[COLUMNIST] Decriminalising substance abuse: A step forward with room for refinement
AWANI Columnist
Julai 10, 2024 05:33 MYT
Julai 10, 2024 05:33 MYT
What drug dependents truly need is not further societal stigmatisation or harsher punishment; they need professional assistance to break the cycle of substance abuse. - PEXELS
SUBSTANCE abuse has plagued Malaysia for generations, stretching back even to the pre-independence era of Malaya. Despite our nation’s progress, this issue continues to persist, like a stubborn thorn in our side, and we are still searching for an effective way to combat it.
After years of demonising drug dependents (as our law calls them), imposing social stigma, and publicly shaming them, we should have realised sooner that our previous approach was fundamentally ineffective. In reality, these individuals are victims of a complex medical problem.
What drug dependents truly need is not further societal stigmatisation or harsher punishment; they need professional assistance to break the cycle of substance abuse.
And so the Ministry of Home Affairs (MOHA), led by Minister Saifuddin Nasution Ismail, has proposed the decriminalisation of substance abuse. and presented the amendment to the Drug Dependents (Treatment and Rehabilitation) Act 1983 (Act 283) to the august house during the recent parliamentary seating.
The intention and efforts to decriminalise substance abuse, subsequently providing rehabilitation to victims, deserve applause. After all, this progressive step acknowledges that dealing with substance abuse requires more effective approaches than mere imprisonment, as highlighted by Mustapha et al. (2020).
However, the reaction to the amendment has been less than welcoming. In the days following the first reading, medical experts have voiced opposition to the changes in Act 283 (Code Blue, 2024). Additionally, several MPs from the governing alliance have requested that the bill be referred to the Parliamentary Select Committee (PSC) for further scrutiny (Malaysiakini, 2024).
The devil lies in the details.
One of the biggest issues with the amendment to Act 283 is that it would grant rehabilitation officers an unacceptable amount of authority.
Following the amendment to Section 8, rehabilitation officers have the power to certify whether a person is a dependant or misuser, akin to diagnosing Substance Use Disorder (SUD).
It is essential to note that the authority to diagnose SUD, a mental disorder classified in the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5), should rest solely in the hands of medical professionals such as doctors, clinical psychologists, or psychiatrists.
Furthermore, the amendment to Section 9, which concerns minors, grants even more power to rehabilitation officers. Under this section, rehabilitation officers have the authority to mandate that parents be present with minor offenders during the rehabilitation programme and treatment. Failure to comply, could result in a fine not exceeding RM5,000 under Section 9(5).
However, this approach may inadvertently discourage families with minors suffering from substance abuse from seeking proper help, particularly those from B40 families in low-income brackets, which are precisely at high risk for substance abuse (Ismail, 2024).
Additionally, the amendment to Section 12 allows rehabilitation officers to recommend the shortening of treatment periods for dependants to Director General (DG). Although the final decision rests with the DG, they typically act in accordance with the recommendations they receive.
The proposed amendment to Act 283, if implemented, would give rehabilitation officers an excessive amount of power, potentially opening the door to corruption and abuse of power.
As described in the amendment, rehabilitation officers are appointed under the provision of the National Anti-Drugs Agency Act 2004 (Act 638). However, it remains unclear whether their training adequately covers the necessary skills for making medical diagnoses. Thus, they should not hold any authority over certifying whether someone is a dependent or misuser, let alone recommending magistrate a proper rehabilitation period or shortening it.
A rehabilitation officer’s role should be limited to receiving reports from dependents themselves or third parties (such as friends or family members), facilitating meetings with medical officers and magistrates, and overseeing rehabilitation or treatment programme on behalf of medical professionals without making medical judgments. The responsibility of diagnosing and recommending rehabilitation periods should rest with the medical officers, who possess the expertise in this field.
The over-empowerment of rehabilitation officers is not the only issue with the proposed amendment.
The amendment to Act 283 introduces changes to the term and definitions related to dependents. If the amendment passes as it is, Act 283 would have jurisdiction over two distinct groups of people: drug and substance dependents, and drug and substance misusers.
A dependent is described as a person who, through the use of drugs or substances, exhibits characteristics of dependency on dangerous drugs and substances that affect self-control.
On the other hand, a misuser is defined as a person who consumes dangerous drugs or substances for non-medical purposes or without a lawful prescription from a government medical office or registered medical practitioner.
In simple terms, dependents are individuals suffering from drug and substance addiction, while misusers are people who experiment with illicit drugs and substances but have not yet shown signs of addiction.
However, despite the significant difference between dependents and misusers, once rehabilitation officers deem someone to be a drug user, they become subject to mandatory rehabilitation, regardless of whether they fall into the category of dependents or misusers.
The only difference lies in the maximum duration of rehabilitation, which is two years for dependents and maximum of six months for misusers if they are ordered to undergo rehabilitation in a rehabilitation centre. If the order specifies treatment or rehabilitation in a community, the time frames would be two years for dependents, and maximum of two years for misusers.
For those undergoing community-based rehabilitation, residing within the area specified in the order becomes mandatory, and they cannot leave this area without written consent from the DG. This significantly restricts their freedom of movement during rehabilitation period. In case of misusers violating these terms, the rehabilitation period can be extended by an additional six months. Repeated offenses may result in up to one year of rehabilitation in a centre.
Set aside the effectiveness of mandatory rehabilitation which is found to produce mixed empirical results, it is essential to recognise that drug misusers generally do not require any form of rehabilitation as opposed to dependents (Huang et al., 2021; Nakhaee et al., 2024; United Nation Office on Drugs and Crime, 2022).
It is not to say that the misuse of drugs is completely safe. If the misuse persists, it can escalate into drug addiction, which would require intervention such as rehabilitation. However, a simple reprimand and fine would suffice, as misusers are neither addicted nor dependent on the substance they misuse. Therefore, they do not need rehabilitation.
Although the amendment to Act 283 has separated misusers from dependents, it did not provide distinctive intervention methods based on the needs of these different groups. Instead, it merely adjusted the rehabilitation period for misusers, ultimately categorising them as a lesser evil, for lack of a better term.
So, what can be done to improve the amendment to Act 283?
1. Collaboration with Medical Officers:
MOHA should collaborate closely with our Ministry of Health when amending Act 283 and involve medical officers instead of rehabilitation officers in certifying whether an individual is a drug dependent, misuser, or neither. Medical diagnosis is a complex process that should not be taken lightly, especially considering that Substance Use Disorder involves both physical and mental examination.
Medical officers should be the sole authority responsible for suggesting suitable rehabilitation periods for those who are in need. They should communicate these recommendations to magistrates, and only they should have the authority to propose shortening rehabilitation periods to the DG.
Empowering medical officers in this way, would certainly necessitate revisiting the proposed empowerment of rehabilitation officers, as they lack the qualifications required for making such critical decisions.
2. Reconsidering Section 9 Punishment:
While it is commendable to involve parents in accompanying minors during rehabilitation programs, the proposed fine of RM5,000 under the amended Section 9 is too steep. Particularly concerning is that a significant proportion of youth involved in substance abuse come from B40 families (Ismail, 2022).
3. Misusers and Mandatory Rehabilitation:
Mandatory rehabilitation should not apply to misusers. Instead, a system of periodic test monitoring could be implemented. Misusers would need to maintain negative test results for a specified period before being removed from the process.
It is unreasonable to restrict freedom of movement for misusers due to minor offenses for a maximum of two years.
Sending the bill to the Parliamentary Select Committee (PSC) is a commendable decision on behalf of drug dependants and misusers (Malaysiakini, 2024a). Let us hope that the amendment will conclude positively and provide much-needed treatment for those who deserve it.
* Chia Chu Hang is a Research Assistant at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.
** The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the position of Astro AWANI.