Current Substance Abuse Disorders and HIV Situation in Malaysia

B. Vicknasingam (1), Singh, D (1), Suppiah, B (1), Schottenfeld, R (2) and Chawarski, M (2)

1) Centre for Drug Research, Universiti Sains Malaysia 2) Yale School of Medicine, New Haven, CT

• Population: 30 million • GDP per capita: $23,100• Industrialized market economy• Federal constitutional

monarchy • Islam is the largest and official

religion (61%)• Major heroin abuse problem

since the 1970s• Proximity to Golden Triangle

Introduction

-From 1980s to around 2003 Malaysia’s drug policy was based solely on a prohibitionist approach.

- Non-medical institutional rehabilitation approach was the main modality for rehabilitating people who use drugs (PWUD).

-High relapse rates within the first six months of release were reported

-Malaysia’s failure to reverse an increasing trend of HIV infection in the United Nations Millennium Development Goal (MDG) prompted the Malaysian government to re-examine its approach towards people who use drugs.

Introduction (cont’d)

-The introduction of harm reduction programs in Malaysia also opened the doors for the public health sector to be involved in providing treatment for people who use drugs in Malaysia.

-However, a dual track drug policy is still being practised in Malaysia. PWUD can still be mandated to undergo rehabilitation. NADA, the primary agency managing prevention, treatment and rehabilitation efforts in the country, has significant enforcement powers and plays a contradictory role in the response to drug use in Malaysia.

2006 2007 2008 2009 2010 2011 2012 2013 -

10,000

20,000

30,000

40,000

50,000

60,000

70,000

45,451 46,833

41,363

49,762

63,466

54,883 54,207

38,005

Arrest under section 3(1) Drug Dependents Act (Treatment and Rehabilitation) 1983, related to opiate and cannabis drug use from 2006 – 2013

Source: Royal Malaysia Police (2013)

2006 2007 2008 2009 2010 2011 2012 2013 -

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

21,654

26,763

34,014

42,304

56,725

72,369 76,812

82,685

Arrest under section 15(1)(a) Dangerous Drug Act 1952 (DDA) related to Amphetamine Type Stimulant (ATS) and Ketamine Drug use from

2006 – 2013

Source: Royal Malaysia Police (2013)

Timeline of drug use initiation

19681970

19721974

19761978

19801982

19841986

19881990

19921994

19961998

20002002

20042006

20080

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Heroin ATS

Prop

ortio

n in

itiati

ng il

licit

use

of e

ach

subs

tanc

e

(Chawarski et al., 2012)

ATS abuse and HIV status

32.9

18.5

0

5

10

15

20

25

30

35

40

Per

cen

tag

e re

po

rtin

g H

IV+

Lifetime ATS No ATS

p<0.001

(Chawarski et al 2012)

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Series 1 30593 31556 31893 36996 38672 32798 22811 14489 12352 15736 23642 11194 9015 7864

2500

7500

12500

17500

22500

27500

32500

37500

42500

Source: National Anti Drug Agency (2013)

Number of People who use drugs (PWUD) detected by the National Anti Drug Agency (NADA) from year 2000 -2013

Drug Seizures (2011 – 2014) Year 2011 2012 2013 2014

Heroin Kg 445.13 362.67 638.61 381.40

Cannabis Kg 796.05 751.80 539.30 578.19

Crystal methamphetamine

Kg 830.29 608.67 1245.63 761.71

Liquid methamphetamine

Kg 122.60 27.96 76.69 1,260.09

Ketamine Kg 106.75 118.07 139.23 216.61

Amphetamine powder

Kg 26.53 457.36 674.62 53.69

Ecstasy Pills 47,761 634,573 335,984 117,702

Yaba Pills 364,879 521,384 524,966 557,336

Erimin 5 Pills 87,012 5,175,069 177,916 467,133

Royal Malaysia Police 2015

No Name of CCRC Capacity Number of clients

1 SERDANG 300 280

2 KG. SELAMAT 300 310

3 BATU KURAU 300 317

4 PERLOP 300 295

5 SERENDAH 250 257

6 GAMBANG 300 270

7 BENTA 250 272

8 KARAK 300 236

9 RAUB 300 277

10 JELEBU 300 313

11 MUAR 300 298

12 TIANG DUA 300 246

13 PAPAR 250 197

14 KUCHING 150 93

15 BACHOK 250 132

16 JELI 300 319

17 BKT. CHABANG 300 299

18 KOTA TINGGI 300 183

JUMLAH 5,050 4,594

Number of PWUD receiving treatment in Cure and Care Rehabilitation Centre (CCRC) - 2013

No State No of CCSC Residents Non residents 1 Perlis 1 34 31

2 Kedah 3 139 785

3 Pulau Pinang 5 293 20,113

4 Perak 5 264 15,901

5 WP Kuala Lumpur 6 231 45,057

6 Selangor 6 286 27,646

7 Negeri Sembilan 5 136 26,120

8 Melaka 1 7 530

9 Johor 8 186 14,525

10 Pahang 4 157 4,384

11 Kelantan 1 25 74

12 Terengganu 3 190 886

13 Sabah 2 40 316

14 Sarawak 4 23 193

JUMLAH 54 2,011 156,561

Number of PWUD receiving treatment in Cure and Care Service Centre (CCSC) - 2013

Methadone Maintenance Therapy (MMT) Facilities (June 2014)

Source : Ministry of Health (MoH) Malaysia

Type of Facility

Number of MMT Facility (Cumulative by Years)

2006 2007 2008 2009 2010 2011 2012 20132014

(June)

Hospital 8 25 27 35 40 48 49 53 53

Health Clinic

2 32 32 77 134 168 203 293 295

Govt G.P 7 9 9 14 21 24 21 22 23

NADA 0 0 3 24 25 32 41 59 59

Prison 0 0 4 12 18 18 18 18 18

Others 0 0 0 0 2 2 1 1 1

Total Govt 17 66 75 162 240 292 333 446 449

•TOTAL GOVT + GP : 814 (June 2014) •No. GP providing OST services : 365 (source : MoH Malaysia)

Coverage: MMT patients (June 2014)

Source : MoH Malaysia

  2006 2007 2008 2009 2010 2011 2012 20132014

(June)

No. of registered patient (Annual)

1,241 2,777 3,047 3,665 5,139 5,086 6,801 5,688 2,189

No. of registered patient (Cumulative)

1,241 4,018 7,065 10,730 15,869 20,955 27,756 33,444 35,633

No. of Active Patient (by end of the year)

932 3,242 5,024 7,455 10,664 14,631 18,401 20,307 20,705

Retention Rate 75% 81% 71% 69% 70% 70% 70.1% 71.3% 84.1%

•TOTAL REGISTERED Patients at government and and private GP = 67,438 (June 2014) •Cummulative number of patients on OST in private GP : 31,805

Needle and Syringe Exchange (NSEP) – Facilities and Coverage

Source : MoH Malaysia

 Year

2006 2007 2008 2009 2010 2011 2012 20132014

(June)

NSEP Site : NGO 45 70 114 218 224 221 529 576 545

NSEP Site : Health Clinic

0 0 6 22 73 76 76 152 152

TOTAL 45 70 120 240 297 297 605 728 697

Registered Client (cumulative)

4,357 6,658 12,230 18,377 24,999 34,244 55,298 72,686 77,179

Needle & Syringe return rate

58.6% 62.2% 63.2% 65.9% 56.4% 63% 58.9% 61.5% 62.2%

* Regular client (at least once a month ): 39,163

Overview of the HIV epidemic in Malaysia 2013

Indicator Number/ percentage

Cumulative no. of reported HIV infections since first detection in 1986 101,672

Cumulative no. of reported AIDS since 1986 20,235

Cumulative no. of reported deaths related to HIV/AIDS since 1986 16,340

Estimated no. PLHIV [EPP 2014] 86,324

Total number of PLHIV [surveillance date] 85,332

New HIV infections detected in 2013 3,393

Notification rate of HIV (per 100,000) in 2013 11.42

Women reported with HIV in 2013 728

Cumulative no. of women reported with HIV as of December 2013 10,956

Children aged below 13 with HIV in 2013 50

Cumulative no. of children under 13 with HIV as of December 2013 1,076

Estimated no. PLHIV eligible for treatment [EPP 2014] 38,418

No. PLHIV receiving ART (surveillance data) as of December 2013 17,369

Estimated adult (15-49 years) HIV prevalence [EPP 2014] 73,005 [0.44%]

Source: Ministry of Health Malaysia

1990 2000 2010 2013 -

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

60.4

74.7

47.6

21.5

5.3

18.9

48.5

73.7

Injecting Drug Use (%) Sexual transmission (%)

PERCENTAGE OF NEW HIV CASES BY RISK FACTOR

Source: Minstry of Health (2013)

Conclusion

- Need for a more consistent drug policy where treatment is the main priority. - There is an increase in ATS use in the country. Methadone and buprenorphine patients are also beginning to use ATS.

-Sexual transmission is the main transmission mode of HIV. We need more sexual risk behaviors studies to understand this problem.

-After several years of implementing treatment programs for PWUDs, it is imperative that the government not only increase the coverage of the program but to also start improving the quality of their programs. For example, only 17% and 12% of NSEP clients have been referred to voluntary counseling and testing (VCT) and MMT respectively (Global AIDS Response Progress Report, 2014).

-The term Medication Assisted Treatment (MAT) should be used for methadone and buprenorphine treatment programs. Currently, the Malaysian government views this as part of the harm reduction program.

Thank you