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close this bookDrug Use and HIV Vulnerability (UNAIDS, 2001, 238 p.)
close this folderChapter 4: Malaysia
close this folderIV. Findings
View the documentA. Patterns of drug use
View the documentB. Epidemiology of drug use
View the documentC. Government responses to drug use
View the documentD. Legislation and application of laws
View the documentE. Evaluation of law enforcement strategies
View the documentF. Risk of HIV infection in prisons
View the documentG. Treatment and rehabilitation
View the documentH. HIV/AIDS

B. Epidemiology of drug use

Number and characteristics of drug users

It is variously estimated that there are between 180,000-400,000 drug users in Malaysia. The lower figure represents the number of persons who have been identified to the authorities since a registration procedure commenced in 1970. It has been further estimated that there are between 170,000 to 200,000 opioid users.

The Ministry of Home believes that the actual number of “active drug users” is closer to between 100,000 and 130,000. The use of amphetamine-type stimulants is on the increase, however, and estimates on the number of persons who have 'ever tried', who 'use intermittently' and who 'use regularly' and in a dependent manner, vary widely.

Between the years 1988 and 1996, the National Drug Information System identified a total of 225,000 drug use cases and 127,00 individuals when duplicate cases were eliminated. This figure comprised 65,000 new cases and 62,000 repeat cases and probably serves as the basis for the Ministry of Home estimate.

The Narcotics Report of 1996 notes that the total number of drug users had decreased by 10.3 per cent from the previous year. A total of 16,752 persons were identified as recidivists, 54.7 per cent of the total drug user population detected during the year (Table 4.2).

Table 4.2 Number of new and relapse cases of drug user detected, 1988-1996


NEW

RELAPSE

TOTAL

YEAR

NO.

%

NO.

%

NO.

%

1988

10,424

41.4

14,781

58.6

25,205

100

1989

7,631

37.9

12,487

62.1

20,118

100

1990

7,389

38.3

11,921

61.7

19,310

100

1991

8,083

39.7

12,258

60.3

20,341

100

1992

8,238

38.3

13,268

61.7

21,506

100

1993

10,383

40.8

15,074

59.2

25,457

100

1994

11,672

40.6

17,084

59.4

28,756

100

1995

13,140

38.5

20,964

61.5

34,104

100

1996

13,846

45.3

16,752

54.7

30,598

100

The number of new drug users detected for 1996 was 13,846 (Table 4.2). This represented a small increase on the previous year, leading the government to conclude that it must intensify its primary prevention efforts. These data from the National Drug Agency indicates that the average number of new drug users per month is 1,154.

Urban centres like Kuala Lumpur and Penang have large populations of injecting drug users and a substantial (but imprecisely estimated) proportion of these are thought to be infected with HIV. No state in Malaysia is currently free neither from injecting drug use nor from HIV infection. Among these urban populations, 98.7 per cent of drug users identified in 1996 were male and were aged between 19-39 years. High proportions of these men are unemployed. Only 0.1 per cent of these persons had a tertiary degree, 0.3 per cent a diploma and 0.7 per cent the equivalent of a higher school certificate.

According to the Narcotics Report, 1996, most people who use drugs are in the 20-39 year age bracket (80 per cent). A study to examine the causes of addiction was conducted by the National Drug Information System of the National Narcotics Agency. The study examined, among others, the onset of drug use and the relation between age, types of drug use, racial background and drug addiction.

Preliminary findings of the study were that 10 per cent of drug users were first detected after one year of drug use, 15 per cent after two years and 8 per cent after 5 years. In relation to drug use, 7 per cent took their drug of choice 4 times a day, 11.5 per cent 3 times a day, 51.1 per cent 2 times a day and 26.2 per cent once a day. A small number reported that they took drugs once a week (3.5 per cent) and some once a month (0.7 per cent).

People who use illicit drugs are generally treated in the community as criminals. Local communities are generally unsupportive and are more likely to reject people who use drugs rather than accept and help them as valued members of the community. While it is government policy that people who use drugs be treated as if they have a health problem, public communications and practices are more closely aligned with the former perspective.

High risk drug use practices

A study of 24,230 drug users in 1995 reported that 23.5 per cent were injecting drug users, 49.8 per cent were fume inhaling heroin and 24.2 per cent were smoking cannabis. The sharing of needles and syringes and other paraphernalia is a common feature of drug use etiquette among groups of drug injectors in Malaysia. This is believed to be related in part at least to a relative scarcity of needles and syringes and to the harshness of the law enforcement response to drug use. A study undertaken several years ago revealed that 77 per cent of respondents admitted to sharing needles and syringes with 10 others and 23 per cent shared with more than 11 others. In a case control study undertaken on 348 drug users in the largest treatment centre in Malaysia, more than 70 per cent of cases stated that they had shared drug injection equipment.

In 1992, a study in northeast Malaysia revealed that the rate of unsafe injecting was high (55 per cent had shared needles in the preceding month). A study undertaken during that same year at a drug rehabilitation centre found that 79 per cent had shared a needle with other users.

Professional injectors exist and are known as “street doctors”. They inject multiple customers with the same, non-sterile injection equipment. Little attention has been paid to date by government to implementing strategies aimed at altering these high-risk drug-injecting norms through outreach and peer education strategies. Anecdotal reports suggest that some interventions of this nature have been implemented by several non-governmental organisations, but only in an ad hoc rather than in response to policy, to scale and in a sustainable way. Such interventions are generally viewed as antithetical to the goal of attaining a drug-free Malaysian society.

Heroin, pre-prepared in syringes is reportedly sold in some villages, resolving a problem when access to a needle and syringe is difficult and enabling the avoidance of severe penalties associated with being caught in possession of drug injection equipment. This situation makes it much more likely that a single needle and syringe will be used on multiple occasions among many people, increasing HIV vulnerability.

Some drug injectors practice cleaning, however, it is likely to be of limited if any use in protecting users from infection with blood-borne diseases since it is usually performed with a small number of water rinses alone. Recently, a nongovernmental organisation introduced the use of bleach to injecting drug users in Kuala Lumpur. Although household bleach is accessible throughout the country, it appears this method of cleaning injecting equipment is not commonly known about or used.

A needle and syringe purchased from a legal pharmacy requires a prescription; the price is approximately US$ 0.32-0.64. A needle and syringe can also be purchased from an illegal pharmacy, without a prescription, at a higher cost. Apart from the legal barriers, the cost factor is likely to discourage the purchase and instead, encourage the sharing of injecting equipment. Since carrying a needle and syringe is in itself illegal under the Dangerous Drugs Act 1952 and can be used as incriminating evidence against a drug user, this will likely serve as a substantial deterrent against obtaining clean injecting equipment from a pharmacy.