KUALA LUMPUR, Dec 17 — Detention centres for drug users do not work because of cold turkey programmes, the lack of medicines, and the approach towards addiction as a crime instead of a health issue, experts said.

Their remarks came after a study, which found drug users detained at rehabilitation centres in Malaysia were much more likely to relapse than those who voluntarily sought help, caused quite a stir when it was published last week, as it brought into focus the question of policy and approach in dealing with drug addiction.

Researchers from Universiti Malaya, Yale University School of Medicine, University of Florida College of Medicine and the Burnet Institute in Melbourne studied 89 people from the compulsory detention centres (Puspen) and 95 from the voluntary Cure and Care Centres in the Klang Valley between 2012 and 2014.

They found that half of those released from Puspen relapsed within 31 days, while those who were released from Cure and Care Centres relapsed after 352 days, a 10-fold increase.

Researchers, policy experts and those who do outreach work with drug addicts believe that the results validate what they have been saying for many years, about how the government should be moving away from a punitive, anti-drug policy to one that focuses on more voluntary, community-based centres.

Puspen, Cure and Care Centres: Same goals, different approach

Although both Puspen detention centres and Cure and Care centres are run by the National Anti-Drug Agency (AADK), they differ in how they treat drug addicts.

Cure and Care Centres give people the option of coming in voluntarily and provide Methadone Maintenance Therapy (MMT) to people who inject drugs (PWIDs), while Puspen detention centres (CCRCs) utilise an approach of total abstinence for those who are arrested and brought there.

Haryati Jonet, a drug user for over 20 years who now does outreach work with addicts, said that the reason why those at compulsory drug detention centres are more likely to relapse is because "cold turkey” programmes are used to address addiction, when it should instead be seen as a health issue.

Lack of access to medicines and "non-judgmental” staff in detention centres also make it difficult for those detained to adequately address their drug addiction, she said.

"Drug users are usually forced to go to CCRCs without any choices or preparation. Additionally, the stigma that surrounds being detained and sentenced to rehabilitation by force also causes trauma to the family, especially spouses and children. This makes it even harder for them to recover,” she told Malay Mail Online.

Haryati believes that the approach adopted by the Puspen detention centres is also ineffective because it does not differentiate between the types of drug users, nor does it seek to address the socio-economic factors which lead to people using drugs in the first place.

"I believe that by force, we cannot expect people to change. Each drug user is unique. One programme doesn't suit all,” she said.

Outdated methods in detention centres

Malaysian Aids Council (MAC) policy manager Fifa Rahman said that addiction should be treated as a chronic and relapsing medical condition, and that this was not the case with Puspen detention centres as they rely on other methods such as "marching” and "religious classes” instead.

"Compulsory drug detention (we don't call them rehabilitation centres because what they do does not rehabilitate) doesn't work because they approach someone out of the blue, when someone has not necessarily been empowered to access treatment on his own, is not mentally ready to be functional, or has been taken there by force,” she told Malay Mail Online.

"Logically, how would marching, abstinence rhetoric, and religious classes help with addressing the underlying causes for drug use?” she added.

Fifa pointed out how drug addiction affected people from different social classes, and how even wealthy people have addiction issues but "don't have their lives ruined by incarceration” because they have the means to seek treatment voluntarily.

Datuk Dr Kamarulzaman Ali, president of Persatuan Cahaya Harapan Kedah/ Perlis, a group which works with drug addicts, said that the current policy approach has failed to identify the external factors of why people suffer drug use relapses.

"With Puspen, you are forcing them to be under detention, while those who go the Cure and Care Centres already have a willingness to stop their habits.

"Detention centres emphasise discipline, waking up early to go marching… but when they leave, they are still going back to the same environment with the (drug) suppliers and the mental problems [are] left unaddressed,” he said.

Decriminalising drug addiction

Dr B Vicknasingam of Universiti Sains Malaysia (USM)'s Centre for Drug Research believes that Malaysia needs to stop looking at drug addiction as a "security problem", but more of a health condition which requires medical intervention.

"Locking them up in an artificial environment is only temporarily putting the problem away and the problem will return once they are released. Treating and rehabilitating drug users in the community is more effective as we are not only providing medical interventions to treat the problem in the brain, but also teaching them to cope with the social environment and not be disruptive in society,” he told Malay Mail Online.

Citing last year's figures from the Prisons Department, Vicknasingam pointed out that the number of prisoners held for drug-related offences in 2015 accounted for 60 per cent (31,504 people) of Malaysia's total prisoner population (52,612).

From this total, 75 per cent, or 23,747 people, were charged under Section 12(2) of the Dangerous Drugs Act 1952 with drug possession. Most of them are serving their sentences in prison under this Act for possession of less than two grammes of heroin.

"These are mostly, if not all, drug users. So in addition to Puspen, we are still putting a large number number of drug users in prison. They should be treated, not put in prison,” he said.

AADK public relations officer Salehuddin Klewan told Malay Mail Online a response would be issued on the matter soon.