Assessment of an Innovative Voluntary Substance Abuse Treatment Program Designed to Replace Compulsory Drug Detention Centers in Malaysia

ABSTRACT

Background: As part of an ongoing initiative by the Malaysian government to implement alternative approaches to involuntary detention of people who use drugs, the National Anti-Drug Agency has created new voluntary drug treatment programs known as Cure and Care (C&C) Centers that provide free access to addiction treatment services, including methadone maintenance therapy, integrated with social and health services. Objectives:  We evaluated early treatment outcomes and client satisfaction among patients accessing C&C treatment and ancillary services at Malaysia's second C&C Center located in Kota Bharu, Kelantan. Methods: In June-July 2012, a cross-sectional convenience survey of 96 C&C inpatients and outpatients who entered treatment >30 days previously was conducted to assess drug use, criminal justice experience, medical co-morbidities, motivation for seeking treatment, and attitudes towards the C&C. Drug use was compared for the 30-day-period before C&C entry and the 30-day-period before the interview. Results: Self-reported drug use levels decreased significantly among both inpatient and outpatient clients after enrolling in C&C treatment. Higher levels of past drug use, lower levels of social support, and more severe mental health issues were reported by participants who were previously imprisoned. Self-reported satisfaction with C&C treatment services was high. Conclusions/Importance: Preliminary evidence of reduced drug use and high levels of client satisfaction among C&C clients provide support for Malaysia's ongoing transition from compulsory drug detention centers (CDDCs) to these voluntary drug treatment centers. If C&C centers are successful, Malaysia plans to gradually transition away from CDDCs entirely.

KEYWORDS:

• Asia
• addiction treatment
• compulsory drug detention centers
• drug policy
• harm reduction
• Malaysia

Acknowledgments

We would like to thank the staff (particularly Ismail, Supindi, Yusri, and Aidilfitriza Mat Yusouf) at the Pengkalan Chepa Cure and Care Center in Kota Bharu, Malaysia as well as Hafiz Afendi, Hasrul Anuar, Ariff Yusoff, and Mazlimi Ramnatathan from SAHABAT for making this research study possible. In addition, we are grateful for the support from the Center for Interdisciplinary Research in AIDS (CIRA) at Yale, Center of Excellence for Research in AIDS (CERiA) at University of Malaya, Vanesa Rajandaran (CERiA), Chris Paiji (Stanford University), Alexander Bazazi (Yale University School of Medicine), and Benjamin Margolis (Yale University School of Medicine).

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

This research was funded by the Yale College Fellowship for Research in Health Studies, the Gary Stein Memorial Fellowship and the Linck Summer Fellowship from Ezra Stiles College at Yale University, the National Institutes on Drug Abuse (R01 DA025943 and K24 DA017072, Altice) and the High Impact Research Grant (HIRGA-E000001-2001, Kamarulzaman) from the Ministry of Higher Education at the University of Malaya.