Pretreatment drug use characteristics and experiences among patients in a voluntary substance abuse treatment center in Malaysia: A mixed-methods approach

ABSTRACT

Background: Drug use in Malaysia remains a significant public health and social problem despite implementation of harsh punitive drug policies such as forcibly placing suspected drug users into compulsory drug detention centers (CDDCs). Following criticism over human right violations in CDDCs, Malaysia has begun to transition towards voluntary drug treatment centers known as Cure & Care (C&C) centers. To best serve the needs of regional C&C centers, data on drug use are essential among patients accessing treatment. Using a mixed-methods approach, the authors examined pretreatment drug use characteristics and experiences with addiction treatment among C&C patients in Kelantan—a religiously conservative state in northeast Malaysia with high prevalence of drug use but where limited data are available on drug use patterns. Methods: A mixed-methods study utilizing surveys (n = 96) and semistructured interviews (n = 20) was conducted among a convenience sample of inpatients and outpatients at the Pengkalan Chepa C&C Center in Kelantan. Results: Survey results showed that 89.6% of participants met screening criteria for moderate to severe addiction severity. Nearly 90% reported lifetime illicit amphetamine (syabu, meth, ice, and pil kuda) use, followed by alcohol (60.4%) and opioids (52.1%). Qualitative results pointed to the powerful influence of peer networks in drug initiation and relapse, and the positive effect of the C&C center on drug rehabilitation. Conclusions: The drug use profile of the Kelantan C&C center enrollees shows extensive pretreatment amphetamine use, polysubstance use, and injection drug use, including high-risk behaviors such as sharing needles, syringes, and containers. Evidence points to the need for integration of social support–oriented practices and behavioral interventions into the rehabilitation of drug users in this region.

KEYWORDS:

• Amphetamine
• compulsory drug detention centers
• drug policy
• harm reduction
• Malaysia
• substance abuse treatment

Acknowledgments

Archana Krishnan and Farrah Khan were previously affiliated with the Yale University School of Medicine. The authors would like to thank the staff at the Pengkalan Chepa C&C Center in Kota Bharu, Malaysia, as well as the research staff at SAHABAT for their invaluable assistance in conducting this study. The authors declare that they have no conflicts of interest.

Author contributions

A.K. conducted the quantitative analysis, interpreted the result, and wrote the manuscript. S.-E.B. analyzed and interpreted the qualitative findings and assisted in writing the Results section. F.K. and M.G. collected the data and assisted in content analysis. Ad.K. and F.L.A. oversaw research conception and design and helped A.K. write the Discussion section.

Funding

This study was funded through multiple grants. Funds from the Yale College Fellowship for Research in Health Studies, Gary Stein Memorial Fellowship, and Linck Summer Fellowship were used for study design, data collection, and management. The High Impact Research Grant from the University of Malaya also facilitated data collection. Data analysis and interpretation and manuscript preparation were facilitated through salary support provided by the following: National Institute on Drug Abuse (R01 AA018944), a diversity supplement (R01 DA030768), and a career development grant (K24 DA017072). None of the above funding organizations played a role in manuscript preparation, review, or approval nor were they influential in the decision to submit the manuscript for publication.