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.