Health Equity Matters, Thailand
In 2005, in response to the escalating HIV epidemics among people who use drugs, Malaysia instituted a National Harm Reduction Program, encompassing a Needle Syringe Program and Methadone Maintenance Treatment. This initiative, a commendable collaboration between the government and civil society, yielded a substantial reduction in HIV infections among people who use drugs—almost 65% within a decade. Malaysia’s efforts are viewed as an exemplary model for the region. While we celebrate this accomplishment, we are cognizant in Malaysia that health and human rights issues persist concerning drugs and drug use. Many individuals who use drugs still face disproportionately high incarceration rates for minor drug-related offenses, such as use and possession. Our prisons are overcrowded, with approximately 50-70% of inmates being drug-related offenders, mostly for minor crimes. Global evidence indicates that incarceration heightens vulnerability to HIV, Hepatitis C, and TB by about 20%. Stigma and discrimination against people who use drugs persist due to the criminal branding facilitated by existing laws.
The recent report by the Office of the UN High Commissioner for Human Rights unequivocally calls for countries to shift away from punitive approaches to drugs and drug use. It urges governments to adopt more evidence-based policies, such as the decriminalization of drug use and personal possession.
This year, SKPA-2 initiated its support for Malaysia in the realm of drug policy reform. One of the initial activities under this newly formed Drug Policy Program was a study visit to Portugal in September 2023. The Honorable Mr. Ram Karpal, Malaysia’s Deputy Minister in The Prime Minister’s Department (Law & Institutional Reform), along with several senior officials from the Malaysian Government, conducted a working visit to Portugal to examine the implementation of the decriminalization policy in Lisbon. Palani Narayanan, Senior Manager, Health and Human Rights (SKPA-2), coordinated and accompanied the delegates. Here are some of the lessons gleaned from this successful visit.
In September 2023, Malaysia’s Deputy Minister in The Prime Minister’s Department (Law & Institutional Reform), The Honorable Mr.Ram Karpal and several senior officials from Malaysian Government undertook a working visit to Portugal to study the implementation of the decriminalisation policy in Lisbon. Palani Narayanan, Senior Manager, Health and Human Rights (SKPA-2) coordinated and accompanied the delegates. Here are some of the lessons gained from that successful visit.
Political leaders acknowledge the futility of the war on drugs and accept pragmatic approaches to drugs and drug use.
The success of Portugal’s decriminalization policy underscores the pivotal role of political support and government ownership. Minister of Health Manuel Pizarro and Dr Joao Goulao, the Director General for Intervention on Addictive Behaviours and Dependencies of SICAD, took great pride in the positive outcomes resulting from Portugal’s decriminalization policy.
These outcomes include a decrease in drug use, reduced crime rates, and a decline in HIV and other bloodborne diseases. Above all, they advise the Malaysian government to adopt a pragmatic approach to address the challenges posed by drugs and drug use. Minister of Health Pizarro acknowledged the inevitability of drugs entering the country, emphasizing the need for multiple strategies, including harm reduction and decriminalization policies.
The Portuguese leaders recognized the need for change when faced with drug-related challenges in the 1990s. Dr Joao Goulao, the lead scientist behind the policy during the Premiership of Antonio Guterres, emphasized that the Decriminalization policy significantly differs from the failed War on Drugs approach. It has resulted in significant cost savings, enhanced treatment options, and reduced law enforcement expenditures.
The decriminalization of drug use policy allows law enforcement to focus on ‘bigger fish’ and allocate their resources to target more serious crimes.
The Public Security Department of the Lisbon Police provides unequivocal support for decriminalization. Inspector Rui highlighted the positive impact on reducing crime rates, saving police resources, and focusing on more serious criminals. Acknowledging ongoing challenges, such as the exceptionally low threshold levels for drug possession in Portugal, Inspector Rui called for a reconsideration in consultation with drug users to ensure logical legal implementation.
Undertake a local threshold study with the buy-in from police.
To establish a comprehensive decriminalization policy, a clear framework for addressing both drug users and sellers is essential. Inspector Rui emphasized the importance of a threshold level, allowing police to distinguish between individuals using drugs (who need support and public health strategies) and drug dealers (who should be processed through the criminal justice system).
Set-up a clear pathway for users and sellers.
A clear pathway for both drug users and sellers must be established. When someone is caught with a small amount of drugs (below the threshold), they are sent to the Dissuasion Commission. This commission assesses the severity of the person’s drug use and recommends treatment, community service, or penalties, involving families in the decision-making process. This approach avoids criminal records for drug users, saving police and court resources.
Dissuasion Commissions (or a similar mechanism) better identify individuals on the spectrum of drug use and provide targeted treatment support.
The Dissuasion Commission, with its paralegals, medical staff, and social workers, plays a crucial role in accurately identifying the severity of drug use and providing targeted treatment or penalty options. Treatment and support can be tailored for the individual, remembering that the one size fits all treatment strategy (particularly mandatory treatment) does not work. This successful and innovative mechanism operates through 18 Dissuasion Commissions on the mainland and 4 on the islands. In Malaysia we shall call it a Drug Use Prevention and Treatment (DUPT) Commission.
Invest in Evidence-Based Treatment and steer away from mandatory rehab.
The success of decriminalization extends beyond changing laws; it involves investing in evidence-based treatment, including methadone programs and community-based treatment/rehabilitation, CBT, and counselling modalities. The Lisbon Treatment Center employs a bio-psychosocial model addressing the social, psychological, and biological dimensions contributing to addiction. Portugal aligns with UN guidelines by not enforcing mandatory drug treatment.
Harm Reduction must continue as a critical component.
Harm reduction services, including mobile units and medically supervised drug consumption rooms, are crucial entry points for individuals grappling with drug use. Similar to Malaysia, these services allow open discussions with social or medical workers, offering immediate referrals to available treatment services. In Lisbon, apart from needle syringe programs and methadone services, a medically supervised drug consumption room has proven effective in addressing overdoses and contributing to the reduction of national HIV/AIDS cases.
Decriminalization principles can be adapted to Malaysia’s context.
Can decriminalisation of drugs for use and personal possession work in Malaysia? Of course, it can. Remember in 2005, against all odds the Ministry of Health and Malaysian AIDS Council joined forces with other key stakeholders to implement national needle exchange and methadone program in 2005. Within 10 years, Malaysia was able to reduce HIV rates by almost 70% and became a success story hailed by WHO and World Bank. While the implementation may differ from Portugal, adapting basic principles such as not criminalizing people who use drugs is crucial. Treatment and support prove to be more effective than incarceration – in Portugal as well as in Malaysia.
Published on: 14-Dec-2023
About the Contributor
Senior Manager, Health and Human Rights
Health Equity Matters, Thailand
Palani Narayanan is the Senior Manager, Health and Human Rights (SKPA-2) and Director of the Malaysian Drug Policy Program. He was previously the Senior Advisor on Harm Reduction at The Global Fund.