Pubdate: Sun, 10 Aug 2003 Source: Star, The (Malaysia) Copyright: 2003 Star Publications (Malaysia) Bhd. Contact: http://www.thestar.com.my Details: http://www.mapinc.org/media/922 Author: Hooi You Ching TREATING DRUG ADDICTION DRUG addiction is like a roller-coaster ride into hell. It launches addicts into an orbit of illusions and of false euphoria and then plunges them back into the cold abyss of reality. When the "joyride" comes to a halt, it is replaced by withdrawal symptoms that often lead to disruptive behaviour. For example, addicts will experience extreme anxiety, restlessness, nausea or vomiting, diarrhoea, fever, cramps, violent kicking and insomnia. Despite continuous efforts by the country's 28 government rehabilitation centres to nip drug addiction in the bud, this social menace is becoming a garden of weed. In the first quarter of 2003 alone, there were 13,519 drug addicts recorded in the country. Of that number, 48.6% were relapse cases. Statistics from the National Drug Agency showed that heroin users total 5,162, which is the highest tally among the different substance abuse users. According to consultant psychiatrist and drug addiction specialist Dr Mohamad Hussain Habil, rehabilitation programmes have in the last two decades accomplished little in arresting the drug problem in the country as evidenced by the high relapse rates. "Statistics reveal that only 10% to 15% drug addicts who have undergone the rehabilitation programme have successfully reformed while the rest have gone back to addiction and so require further treatment. "In the long term, it is cheaper to manage drug addicts in the community compared to treating addicts in rehabilitation centres," says Dr Hussain. Clearly, there is a need for alternative treatment that is effective in rehabilitating addicts as well as improving their quality of life and level of productivity. In countries like Australia, Holland, UK and the US, the drug addiction medication known as methadone has shown to be an effective and cheaper alternative for treating opioid-dependent addicts. For instance, studies from the US-based National Institute on Drug Abuse showed that more than 70% of those who enrolled in methadone maintenance therapy (MMT) for more than 12 months no longer use heroin. Methadone is a synthetic opioid (the class of drug that heroin, morphine and other opium-like chemicals belong to) that is used to suppress the cravings that afflict individuals dependent on opioid drugs. However, it is not an effective treatment for other drug-dependencies such as cocaine, benzodiazepines and nicotine. Drug users find it difficult to kick the drug habit because it produces an instant, though short-lived, euphoric effect. In the case of heroin addiction, gratification lasts a mere three to five hours before the next craving comes on. As a result, addicts experience the sharp peaks (highs) and valleys (lows) due to the waxing and waning of heroin in the bloodstream. However, as the body develops greater tolerance against the effects of the drug, chronic users will experience severe cravings for the drug in increased dosages. Due to methadone's long-acting properties (up to 24 hours), it helps eliminate the physical cravings for opioids without producing the "highs" experienced in heroin or morphine addiction. And since narcotic withdrawal from methadone is slower and less significant, drug addicts will find themselves in a much calmer state. "Studies have shown that addicts on methadone lead more stable and productive lives. They are less likely to be involved in criminal activities because there is less need to sustain their drug habit. Methadone supports the addicts while they are going through withdrawal. During the course of treatment, the doctor will monitor the medication regularly. At the end, when the addict is ready to go without 'crutches', we will gradually wean them out of the programme. "As heroin users routinely share their needles to get their fix, treating addicts with methadone can significantly reduce the spread of HIV/AIDS infection, hepatitis B and hepatitis C as the medication is taken orally once a day. From a public health point of view, MMT has the potential to reduce the social, economic and financial burden faced by the addicts and society. Improvements in health and lifestyle will certainly help addicts maintain employment and social relationships," he says. According to a report published in 2001 by Dr Adeeba Kamarulzaman from Universiti Malaya, out of the 44,208 HIV/AIDS cases, 76% were attributed to needle sharing of recreational drug use. Although methadone has been used for the last 30 years to treat opioid addiction in the US, it was only registered in Malaysia early this January. While the use of methadone as routine treatment in drug addiction is still pending approval from the government, the Health Ministry allows clinical trials to be conducted. "It has taken the medical community in Malaysia 13 years to dispel misconceptions and to prove that MMT is safe and effective. We hope methadone will soon be used as a first line of treatment in heroin addiction. So far we have recruited 70 doctors to be trained in methadone prescription," he adds. But how safe is methadone? Clinical studies have shown that long-term use of methadone causes no serious side effects and does not impair cognitive functions or interfere with physical ability. However, some may experience minor withdrawal symptoms like constipation, drowsiness, reduced libido and excessive sweating. A person can only become a patient of methadone treatment after being accessed by a trained doctor or general practitioner. The assessment takes into account their medical condition as well as alcohol and drug use. While Dr Hussain is convinced that hardcore addicts should do time at rehabilitation centres, he points out that it is a logistical nightmare to place all 400,000 drug addicts in such centres. "Instead of a two-year rehabilitation programme, the period could be shortened to six months of institutionalised rehabilitation and followed by long-term community monitoring. During this time, inmates can be put on medication such as methadone to prevent relapse," he suggests. Dr Hussain admits that resistance to the use of MMT is due to fears that MMT is merely substituting one drug for another. "That methadone itself can be potentially addictive is no different from other drugs. For instance, morphine is given in small doses to patients who suffer from myocardial infarct (heart attack) or recurrent chest pains. But heart patients do not become addicted to morphine. "Addiction is a chronic relapsing disorder. The addicts need prolonged treatment, even after rehabilitation," says Dr Hussain, while stressing the fact that methadone is not a cure for the problem of opioid addiction but complementary to existing treatments.