TREATING DRUG ADDICTION ­ A GP'S PERSPECTIVE

Your Health Matters

When I was a young child, I was fascinated with people who were
addicted to opium. During those early days in Penang, we did not hear
of morphine, pethidine, heroin or ganja addicts, only opium or "ah
pian". It was not unusual to see an opium addict using the opium pipe
to smoke opium then.

Why treat drug addiction?

Today, we need to ask why it is so important to treat and
rehabilitate these drug addicts. One reason ­ 75% of those infected
with HIV in Malaysia are drug addicts. They share dirty and
contaminated needles and so transmit HIV/AIDS.

Only 25% of HIV patients acquire it by sexual transmission. If drug
addiction is not controlled, the rapid spread of HIV/AIDS is bound to
escalate. Today, Malaysia already has 80,000 people infected with HIV.

Supplying needles and condoms to drug addicts is a progressive and
forward-looking step. We have to bypass all religious taboos while
talking about abstinence is easier said than done.

The supply of needles and condoms to drug addicts is nothing new. It
has been very successfully carried out in Australia and it was found
that HIV infection rate could be reduced by as much as 80% in this
high-risk population.

Drug addiction ­ changing times

As a general practitioner for the past 30 years, I have a special
interest in treating patients with drug addiction. As the years go
by, the habits of these addicts change. In the early 70s, we see
principally opium addicts. They either smoke or ingest the opium to
get a high. One odd observation is that some of these opium addicts
can live to a ripe old age of 80 years and above

In recent times, drugs of addiction include heroin, morphine and
marijuana. More recently, the younger generation has been using
morphine, heroin and marijuana. Morphine and heroin are refined from
opium, and opium is derived from the poppy flower.

The latest craze among the drug users is metamphetamine. Each drug
has its own street name:

The role of the general practitioner

For the year 2004, 200 million people around the world abuse
addictive drugs. A UN survey has found that US$322bil (RM1,159.2bil)
worth of addictive drugs are traded throughout the world, more than
the GDP of 88% of the world's countries.

As general practitioners, we are in the best position to treat these
drug addicts. It is impossible for a few drug addiction specialists
throughout the country to treat a population of more than 270,000 drug addicts.

Currently there are 29 centres throughout the country treating only
about 8,000 addicts, and it is too expensive to treat and
rehabilitate all the addicts at one go.

As a doctor treating drug addiction, I have found that we can make
treatment work. It is not as hopeless as one thinks.

It has been found that treating drug addicts in a community setting
gives a recovery and cure rate that is better than with
institutionalised treatment (where the success rate is less than 20%).

With the advances in medical science, drug addicts can be put on
substitution medications by the general practitioner, almost like the
way we treat patients with diabetes mellitus and high blood pressure.

The advantage of using substitution medication is that the patients
can go back to their regular work and thus thousands of working hours
will be saved.

Furthermore, they can live a normal life and bring benefit to their
families and country. They feel confident mixing within society
again. When they are on substitution treatment, they no longer want
to go back to heroin. They feel a sense of well-being and live
normally just like any one of us.

Considerations in community-based treatment

I find that for a doctor to treat these drug addicts, it is very
important for him to work very closely with the police, law and
regulatory enforcement officers.

The local police must be well informed of what the doctor is doing;
otherwise they may think that that the doctor is a drug pusher.

Good doctors must not misuse the power given to them. Many doctors
shy away from treating these drug addicts for fear of being harassed
by the drug addicts or attracting the unwanted attention of the
police and drug regulatory enforcement officers. Getting good doctors
to be interested in treating drug addicts is a real challenge.

The government should not just consider giving free needles and
condoms to these drug addicts, but it should also seek ways to
integrate these drug addicts into the primary health care system. We
should not deny them of their rights as patients.

It is more advantageous for the general practitioner to treat these
drug addicts as an outpatient compared to management in a centralised
treatment and rehabilitation centre. The general practitioner who is
trained in drug addiction treatment will be more easily accessible to
the drug addicts.

Patients are encouraged to come with their family members and close
relatives so that these close family members can give them moral
support and encouragement during the detoxification and
rehabilitation period. Patients must be made to feel that they are
wanted by the family, relatives, friends and society as a whole.

The cost of detoxifying and rehabilitating these patients must be
made as low as possible because most of these drug addicts are from
working class families and by the time they seek treatment, their
money would have been drained away by these drugs of addiction.

The doctor's role initially is to detoxify the patients and prepare
them for proper substitution treatment and rehabilitation.

Invariably I find that I would need the support of a good and
dedicated NGO to be able to move on with the longer term plan of
rehabilitation.

Religion can also play a very important role. This will give patients
a lot of self confidence, and also be a source of spiritual support, of course.

At the same time, family and friends can move them to a different
environment that is free from drug addiction.

For a drug addict, meeting the drug pushers, his old addicted friends
or visiting the places where he had previously bought his drugs can
trigger his urge to start the old habit.

A new job has to be found for him by the family and NGOs, so that
when he is fully recovered, he can go back to work and keep himself occupied.

The time taken to detoxify and rehabilitate these patients in the
community by the general practitioner is also very much shorter
compared to those who are institution-based.

It is indeed very expensive to confine a patient away from society
for up to two years. By the time they come out of the rehabilitation
centre, they are almost lost and they find it difficult to integrate
into the outside environment.

The incarcerated drug addicts feel as though they are criminals, even
though some of them have not committed any crime.

The current law stipulates that to be an addict is already a crime,
and this should be amended to encourage community-based care.

In a clinic setting, the drug addicts can have a say in choosing the
type of treatment that they feel is more suitable to them. The
trained doctors themselves can also act as counsellors during the
period of treatment.

They must let the addicts feel that they are wanted by society and
the community as a whole. A close rapport is very important between
the patient and the doctor to ensure success of treatment.

Conclusion

Finally, one should treat every drug addict with dignity so that we
can win his confidence. The good doctor is non-judgemental and
remains objective in his approach. He tries to make the addict feel
that he is his friend and that he is there to help.

If he is treating him solely for the sake of making money, the drug
addict can smell him out a mile away and the treatment programme is
doomed to failure.

Dr Lim Boon Sho is deputy president of the Federation of Private
Medical Practitioners Associations Malaysia and member of DrsWhoCare.
This article is contributed by the Federation of Private Medical
Practitioners Associations Malaysia