran. All English and Persian studies conducted on Iranian high-risk groups were included in the study. The review was reported based on PRISMA guidelines and data were analysed at 95% confidence level using random effect models. Overall, 916 relevant papers were recognised and 14 articles were included in the meta-analysis. The pooled estimates of HBV/HCV, HCV/HIV, HBV/HIV and HBV/HCV/HIV were 1.3% (95%CI: 0.5-2.1), 16.3% (95%CI: 1.1-31.6), 0.5% (95%CI: 0-1.4) and 0.5% (95%CI: 0.2-0.8), respectively. Based on subgroup analysis, there was a higher proportion of all co-infections from the years 2010-2016 as compared to that of the years 2003-2009. Our results highlighted that HCV/HIV co-infection in Iranian high-risk groups including injection drug users (IDUs) and prisoners is common. In addition, the increasing trend of coinfections should be considered alarming for policymakers.
Unemployment issue is becoming a factor which causes relapses especially among former drug addicts
that has undergone rehabilitation. Therefore, this paperwork seek to unfold and discuss degree of
relationships between introvert and extrovert personality with career interest according to six RIASEC
major field to drug addicts. Research objective are to identify the relationship between introvert and
extrovert personality with career interest among drug addicts in Sabah. Most of the respondent in
treatment center has no knowledge about their own personality in career development especially after
finishing treatment thus causing relapse due to failure of getting the right employment for themselves.
It is considered serious due to economic and life instability are one of the factor which contribute to
relapse among drug addicts. Occupation or career selection are constantly highlighted as one of the
major problem in former drug addict life. This shows that a careful career selection needs to be done. Career process are also continuous process of involvement to help self-development especially in line
of job they do. Therefore, it is hopeful that this research could give valuable impact and use to drug
addicts rehabilitation authority with implementation of career guidance to clients hence assisting them
in making effective career choice in the future.
Evidence indicates that detention of people who use drugs in compulsory centers in the name of treatment is common in Cambodia, China, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Thailand, and Vietnam. The expansion of such practices has been costly, has not generated positive health outcomes, and has not reduced supply or demand for illicit drugs. United Nations agencies have convened several consultations with government and civil society stakeholders in order to facilitate a transition to voluntary evidence- and community-based drug dependence treatment and support services. In an effort to support such efforts, an informal group of experts proposes a three-step process to initiate and accelerate national-level transitions. Specifically, the working group recommends the establishment of a national multisectoral decision-making committee to oversee the development of national transition plans, drug policy reform to eliminate barriers to community-based drug dependence treatment and support services, and the integration of community-based drug dependence treatment in existing national health and social service systems.In parallel, the working group recommends that national-level transitions should be guided by overarching principles, including ethics, human rights, meaningful involvement of affected communities, and client safety, as well as good governance, transparency, and accountability. The transition also represents an opportunity to review the roles and responsibilities of various agencies across the public health and public security sectors in order to balance the workload and ensure positive results. The need to accelerate national-level transitions to voluntary community-based drug dependence treatment and support services is compelling--on economic, medical, sustainable community development, and ethical grounds--as extensively documented in the literature. In this context, the expert working group fully endorses initiation of a transition towards voluntary evidence- and community-based drug dependence treatment and support services across the region, as well as the steady scale-down of compulsory centers for drug users.Components of voluntary community-based drug dependence treatment and support services are being implemented in Cambodia, China, Indonesia, Malaysia, and Thailand. However, significant technical and financial support will be required to be allocated from national budgets and by international development agencies in order to complete the transition and reduce the reliance on detention of people who use drugs in Asia.
Matched MeSH terms: Drug Users/statistics & numerical data*
Co-infections with human immunodeficiency virus type 1 (HIV-1) and human pegivirus (HPgV) are common in hepatitis C virus (HCV)-infected individuals. However, analysis on the evolutionary dynamics and transmission network profiles of these viruses among individuals with multiple infections remains limited. A total of 228 injecting drug users (IDUs), either HCV- and/or HIV-1-infected, were recruited in Kuala Lumpur, Malaysia. HCV, HIV-1 and HPgV genes were sequenced, with epidemic growth rates assessed by the Bayesian coalescent method. Based on the sequence data, mono-, dual- and triple-infection were detected in 38.8%, 40.6% and 20.6% of the subjects, respectively. Fifteen transmission networks involving HCV (subtype 1a, 1b, 3a and 3b), HIV-1 (CRF33_01B) and HPgV (genotype 2) were identified and characterized. Genealogical estimates indicated that the predominant HCV, HIV-1 and HPgV genotypes were introduced into the IDUs population through multiple sub-epidemics that emerged as early as 1950s (HCV), 1980s (HIV-1) and 1990s (HPgV). By determining the difference in divergence times between viral lineages (ΔtMRCA), we also showed that the frequency of viral co-transmission is low among these IDUs. Despite increased access to therapy and other harm reduction interventions, the continuous emergence and coexistence of new transmission networks suggest persistent multiple viral transmissions among IDUs.
Methadone Maintenance Therapy (MMT) for opiate dependence was first started in Malaysia in 2005. The service was initially provided by psychiatric clinics in hospitals and primary care clinics. Handling patients with opiate dependency especially in a primary care clinic is very challenging due to various constraints hence the success is doubtful. 143 patients from Tampin Health Clinic were recruited from November 2006 until March 2009. Retention rate in the program was high. Significant improvement was seen in the World Health Organization Quality Of Life score (WHOQOL-BREF) in all 4 domains done at baseline, 1st year and 2nd year in the program. After joining the program, there were no new blood borne virus infection for HIV and Hepatitis B and only 1 had Hepatitis C. Minimal number of patients were involved in new drug related offences while in the MMT program. Existing primary care clinics can be empowered to scale up this service in Malaysia.
HIV status disclosure plays a crucial role in reducing risk behaviors of drug and sexual partners and thereby limiting HIV transmission. As people who inject drugs (PWID) bear a significant HIV burden and disclosure research among PWID is relatively few, we reviewed the literature to highlight what is known about disclosure among HIV-positive PWID. Searches of articles published from 2000 to 2015 yielded 17 studies addressing different aspects of disclosure, and results are presented by major themes. Our results suggest that despite the difficulties, most PWID (64-86%) disclose their HIV-positive status to trusted individuals (family members and intimate sexual partners) and to those who are known to be HIV-positive. Disclosure to non-intimate sexual partners and fellow drug users is relatively lower. Disclosure decision-making is primarily driven by the perceived positive and negative consequences of disclosure. Subsequent risk reduction practices following disclosure are influenced by the feeling of responsibility, as well as partners' willingness to accept risk. Cultural family values, ethnicity, and different localities were several contextual factors that affect patterns of disclosure and risk behaviors of PWID. Areas for future research are recommended.
BACKGROUND: The objective of this study was to determine the effectiveness of MMT program among injecting drug users (IDUs) in Kota Bharu, Kelantan.
METHODS: The study was a retrospective study based on the records of injecting drug users (IDUs) involved in the MMT program from November 2005 to 31st Jan 2008, registered at the Psychiatric Clinic of Hospital Raja Perempuan Zainab II. Opiate Treatment Index (OTI) was used as the research instrument. Repeated measures ANCOVA was used to compare the mean scores during the entry period and after completing twelve months of MMT program after adjusted for age, marital status, and level of education.
RESULTS: A total of 117 file records were reviewed. There was significant reduction in the mean scores after 12 months of heroin Q score, HIV Risk-taking Behavior Scale and health scale after adjusted for age, marital status, and level of education. For Heroin Q score, mean difference was 2.01 (95% CI: 1.45, 2.56), for HIV Risk-taking Behavior Scale, mean difference was 7.64 (95% CI: 6.03, 9.26), and for health scale, mean difference was 5.35(95% CI: 3.90, 6.79).
CONCLUSION: This study supports the evidence that MMT program is effective in treating heroin and opiate dependence.
KEYWORDS: Kelantan; intravenous drug users; methadone; opiate treatment index
Study site: Psychiatric Clinic, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia
OBJECTIVES: Stigma towards people living with HIV/AIDS (PLWHA) is strong in Malaysia. Although stigma has been understudied, it may be a barrier to treating the approximately 81 000 Malaysian PLWHA. The current study explores correlates of intentions to discriminate against PLWHA among medical and dental students, the future healthcare providers of Malaysia.
METHODS: An online, cross-sectional survey of 1296 medical and dental students was conducted in 2012 at seven Malaysian universities; 1165 (89.9%) completed the survey and were analysed. Socio-demographic characteristics, stigma-related constructs and intentions to discriminate against PLWHA were measured. Linear mixed models were conducted, controlling for clustering by university.
RESULTS: The final multivariate model demonstrated that students who intended to discriminate more against PLWHA were female, less advanced in their training, and studying dentistry. They further endorsed more negative attitudes towards PLWHA, internalised greater HIV-related shame, reported more HIV-related fear and disagreed more strongly that PLWHA deserve good care. The final model accounted for 38% of the variance in discrimination intent, with 10% accounted for by socio-demographic characteristics and 28% accounted for by stigma-related constructs.
CONCLUSIONS: It is critical to reduce stigma among medical and dental students to eliminate intentions to discriminate and achieve equitable care for Malaysian PLWHA. Stigma-reduction interventions should be multipronged, addressing attitudes, internalised shame, fear and perceptions of deservingness of care.
KEYWORDS: HIV/AIDS; Malaisie; Malasia; Malaysia; VIH/SIDA; cuidados sanitarios profesionales; discriminación; discrimination; estigma; homosexuality; professional healthcare students; stigma; stigmatisation; substance abuse; étudiants en profession de soins de santé
The use of substances to enhance human abilities is a constant and cross-cultural feature in the evolution of humanity. Although much has changed over time, the availability on the Internet, often supported by misleading marketing strategies, has made their use even more likely and risky. This paper will explore the case of Mitragyna speciosa Korth. (kratom), a tropical tree used traditionally to combat fatigue and improve work productivity among farm populations in Southeast Asia, which has recently become popular as novel psychoactive substance in Western countries. Specifically, it (i) reviews the state of the art on kratom pharmacology and identification; (ii) provides a comprehensive overview of kratom use cross-culturally; (iii) explores the subjective experiences of users; (iv) identifies potential risks and side-effects related to its consumption. Finally, it concludes that the use of kratom is not negligible, especially for self-medication, and more clinical, pharmacological, and socioanthropological studies as well as a better international collaboration are needed to tackle this marginally explored phenomenon.
Data from the Malaysian National Drugs Agency December 2013 Report, showed that among 7864 drug users, 632 were abusing Amphetamine Type Stimulant. Rates of admission due to Methamphetamine abuse in pregnancy are higher compared with men and non- pregnant lady in the United States.1 A number of issues may complicate the management of pregnant women who abused methamphetamine such as the low motivation for them to come forward voluntarily for treatment, the high rates of fetal and maternal complications due to methamphetamine abuse,2,3 and the inavailabiliy of effective treatment for methamphetamine dependence.