Drug substitution therapy: Success and limitations of the methadone and buphrenorphine maintenance programmes

• Main Authors: Mohamed, Mahmood Nazar, Kasa, Muhamad Dzahir
• Format: Article
• Language: English
• Published: Agensi Antidadah Kebangsaan 2007
• Subjects: BF Psychology; HV Social pathology. Social and public welfare
• Online Access: http://repo.uum.edu.my/3847/1/1-2.pdf; http://repo.uum.edu.my/3847/; http://www.adk.gov.my/html/pdf/jurnal/2007/1-2.pdf

Due to the severity of its drug problem, the Malaysian Government has allocated significant resources to rehabilitate drug addicts, which includes institutional drug rehabilitation and community care, all of which are mandated by the law for drug abusers charged under Section 6 (1) APD. In 2005, the government approved opiate maintenance therapies. However it was observed that in the early stages of the DST practice, there were various reports of substitute abuses in several parts of the country. Incidences of injecting subutex cocktail and oral consumption of subutex with benzodiazepines such as dormicum have been highlighted in the local press; including the exposé by the participants of the programme on the availability of these substitute drugs on the streets, have tainted the practice of DST in the country. The aim of this research to study the current DST practice in Malaysia, and the compliance to the DST protocol by the medical doctors involved in the DST; determine if there are positive outcomes of the DST among those following the programme; and to determine if there are any incidences of abuses among those involved in the programme.The study utilizes a cross-sectional survey designed to gather data from the practicing medical officers and drug dependents who have participated in the DST programme.Data was collected through several approaches; firstly via a structured interview conducted on a sample of participating general practitioners in Kedah, Perlis,Penang, Kuala Lumpur and Johor who practiced DST. The interviews, among others will ascertain (i) if GPs adhered to the prescribed maintenance protocols set forth by MOH (ii) the number of clients/patients under the DST (iii) psychosocial intervention and (iv record keeping.Data was also collected through structured interviews with drug dependents who accessed the GPs for buprenorphine or methadone maintenance therapy in hospitals.This is to ascertain (i) reasons for using DST (ii) past drug and treatment history (iii) dosage and length of time under DST (iv) familial and social support (v) dependency and possible abuse or misuse of the substitute drugs.Participants of the DST answer a Drug Profile Questionnaire, the Severity of Dependency Scale, ICD-10 Symptoms Checklist for Mental Disorders (Psychoactive substance use syndrome) and The Addiction Severity Index-Lite.More than 50% of the respondents reported benefits of the therapy; however incidences of non-adherence among the GPs were also identified. More importantly, almost half of the respondents reported abusing the substitute therapy by injecting and mixing them with other substances.