It has been 35 years since drug abuse was declared a national security problem in Malaysia. Back then, and indeed until about 10 years ago, heroin use was the number one challenge for drug policy makers.

Thanks to the introduction of a farsighted policy in 2006 to implement harm reduction programmes, like methadone maintenance therapy (MMT) and needle-syringe exchange programmes, the challenge of opioids is much more manageable in recent times. The human immunode ciency virus (HIV) epidemic has also begun to come under control.

The issue that drug policy makers face today is a new breed of stimulant drugs that are cheap and readily available. This is due to their inherently easy to obtain ingredients and flexible manufacturing techniques. These drugs are known as ATS and they encompass both the amphetamine and methamphetamine type of drugs, both of which are highly addictive with euphoric effects. Examples of ATS include speed, methamphetamine or meth, ice, shabu and ecstasy.

ATS have already overtaken opioids as the drug of choice for drug users in Malaysia. Arrest data from the National Anti-Drug Agency (NADA) indicates a steady increase in ATS use in the country over the last five years. A review of data on drugs provided by NADA from 2013 to 2017 highlights that an increasing proportion of those arrested use methamphetamine (whether in crystalline or pill form) and ecstasy as their drug of choice.

By 2017, 58 percent of all arrests were for methamphetamine. Specifically, out of 26,791 persons apprehended by NADA in 2017, 15,549 (58 percent) were using methamphetamine, two-thirds of which were using crystalline methamphetamine. As many as 4,366 (28 percent) were using methamphetamine tablets and 764 (5 percent) were using ecstasy.

In other words, the percentage increase year on year is fastest and highest for methamphetamine in comparison to other drugs. For the first time ever, NADA’s data in 2017 for methamphetamine use surpassed those arrested for opioids.

There are obvious limitations of the arrest data provided by NADA – these numbers of arrests tell us nothing about the size of the population of drug users or whether arrestees were occasional, frequent or dependent users. The numbers do, however, alert us to the fact that ATS has quickly risen as the most popular drug of choice in Malaysia and crystalline methamphetamine is by far the most popular form of ATS used.

It is also worth mentioning that our quick survey of selected, privately run treatment facilities in Kuala Lumpur also suggest a similar trend. The majority of those who are currently in inpatient treatment and rehabilitation are ATS users on methamphetamine.

The rising trend of ATS consumption has profound implications for the treatment and rehabilitation of drug use in the country. It also sheds light on the limitations of the drug dependence treatment system in the country.

There is a diversity of users and their drug use patterns, therefore interventions and treatments must be equally diverse in order to avoid a mismatch between the drug abused and treatment offered. Treatment for ATS is a challenge on its own. Current treatments, such as methadone maintenance, are still aimed at opiate users, but these cannot be used to treat ATS dependence. There is no substitution drug for ATS dependence in the same way that methadone is available as a substitute for heroin use or opioids. While pharmacological treatments show initial promise in clinical trials, there are currently none which have been approved for use in the treatment of ATS dependence.

Treatment for ATS is made more problematic as it is unclear what harm reduction means in the context of ATS. There are perceptions that harm reduction as an approach is only meant for people who inject opioid drugs and, therefore, does not apply to ATS users. This view must be corrected as a “harm reduction” approach applies to all forms of drug use and can contribute towards reducing the risk of overdoses or infectious disease. For instance, ATS is a popular drug used by men who have sex with men to enhance sexual performance, which could contribute towards a higher risk for contracting the HIV.

This is not to say that all is doom and gloom in the treatment of ATS. Psychosocial interventions have shown some effectiveness in treating methamphetamine use disorders thus far. However, Malaysia has limited capacity to support longer-term psychosocial rehabilitation of ATS dependents.

We have a shortage of medical doctors, psychiatrists, psychologists, counsellors and law enforcement officials who are trained in addiction treatment and rehabilitation and are able to understand and respond to ATS intoxication and dependence. It should also be highlighted that NADA and Ministry of Health (MoH) professionals currently working on addiction are generally more familiar with opioids, but will need more training to be conversant with diagnosing and treating ATS use disorders.

It is clear that Malaysia’s current policy is not sustainable in responding to the rising threat of ATS. Incarceration for drug use has resulted in overcrowding in prisons with drug users constituting more than 40 percent of all prisoners in 2016. Furthermore, there is no evidence to show that the therapeutic counselling programme in prisons is effective in treating drug dependence in general.

It must be stressed that ATS users also come with the added challenge of psychosis, hallucinations and violent and/or aggressive behaviour. News of the RapidKL bus driver ramming seven cars on Jalan Ampang or the father hacking his five-year-old son to death with a parang in August 2018 only solidify the need to address this pertinent issue. It is high time for Malaysia to introduce and strengthen counselling approaches designed for the long-term treatment for stimulant dependence, including the training of frontline health and enforcement personnel to respond to and manage the acute episodes of stimulant intoxication.

In an effort to start the ball rolling on addressing the complexities of ATS in the country, ISIS Malaysia will convene a regional roundtable in 2019 on “Responding to ATS in the Asia-Pacific Region: Where Are We and How Do We Move Forward?”. The roundtable will focus on data and epidemiology, treatment, prevention and policy, and highlight the institutional and professional gaps in responding to ATS by drawing lessons learnt from neighbouring countries.

This article first appeared in the ISIS Focus 1/2019 No. 9

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