DECEMBER 20 — It is disheartening to read the level of understanding of the Honourable Deputy Home Minister Datuk Nur Jazlan Mohamed regarding Methadone Maintenance Therapy (MMT) programme in the treatment of opioid use disorder (Defending Malaysia’s zero tolerance policy, Jazlan claims US’ liberal approach failed – Malay Mail Online,December 15, 2016).

His negative statements regarding methadone portray the lack of understanding about the role of Medication Assisted Therapy (MAT) in the medical management of addictive disorders, particularly opioid.

Although I respect Malaysia’s zero tolerance policy towards drug, the Honourable Deputy Minister should have been better advised about the conceptual progress in understanding addiction. I believe that the zero tolerance policy is modeled around the archaic concept that addiction is solely a problem with moral and social failure. Medical model of addiction states that addiction is a chronic and relapsing disease, equivalent to other chronic diseases like hypertension and diabetes.

This is where the use of MAT such as methadone comes into the picture. Easy accessibility and voluntary participation into the MMT programme has transformed the life of opioid dependents towards the better. The first dose of methadone given by the then Health Minister Datuk Dr Chua Soi Lek at the Methadone Clinic of Hospital Kuala Lumpur in October 2005 kick-started Malaysia’s MMT programme that has been shown to cut down the transmission rate of infective diseases such as HIV and hepatitis while improving the health and medical status of its clients.

Many life have been saved, families reunited, jobs regained, criminality reduced and most importantly the opioid dependents who were once labeled as the pariahs of society were re-habilitated at a lower cost compared to compulsory detention in a drug rehabilitation centre. The effectiveness of methadone for opioid addiction treatment has been proven not lest by the most recent study currently debated, but also in the myTOS study by the Ministry of Health.

Providing methadone is unlike substituting drug with another drug because methadone replaces illicit opioid (heroin, morphine) that is of unknown purity and safety. Methadone alleviates the withdrawal symptoms of illicit opioids but at the same time prevent the euphoria sought by illicit opioid users, which helps to re-engineer the brain’s reward circuit, the main problem with addiction. This way, methadone users can focus to being the individuals they once were.

Continuing with the ‘cold turkey’ approach also does not make sense. Do we feel happy and satisfied to see individuals struggle with the unbearable body aches and pains while having profuse diarrhoea during the withdrawal period?

Humanising the treatment and providing a safer and more comfortable journey to recovery will betterpromote drug rehabilitation compared to making them go through hellish ride just because ‘it is part of the policy’.   

I also hope that the Honourable Deputy Minister not to confuse himself with the ‘soft approach’ of substances with substitution therapy such as opioid, with treatment of substances without substitution therapy like cannabis and methamphetamine.

The practical approach maybe different but what is important is that psycho-social approaches held by agency like Agensi Anti-Dadah Kebangsaan (AADK) must be combined with medical management to treat addiction in a complete manner. No one approach is superior to the other, so ridiculing any of these is not going to help anybody.

* Dr Mohd Fadzli Mohamad Isa is the Immediate Past President of Chapter for Early Career Psychiatrist (ECP) of the Malaysian Psychiatric Association.

** This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail Online.