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Treating drug addiction – a GP’s perspective
Dr LIM BOON SHO | TheStar Online | June 18, 2006

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:

# Opium is called “black earth” (or “tor” in Chinese)

# Heroin is called “fit” or “ubat”

# Marijuana is called “grass” or “pot”

# Metamphetamine is called “ice”

# MDMA is called “ecstasy” or “pil gila” or “pink lady”

# Ketamine is called “vit. K”



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. For further information, e-mail starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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