TATAPAN PEMBUKA KATA
• Detoksifikasi Pil Khayal termasuk Dormicum, Eramine5, Pil Kuda dan lain-lain
• Rawatan ketagihan Alkohol, Syabu ( ICE) dan Ketamine
• Pusat Rehabilitasi sementara kes-kes ketidakstabilan mental akibat ketagihan serius dan kronik
• Sesi Percuma Kongsian Masalah dan Kaunseling
Methamphetamine atau syabu adalah dadah perangsang, pertama kalinya dicipta pada tahun 1893 di Jepun. Pada perang dunia kedua telah digunakan secara umum oleh tentera-tentera Jerman, Amerika dan Jepun sebagai penggalak tenaga dan ketahanan fizikal di dalam peperangan. Selepas perang dunia kedua ,tentera Jepun telah secara berleluasa mengedar jenis dadah ini kepada orang awam. Justeru mencetuskan permulaan penyalahgunaannya di kalangan penduduk awam. Ketagihan Methamphetamine memang telah dikenalpasti sejak dulu. Sepanjang penyalahgunaannya telah diberikan berbagai jenis nama seperti ICE, SYABU, SPEED, METH, YABA, CRANK, ICE BABY, HOT ICE, dan lain-lain.
•Euphoria – keterujaan tahap emosi dan pemikiran kearah rasa gembira dan kemuncak kepuasan
•Rasa kerisauan tanpa sebab(anxiety)
•Lekas meradang (irritability)
Jika diambil dengan dos tinggi akan mengakibatkan sifat lekas meradang, agresif, kerisauan yang melampau, halusinasi dan paranoid disertai delusi dan psikosis.
Pengguna syabu cenderung menjadi liar dan ganas. Gangguan perasaan boleh berlaku secara tiba-tiba pengguna boleh bertukar dari sifat penyayang kepada ganas sekelip mata. Paranoia yang terhasil dari kesan syabu, mengakibatkan pengguna sentiasa menyangka buruk tanpa asas, kelakuan hyperaktif dan perubahan mood.
Ketamine dicipta oleh Dr. Craig Newlands dari Wayne State University. Dicipta sebagai ubat bius sewaktu Pembedahan dijalankan. Pada awalnya digunakan oleh askar-askar Amerika semasa peperangan Vietnam dan berterusan digunakan sehingga sekarang.Penyalahgunaannya amat membimbangkan Kerana potensi gangguan psikotropiknya. Ianya juga digunakan oleh doktor-doktor haiwan.
Ketamine dijual sama ada di dalam bentuk cecair atau debu. Di dalam bentuk debu, ianya kelihatan seolah-olah seperti Kokain, Yang digunakan melalui kaedah Snort (sedutan), jarum suntikan dan kemungkinan ditambah dalam minuman. Ada kemungkinan juga ianya dihisap dengan campuran ganja (marijuana) dan tembakau menggunakan paip.
Pengambilan Ketamine menghasilkan kesan serupa seperti Dextrometorphan (sejenis ubat batuk). Kesan khayal Halusinasinya akan berterusan selama sejam jika disedut (Snort) dan sehingga 2 jam jika ditelan.Apabila dos yang rendah diambil , kesan halusinasi hanya dirasai di dalam bilik gelap dengan mata tertutup. Tetapi berlainan pula jika dos yang digunakan lebih tinggi, yang mana kesan halusinasinya adalah lebih kuat dan nyata.
•Rasa mengantuk / pening •Keliru •Muntah-muntah •Panik •Mood yang tidak menentu •Tingkahlaku pelik dan tidak boleh dijangka
Thursday, December 31, 2009
New Hope For Drug Addicts
The Sun, 29 July 2002
Malaysia: A newly introduced medication is set to change the way drug addiction is treated in the country. Introduced here eight months ago by Dr. Mahmud Mazlan, one of the only two drug addiction specialists in the country, buprenorphine has been effective in treating addiction to drugs, particularly heroin. With the use of bupreborphine, addicts need not suffer excruciating withdrawal symptoms or go cold turkey.
Dr. Mahmud who heads the psychiatric department of Hospital Muar spent a year at the substance abuse unit at Yale University Medical School as a visiting scholar and was involved in research on the use of buprenorphine. He initiated the establishment of a substance abuse center, staffed by members of a non-profit group of former addicts called Pesayap, at Hospital Muar. About 400 doctors have been trained in the new treatment under the Treating Drug Addiction – A Helping Hand programme launched by the Federation of Private Medical Practitioners’ Association of Malaysia.
Burnt by Ice
Crystal methamphetamin is currectly a popular drug among youths.
WHEN May had her first puff of Ice, she never thought that she would be addicted to the substance, which looks exactly like table salt.
"The reason is simple. I wanted to lose weight. At that time, I knew about drugs, but I didn't know how they looked like or how to take them," says the 28-year-old.
But when May saw a friend taking Ice, she was told that it's ok to take it.
According to her friend, unlike heroin, Ice does not cause addiction.
"Apparently not, you do get addicted," she laments.
"Back then, I lost a lot of weight, to the point I was almost anorexic, but now I've put on a lot more (weight) back on, so I'm feeling much better," says May, who is currently going for treatment.
After seeking treatment, May now has a stable job and income, and is able to take care of her daughter at home.
Ice, the nickname for crystal metamphetamine, is currently a popular drug among youths, says consultant in addiction medicine Dr Mahmud Mazlan.
While heroin remains the most prevalent drug addiction in Malaysia, methamphetamine addiction is currently ranking first in terms of new cases.
"Chances of recovery (for metamphetamine addiction) is good if hospitalisation and proper medication and psychosocial intervention is properly administered," Dr Mahmud says.
In his experience in Malaysia, more than two-thirds recover after one year of treatment if medications and initial hospitalisation is utilised. Otherwise, the success rate is less than 10%.
" (Methamphetamine) is classified as a stimulant drug and unlike opiates (like heroin and morphine), it has three major differences in causing addiction,"he explains.
For starters, you don't have to take methamphetamine daily to become addicted. Once or twice a week of regular methamphetamine use can cause dependence.
Unlike heroin- which causes withdrawal a few hours after the last injection - withdrawal symptoms for methamphetamine starts after two weeks of abstinence, says Dr Mahmud, adding that without immediate withdrawal symptoms, many people addicted to methamphetamine thought that there were none.
However, methamphetamine causes more brain and blood vessel damage than heroin does.
According to Dr Mahmud, while heroin only causes permanent impairment to the reward system in the brain, methamphetamine can cause stroke, heart attacks and permanent psychosis (resembling schizophrenia) with chronic use.
"It can also result in aggressiveness, sexual crimes and suicidal behaviour because of severe depression when (users) stop for more than two weeks," Dr Mahmud says.
Besides, methamphetamine is also associated with memory loss and severe dental problems.
There are three main groups that use Ice, says Dr Mahmud.
Men or sex workers use it to enhance their sexual performances; people involved in industries that value high performance may use it to increase work performance; and people addicted to other drugs like heroine and ecstasy may use it as a pleasure drug.
Luckily for May, her family detected her habit just in time, because for her, ultimatums do not work for a person who is already hooked on drugs.
"You can't just tell a person on drugs to stop by themselves, it doesn't work that way. I wasn't given a choice to go for rehabilitation, but if I were given one then, I wouldn't have gone for it. So there must be some sort of intervention somewhere," May says.
"The process of rehabilitation was long, and I'm still in the process. I don't take drugs anymore, but I'm taking medication now. It's like substituting one drug for another; the only difference is that one of them is legal."
Going through treatment, May had her share of withdrawal symptoms.
"When you have withdrawal, you get very depressed. Some people get depressed to the point of being suicidal; some people get schizophrenia - they hear voices; and some experience very extreme paranoia.
And it is very real," says May."And it is very difficult to accept that you are experiencing schizophrenic symptoms because of drugs. It's like you've become crazy."
"Eventually I want to stop medication, and I wish I can be a responsible mother and a responsible citizen too."
When asked of her advice to young people out there, rather than just a straight "don't try it", May advises them to read up about drugs.
"For those who have never tried it, read up about the street drugs out there. There are some designer drugs that can really mess up your brain.
"And also, know more about the symptoms and the kinds of people who take drugs, and stay away from them. That is perhaps the only way," she adds.
Coming from a drug user, I was curious. If everyone were to take her advice, wouldn't drug addicts feel deserted? May's answer was, "wouldn't you seek therapy?"
"(When you feel deserted), you would feel very conscious and know that 'its not cool to take drugs'," May said. But if drug addicts really want to stop, May suggests that they seek help.
"It is affordable. If you can afford drugs, I'm sure you can afford to pay for medication," May said.
Monday November 23, 2009
Party drugs that kill
By YIP YOKE TENG
PETALING JAYA: Party drugs are fast reshaping the trend of drug abuse in the country, spreading aggressively to reach suburban schools and children as young as 11.
These drugs, covering a wide range of amphetamine-type stimulants (ATS) and ketamine, are overtaking conventional opiate-based options due to their easy availability and a common misconception that they do not cause withdrawal symptoms.
Private drug rehabilitation centres reveal that almost 80% of their newcomers are users of such party drugs, also called synthetic or designer drugs.
Social workers describe the centres as psychiatric institutions because the inmates, many in their teens or 20s, struggle with brain damage and other detrimental side-effects.
New cases involving party drugs recorded a five-fold increase in the past eight years while heroin showed almost no increase, according to Dr Mahmud Mazlan, who runs seven clinics specialising in drug treatment.
The users are getting younger, too. Dr Mahmud said the patients were mostly in their early 20s in 2007, while in 2008, many of them were in their late teens.
However, this year, he has received patients as young as 12 and 15. Some social workers have even been approached by parents of users who were only 11.
“It has touched the younger and more vulnerable group. I have already received cases from semi-urban schools.
“Runners and pushers let the kids try the drugs for free for two weeks, and when they are hooked, the kids steal, extort or push the drugs to their friends to get their fix.
“Girls, sadly, often even offer sex for it,” Dr Mahmud said when interviewed at his clinic in Chow Kit, Kuala Lumpur.
He also has another clinic in Kuala Lumpur and others in Muar, Malacca, Seremban, Klang and Ipoh.
“The number of new synthetic drug users admitted into my clinics has doubled every year since the opening of my first clinic in 2001,” said the doctor, who is working with Yale University on research pertaining to substance abuse.
Currently, his clinics have about 200 methamphetamine patients, compared to only two in 2001. Additionally, there are 40 ketamine-dependent patients in the clinics now.
“It has become an epidemic in South-East Asia and the United States, as well as in Malaysia. About 80% of ATS users are in Kuala Lumpur, followed by Penang and Johor,” he added.
According to him, methamphetamine crystals (street names: syabu, ice) and tablets (WY, Pil Kuda, Yaba) have been available in the country since 1997, while ketamine was brought into the country around 2003.
The popularity of these drugs increased drastically about two years ago as the police urine test then could not detect their presence. Liquid Ecstasy, another designer drug whose use is spreading fast, can also deceive urine tests.
Dr Mahmud’s study of 704 drug users in Malaysia between December 2006, and March 2009, showed that the sharp increase in party drug abuse would soon overtake the opiate-based options (refer graph). He said another focus group study concluded that several myths have also contributed to the swing in trends.
The myth about methamphetamine is that it is not addictive, while the opposite is true. Another misconception is that it helps one perform better — that it can help students concentrate, drivers stay alert or enhance sexual performance.
“However, the fact is that the drug makes one awkwardly confident. When the drug’s effects fade after two to three days, the person becomes less than what he was. After one year, when dependency develops, they cannot perform at all without the drug, and become emotionally down or just live like zombies,” he said.
The third myth is that methamphetamine does not cause withdrawal symptoms but the fact is that these occur two weeks after stopping its use.
“On top of all that, methamphetamine is easy to make even for someone who does not possess a degree in chemistry. Two of my patients tried their hands at it, but unfortunately, the concoction exploded and almost burned their face,” he said.
He said although more people were suffering as a result of party drug abuse each year, there were only a handful of local physicians trained in this field, while the facilities and resources needed were expensive.
Dr Mahmud has set up a foundation to help stop the spread and regularly disseminates relevant information through his website www.substanceabuse.com.my.
Statistics on new addicts compiled by the National Anti-Drug Agency has also shown a steady expansion of the categories under ATS (refer table), from 16.71% in 2007 to 24.26% in 2008 and 25.83% between January and September this year.
Not all party drug users show signs of addiction, thus, the number of actual users is much higher.
Agency assistant director-general (operations) Prof Dr Mahmood Nazar Mohammed said its Narcotics Treatment Centres (Puspen) in border towns have shown a sharp increase in ATS abusers.
The supply of such party drugs in Kelantan and Kedah comes from Thailand, he said, adding that all inmates in Sabah were ATS abusers.
“From our observation, it is mainly due to the drop in the availability of opiate-based drugs, as well as a drop in the number of abusers in these categories due to the effectiveness of methadone replacement and suboxona programmes,” he said recently.
He said the agency would begin a pilot programme by the year-end to treat synthetic drug abusers, and has plans to establish a centre to solely treat ATS abusers, with the Health Ministry supplying psychiatric services.
He also said it was untrue that Puspen did not accept ATS abusers because of a lack of expertise and manpower.
“Most users do not carry signs of addition, and for addicts to be charged under the Dangerous Drugs Act 1952 that sends them to our rehabilitation centres, they have to be certified by medical practitioners.
“Still, a total of 150 drug users, including those charged under Sect 15(1)(A) of the Act, are in our community rehabilitative Matrix programme being carried out in Kelantan, Papar and Muar. We have recorded a 73% compliance rate of those who have been charged,” he said.
Asked if current laws were an effective deterrent, he said the Act served as an instrument for early intervention, where the agency could advise abusers to stop.
Section 15(1)(A) of the Dangerous Drugs Act 1952 covers any person who consumes or administers to himself any dangerous drugs. If convicted, they can be fined a maximum of RM5,000 or jailed up to two years.
Meanwhile, Dr Mahmud said family vigilance was the only option to prevent drug abuse.
“Having a child who consumes or abuses drug does not mean bad parenting,” he said.
“I have very humble and admirable parents sending their children to me, including high-ranking elected representatives.”
He advised parents to be wary of the early signs of abuse – abnormal sleep cycle, appetite and weight loss, asking for money, acting overly friendly or, in the more advanced stage, becoming verbally abusive.
He said parents should also look out for sachets containing a salt-like substance, or “bonk”, an apparatus to snort syabu.
Sunday June 1, 2008
Recovering from addiction
By LIM WEY WEN
Photos by RAJA FAISAL HISHAN and AZHAR MAHFOF/The Star
The memory of the high when they use is the greatest hurdle for recovering addicts. This understanding may be the key to long-term recovery.
AT 30, Hafizi Harun can still remember in detail how he took heroin when he was in his teens.
“It is difficult to forget the art of taking drugs – the way you roll the foil, the way you light up, or the way you search for a vein to inject,” says Hafizi.
Listening to this without judgment, it occurred to me that he is just describing something that is most pleasurable to him at a point in his life. Just as my mother would describe, in detail, the way her dough rises in the oven when she bakes.
“You miss the ritualistic behaviour that comes with drugs,” says Hafizi. But spending a year in Pengasih rehabilitation centre had changed Hafizi’s life. Even though memories of his life as an addict come back, he has learnt the art of talking himself out of it.
“Overcoming the wanting or craving is the most difficult hurdle for drug addicts who want to stop their habits,” says Mohd Yunus Pathi, President of Persatuan Pengasih Malaysia – a non-profit organisation initiated by reformed drug users in 1987.
Even after stopping drugs for 10 years, it takes only one time of drug use to cause a relapse, says consultant in addiction medicine, Dr Mahmud Mazlan.
“No addict in the whole world wants to be addicted, but all addicts want to use drugs once in a while. That’s why they often experience relapses,” he continues.
But understanding and admitting the possibility of going into a relapse might be the key to Hafizi’s success in keeping clean for about 10 years now.
“I applied what I learnt in Pengasih and used the techniques to overcome my craving,” says the Persatuan Pengasih Malaysia training manager.
The reward circuit and you
“The one thing you have to understand about drug addiction is that it is pleasurable,” says Dr Mahmud.
And brain scans have shown that our tendency to like pleasurable things and avoid less attractive ones may have a lot to do with the way our brain is wired.
“Two areas in the brain, called the ventral tegmental area (VTA) and the nucleus accumbens (both located in the centre of the brain), are the primitive parts of the brain. They are the ones that control our drive to eat and to have sex because they are vital for our own survival and the survival of our species,” Dr Mahmud explains.
When we are experiencing something pleasurable (anything from good food to sex), the neurons (brain cells) in the VTA release neurotransmitters (chemicals) called dopamine to other parts of the brain to makes us feel good.
So, if you have a soft spot for chocolates or nasi kandar, your brain will secrete these chemicals every time you take them.
“You will take it again and again because you feel good,” Dr Mahmud elaborates.
And if sexual orgasm is the highest attainable pleasure any mortal can have, drugs can give a person more, he says.
But, what feels good may not be good for you. Too many chocolates without adequate exercise can lead to obesity, and too many nasi kandars may land you with hypertension and high cholesterol levels.
Even so, that knowledge does not stop us from indulging every time we have cravings for them.
Pleasure brought by drugs has a similar effect. When you have something that gives more pleasure than could be attainable from a normal life, the brain “short-circuits”, and other pleasures in life pale in comparison, says Dr Mahmud.
“Withdrawal symptoms are not the main reason why drug addicts can’t stop, but it is because they can’t find pleasure in life anymore without drugs. They have a reduced ability to experience normal pleasure.”
Making things worse is our brain’s tendency to suppress painful memories and retrieve pleasurable ones. “After stopping drugs for one or two months, the memory of the pleasure comes back to haunt them (drug addicts),” says Dr Mahmud. “Craving is not just thinking about the drug. It is the hunger of the drug.”
In what Dr Mahmud describes as “drug insanity”, the whole body of a drug addict reacts when the hunger strikes and all rational thoughts are thrown out of the window.
“At that moment, what matters to them is only how to get their drugs,” he explains.
While drug addiction used to be a regarded as a moral failing rather than a medical condition. But in recent years, doctors are increasingly viewing it as a disease.
In a US National Institute on Drug Abuse (NIDA) press release in 2004, Director Dr Nora Volkow said, “Drug addiction is a brain disease. Although initial drug use might be voluntary, once addiction develops, this control is markedly disrupted.
“Imaging studies have shown specific abnormalities in the brains of some, but not all, addicted individuals. While scientific advancements in the understanding of addiction have occurred at unprecedented speed in recent years, unanswered questions remain that highlight the need for further research to better define the neurobiological processes involved in addiction.”
The progression of drug addiction
“People do not go straight into addiction once they take drugs,” says Yunus, who came out of heroin addiction 25 years ago.
Judging from the intake of residents at the Pengasih rehabilitation centre and drop-in centres, Yunus estimates almost 65-70% of youths in Malaysia have experienced taking drugs at least once.
“These people are drug users. They are not addicted,” he adds.
In 2007, the Malaysian Crime Prevention Foundation found that 71% of new drug addicts are between the ages of 19 and 39. Most teenagers try out drugs for the first time between 13 and 15.
While most of us try drugs because of curiosity, stress or peer pressure, the continued use of drugs has a lot to do with the physiological response of our brains to drugs.
“People become addicted because they are experiencing emotional, psychological or spiritual disturbance,” Yunus says.
At first, when people take drugs, they can control their intake, Dr Mahmud says. At this stage, people can take drugs occasionally without experiencing dependency on the drug. But after a longer period of time (depending on the type of drug), they start to take drugs every day and it takes another year or two for the disease to set in.
When the disease sets in, drug abusers lose control of their drug intake. Physiological changes in the brain and mental dependence on the pleasure brought by drugs make them unable to do so, says Dr Mahmud.
“At that time, the need to have money (to buy drugs) increases but the ability to produce income decreases. That’s why people go for crime to get money to support their habit,” says Dr Mahmud.
You know you are addicted to drugs when you can’t stop although you want to, says Dr Mahmud. Your drug stores seem to deplete faster than usual and life seems boring to you.
“Drug users know when they are addicted, but it is also difficult for them to accept the fact,” Dr Mahmud notes.
Realising this, Dr Mahmud feels that one of the ways to treat addiction is to point out to addicts that there are other things in life that is worth looking forward to.
What Yunus does now is to remind young people around him that they can find happiness in other things in life, but not drugs.
“If you think you have a problem now, drugs will only make it worse,” he says.
Is willpower enough?
Ask anyone who was hooked on drugs and they will tell you that addiction was not their intention.
Jeffri Ahmad, a recovering addict, told me as much. “When I started using drugs, I was also under the impression that I would be able to control it,” said the 38-year-old.
However, recreational use turned into addiction when Jeffri found it very difficult to stop. “It is so easy to get back on drugs because the sometimes you just want a little bit of relief from the pressures in life once in a while.”
At one point, Jeffri decided to stop because he could no longer sustain a lifestyle with drugs anymore.
“I wanted to stop drugs on reasons of self-preservation,” says Jeffri. To be on drugs, he had to make more money, but at the same time he was less able to work efficiently.
After a couple of years being on treatment, Jeffri is still in the process of recovery. “My business partner asked me to go for treatment and he has been very supportive.
“Willpower is not enough, because no one has managed to come out of drug addiction alone,” says Jeffri. “You need somebody to tell you that you need to stop,” he added.
Reviewing treatment approaches
Despite tough measures we have taken to curb drug abuse and addiction, including the death sentence for drug peddlers and prison for those in possession of drugs, the population of drug addicts is still large.
While public education should be ongoing, treatment (drug substitution therapy, rehabilitation and counselling) should also be made easily accessible to drug addicts.
“Nowadays, drug addicts who come for treatment can be arrested in front of the clinic itself.
“Certain laws should be amended to protect these people who came for treatment,” says the Federation of Private Medical Practitioners’ Associations Malaysia (FPMPAM) president Dr Steven Chow .
A recent public education programme called ‘Jiwa Baru’ offers a hotline (1300-80-7777) where people can call up and seek advice on drug addiction. Personnel manning the hotline would be able to help people locate the nearest treatment facility available in their area.
“Based on today’s statistics, there are about 250,000 to 270,000 registered addicts on heroin alone. And the actual number of addicts that you are able to detect is only one quarter of the actual number,” says Dr Chow.
In a community based treatment (CBT) programme provided by FPMPAM, with the guidance of the Ministry of Health, addicts now can have confidential medical treatment in settings such as private clinics, specialist centres or at home, says Dr Chow.
”It all boils down to logistics. If 500,000 drug addicts needed treatment, it is impossible to treat them all in an institution.
“You have to try to let them go back to the society, remove the stigma against them, give them their lives back as fast as possible and they must be spiritually connected to a religion of their choice,” he adds.
“All these can only be done in a community,” says Dr Chow. Medications is just a bridge for someone that is totally out of control to come back to his senses.”
However, the best mode of treatment in addiction depends on many factors, including the type of drug used, the motivation of the addict, the duration and the severity of addiction.
“We have one of the best policies for drug abuse in Malaysia, but there is a need to review our approach to treatments for drug addicts, particularly the needle exchange programme and methadone replacement therapy,” Yunus said, adding that rehabilitation centres can also make themselves self-sufficient in order to reduce government expenditure.
He says that although both the programmes are meant for reducing the spread of diseases such as HIV, there is a need to evaluate whether these programmes are also effective in curbing the drug problem.
Methadone therapy, for instance, is effective only when properly administered. Otherwise, addicts will abuse it if administered without proper supervision, Yunus said.
A National Drug Substitution Therapy Register has been established since year 2006 to monitor patients and doctors involved in drug substitution therapy (methadone and buprenorphine/naloxone) to prevent abuse.
“We should make a clear stand. Are we moving towards a drug-free nation, or are we saying that its ok to take drugs, as long as we use clean needles?” Yunus says.
“The government, NGOs and medical professionals should come together and discuss the way forward for us to curb our drug problem,” he adds.
On what the society can do to help curb drug addiction, Yunus said that helping drug addicts seek treatment and embracing recovered drug addicts back into the society helps.
Helping drug addicts is only in the society’s best interest, he concludes.
“You will never know if your loved one will become a drug addict one day because drugs are available everywhere. If you help your son’s friend who is a drug addict recover, you help your son by preventing him from becoming one too.
“When I first started to take drugs, I didn’t learn to do it from a manual. I learnt it from my friends,” Yunus says.
Hafizi, however, thinks that recovered former drug addicts should also do their part to earn the society’s trust.
“We should not sit back and ask the society to trust us. We must work hard to prove ourselves so that we will earn their respect,” he says.