THE Drug Dependants (Treatment and Rehabilitation) (Amendment) Bill 2024 appears to lack expert guidance and input.
Section 6(2) of the bill states: “Where a drug or substance dependant is produced or appears before a magistrate, the magistrate shall, on the recommendation of a rehabilitation officer and after giving such person an opportunity to make representations –
“(a) order such person to undergo treatment and rehabilitation at a rehabilitation centre specified in the order for a period of two years and thereafter to undergo treatment and rehabilitation in a community under the supervision of a Rehabilitation Officer at a place specified in the order for a period of two years;”
“or (b) order such person to undergo treatment and rehabilitation in a community under the supervision of a rehabilitation officer at a place specified in the order for a period of two years.”
We wish to highlight that substance dependence is a medical and health condition. Rehabilitation officers are not doctors and are therefore not qualified to provide expert recommendations on the management of substance dependants.
The magistrate must obtain a recommendation from a doctor (one with specialised training) before determining the period for treatment and rehabilitation.
The act’s definition of “dependence” is also troubling. The act loosely defines dependence as “menjejaskan kawalan kendiri” or negatively impacting one’s self-control, which is incorrect.
The accepted definition of substance dependence should come from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), where there are 11 criteria. Drug use disorder under DSM-5 is defined as a problematic pattern of drug use leading to distress or functional impairment.
Criteria include unsuccessful attempts to cut down or control use, spending excessive time acquiring or using drugs, craving, neglecting responsibilities, and continued use despite social or personal consequences. Tolerance and withdrawal symptoms may develop. Severity based on the number of met criteria: mild (2-3), moderate (4-5), or severe (6+) (DSM-5-T).
The causes of substance dependence are rooted in biological, psychological, and social factors. It requires extensive assessment through taking a detailed and targeted history, clinical examination, before doing blood/urine tests. Most doctors have to undergo specialised training for this.
The question we need to ask is “Are officers and volunteers from the National Anti-Drug Agency trained in this area?”.
Substance dependence must be treated by psychiatrists or psychologists (with specialised training in managing addictions).
In view of these many concerns including concerns highlighted by many other experts, we urge the government to halt the bill until proper engagements are held with stakeholders. We wish to state that the Home Ministry had not consulted MMA with regard to the bill.
Careful consideration and refinement by a special committee are needed before the bill is passed. – July 4, 2024
Dr Azizan Abdul Aziz is president of the Malaysian Medical Association