Non-Communicable Diseases: Risk Factors and other Health Problems 153 Table 9.6: Proportion of AUDIT Risk Stratification Score Among Current Drinkers Aged 18 Years and Above in Malaysia (n=544) Sociodemographic Characteristics Unweighted Count Estimated Population Percentage (%) 95% CI Lower Upper Low Risk Drinkers 440 1,389,637 81.5 75.32 86.36 Risky Drinkers 99 300,089 17.6 12.79 23.71 Drinkers with Probable Alcohol Dependence 5 16,091 0.9* 0.33 2.64 *Prevalence with high RSE, interpret with caution **Only those who answered all 10 questions in the Audit were included
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Non-Communicable Diseases: Risk Factors and other Health Problems 155 Substance Abuse
National Health and Morbidity Survey 2019 Technical Report − Volume I 156 Substance Abuse Contributors to this section: Wan Shakira Rodzlan Hasani, Muhammad Fadhli Mohd Yusoff, Rushidi Ramly, Rusdi Abd Rashid, Musalnizan Mustalkah, Fazila Ahmad, Eida Nurhadzira, Aliza Lodz, Norli Abd Jabbar, Tania Gayle Robert Lourdes, Jane Ling Miaw Yn, Halizah Bt Mat Rifin, Nur Liana Ab Majid, Thamil Arasu Saminathan, Hasimah Ismail, Ahzairin Ahmad, Shubash Shander Introduction The World Drug Report 2017 estimated that a quarter of a billion people, or around 5 per cent of the global adult population, used drugs at least once [1]. Additionally, 29.5 million of those drug users, or 0.6% of the global adult population, suffer from drug use disorders. Marijuana or cannabis remains the world’s most widely used drug, with an estimated 192 million users, while Amphetamines remain the second most commonly used drug, with an estimated 34 million past-year users. Opioids continue to cause the most harm, accounting for 76 per cent of deaths where drug use disorders were implicated [2]. Kratom (Mitragyna speciosa), an herbal plant native to areas in Southeast Asia which is also colloquially known as herbal speedball, is increasingly been used recently for its stimulant side effects and analgesic property. It is currently classed as a “new psychoactive substance” as it consists of synthetic opioid which is more potent than codeine. Kratom has recently been identified as a substance that may have negative public health consequences in the near future that can be similar to illicit drugs. While cases of addiction, withdrawal and even fatalities have been reported from the use of kratom, especially among polydrug users, this substance, though banned in Thailand, can be acquired legally in Malaysia at the moment. There is concern that the use of this substance is becoming increasingly common among Malaysians. Objectives General objective To determine the prevalence of ever and current drug use among adults in Malaysia. Methods The target population consisted of non-institution respondents aged 18 years and above in Malaysia. This study used a self-administered questionnaire. Findings The total numbers of adult respondents included in this module were 9,648. Overall, the prevalence of lifetime drug use in Malaysia was 1.5% (95% CI: 1.19, 1.93) while the prevalence of current drug use was 0.5% (95% CI: 0.37, 0.79). The prevalence of lifetime (ever) drug use in the rural area was 2.2% (95% CI: 1.43, 3.24) while in urban area was 1.3% (95% CI: 0.99, 1.80). The prevalence of male [2.8% (95% CI: 2.16, 3.57)] user was significant higher than female [0.2% (95% CI: 0.10, 0.40)]. The prevalence of those aged 18 to 40 years [1.9% (95% CI: 1.37, 2.51)], those aged 41 to 59 years [1.3% (95% CI: 0.83, 1.95)] and those aged more than 60 years [0.6% (95% CI: 0.32, 0.99)]. Our study also showed that the prevalence of those who were single was 1.8% (95% CI: 1.19, 2.59) and married was 1.5% (95% CI: 1.09, 2.04). Those in secondary education and tertiary education have the prevalence of 1.8% (95% CI: 1.30, 2.36) and 1.1% (95% CI: 0.69, 1.78) respectively. Prevalence of private employee was 1.8% (95% CI: 1.23, 2.60) and unemployed was 1.5% (95% CI: 0.86, 2.52). The prevalence of bottom 40% household income group was 1.6% (95% CI: 1.18, 2.18) and middle 40% household income group was 1.5% (95% CI: 0.93, 2.44). The prevalence of lifetime opiate, marijuana, amphetamine / methamphetamine and kratom consumption were 0.2% (95% CI: 0.14, 0.39), 0.7% (95% CI: 0.53, 1.01), 0.5% (95% CI: 0.32, 0.80) and 0.6% (95% CI: 0.46, 0.90) respectively. The prevalence of age of initiation at 15-17 years was 23.5% (95% CI: 14.41, 35.89), 18-24 years was 57.6% (95% CI: 45.52, 68.91) and 25 or older was 17.5% (95% CI: 11.50, 25.60).
Non-Communicable Diseases: Risk Factors and other Health Problems 157 The prevalence of current drug use was 0.5% (95% CI: 0.33, 0.83) in urban area and 0.6% (95% CI: 0.36, 1.09) in rural area. The prevalence of those aged 18 to 40 years [0.7% (95% CI: 0.42, 1.07)], those aged 41 to 59 years [0.4% (95% CI: 0.22, 0.80)] and those aged more than 60 years [0.2% (95% CI: 0.11, 0.58)]. Our study also showed that the prevalence of those who were single was 0.6% (95% CI: 0.35, 1.14) and married was 0.5% (95% CI: 0.30, 0.81). Those in secondary education and tertiary education have the prevalence of 0.7% (95% CI: 0.45, 1.19) and 0.4% (95% CI: 0.21, 0.85) respectively. The prevalence for B40 was 0.6% (95% CI: 0.38, 0.92). It was reported that the source of obtaining drug by the current user was 34.4% (95% CI: 18.55, 54.73) bought from someone and 38.3% (95% CI: 18.60, 62.87) obtained from friends. Conclusion Drug abuse is a public health problem that is associated with negative clinical and social implications. Although the prevalence of lifetime drug use (1.5%) was lower as compared to global prevalence of drug use of 5% [1], clearly showed that Malaysia not spared from the scourge of drug abuse menace. The World Drug Report 2018 [2] showed that cannabis (marijuana) is the most commonly used drug across the world similar with finding in this study, followed by kratom and amphetamine. Despite cannabis being the most commonly used drug, opioids such as heroin are causing the biggest problems to users as the number of people classed as dependent on cannabis was lower than for other drugs. The finding from this survey demonstrated that kratom usage came second to the use of cannabis which is contrary from World Drug Report showed the second use of drug was amphetamine. This different pattern of usage may be attributed to the current trends of drug usage in Malaysia as the use of kratom is becoming increasingly common among Malaysians. The age of initiation of drug use in Malaysia showed that the onset of drug use occurred at a relatively young adulthood stage, which was similarly commonly reported worldwide. A report among hospitalised drug users in the United States of America showed that age of drug use initiation was younger among rural patients as compared to urban patients [3]. During their younger age, exposure to recreational drugs may be limited due to logistics and accessibility. Their first encounter to drugs may start when these rural youths started to seek social and economic opportunities in urban areas. Recommendations Cannabis (marijuana) remains by far the most commonly used drug worldwide similar with finding in this study, followed by kratom and amphetamine. Therefore the service on Medication Assisted Therapy (MAT) must be expanded to ensure that all type of drug user able to be treated accordingly. The existing MAT services that available currently should be expanded as the drug user not confined to opioid base but more on polydrug user. The service must be holistic, comprehensive and integrated that fulfil the requirement of bio-psycho-social and spiritual components in treating the drug addiction. The One Stop Center for Addiction (OSCA) is one of the way forward in providing this holistic treatment and should be implemented in all states in Malaysia. And at the same time, the service must be integrated with other agencies such National Anti-Drug Agency (NADA), religious bodies and NGO’s. Nevertheless, prevention, treatment and after-care must be enhanced and concerted effort to ensure the good result and sustainability of the strategy in line with SDG and fulfilling the international community’s pledge to leave no one behind. References 1. Word Drug Report 2017: Executive Summary Conclusions and Policy Implications. (ISBN:978-92-1-148291-1, eISBN: 978-92-1-060623-3, United Nations publication, Sales No. E.17.XI.6). 2. United Nations Office on Drugs and Crime, World Drug Report 2018: Executive Summary. Conclusion and Policy Implication. (ISBN: 978-92-1- 148304-8, eISBN: 978-92-1-045058-4, United Nations publication, Sales No. E.18.XI.9). 3. The TEDS Report. A Comparison of Rural and Urban Substance Abuse Treatment Admissions. Center for Behavioural Health Statistics and Quality (formerly the Office of Applied Studies), Substance Abuse and Mental Health Services Administration (SAMHSA). 2012
National Health and Morbidity Survey 2019 Technical Report − Volume I 158 Table 10.1: Prevalence of Ever and Current Drug Use Among Adults Aged 18 Years and Above in Malaysia by Socio-Demographic Characteristics (n=9,648) Sociodemographic Characteristics Ever Drug / Substance Use Current Drug / Substance Use Count Estimated Population Prevalence (%) 95% CI Count Estimated Population Prevalence (%) 95% CI Lower Upper Lower Upper MALAYSIA 138 303,086 1.5 1.19 1.93 50 108,430 0.5 0.37 0.79 Location Urban 74 210,051 1.3 0.99 1.80 27 81,487 0.5 0.33 0.83 Rural 64 93,035 2.2 1.43 3.24 23 26,943 0.6 0.36 1.09 Sex Male 127 283,826 2.8 2.16 3.57 46 101,985 1.0 0.69 1.44 Female 11 19,260 0.2* 0.10 0.40 4 6,445 0.1* 0.02 0.23 Age Group (Years) 18 – 40 83 215,862 1.9 1.37 2.51 30 78,218 0.7 0.42 1.07 41 – 59 40 72,007 1.3 0.83 1.95 13 23,551 0.4* 0.22 0.80 60 & above 15 15,216 0.6 0.32 0.99 7 6,661 0.2* 0.11 0.58 Marital Status Single 44 100,446 1.8 1.19 2.59 14 36,068 0.6* 0.35 1.14 Married 87 193,336 1.5 1.09 2.04 31 64,511 0.5 0.30 0.81 Widow(er)/Divorcee 7 9,304 0.7* 0.29 1.70 5 7,851 0.6* 0.22 1.62 Education Level No Formal Education 2 4,792 0.6* 0.12 2.59 1 1,270 0.1* 0.02 1.07 Primary Education 26 61,879 1.7* 0.87 3.26 10 11,081 0.3* 0.14 0.67 Secondary Education 84 173,716 1.8 1.30 2.36 30 72,869 0.7 0.45 1.19 Tertiary Education 25 60,598 1.1 0.69 1.78 9 23,210 0.4* 0.21 0.85 Occupation Government Employee 10 19,101 1.3* 0.48 3.27 3 11,305 0.7* 0.17 3.24 Private Employee 60 139,224 1.8 1.23 2.60 18 42,181 0.5* 0.30 0.98 Self Employed 41 99,446 2.9 1.94 4.19 18 36,119 1.0 0.58 1.85 Unpaid Worker/ Homemaker 4 7,481 0.2* 0.08 0.64 1 1,875 0.1* 0.01 0.40 Retiree 1 400 0.1* 0.01 0.38 1 400 0.1* 0.01 0.38 Student 1 2,683 0.4* 0.05 2.62 1 2,683 0.4* 0.05 2.62 Not Workinga 21 34,752 1.5 0.86 2.52 8 13,866 0.6* 0.24 1.42 Household Income Category Bottom 40% 91 194,657 1.6 1.18 2.18 36 71,511 0.6 0.38 0.92 Middle 40% 31 74,521 1.5 0.93 2.44 10 28,065 0.6* 0.25 1.29 Top 20% 10 19,722 1.1* 0.45 2.73 1 1,492 0.1* 0.01 0.60 Drug & substance use: use of controlled psychoactive substance for non-medical and non-scientific purposes such as opiod (heroin, morphine), marijuana, amphetamine/ methamphetamine (meth, syabu, ice and yaba pills), inhalant & kratom Ever Drug: Ever drug use: Self-reported history of taking or using drug at least once in a lifetime Current drug use: Self-reported history of taking or using drug in the past 30 days.
*Prevalence with high RSE, interpret with caution
a - Not working includes Unemployed, and Old Age