Malaysia's heroin epidemic is long done. Heroin use has been on steady decline since 2013, in part due to a successful rehab program that began in the late '90s and early aughts. But there's another reason behind heroin's decline in popularity—the rise of meth.
Methamphetamines, known as "shabu," across much of Southeast Asia, have been on the rise for years and addiction specialists are running out of solutions.
“The situation has completely changed,” said Pastor Richard Lee, co-founder and director of Kenosis Home, a Kuala Lumpur rehab center.
For nearly 20 years, Lee was trapped in a grim cycle of heroin dependence. He spent those days dealing drugs, homeless, or incarcerated. But once he figured out how to stay clean, he was motivated to help others do the same.
Lee founded Kenosis in 2001, relying on an 18-month, faith-based rehabilitation program that, in Malaysia, seemed to work. His center had low relapse rates and a lot of his former patients took Lee's work to heart, volunteering at the center to help others afterwards. Today, it's grown to nine locations across Kuala Lumpur.
But it's also struggling to replicate its success with patients addicted to meth.
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The shift from heroin to meth as the drug of choice for most Malaysians is pretty staggering. Today, nearly 75 percent of the patients at Kenosis centers come in with meth addictions. The number of those addicted to heroin have fallen to less than 20 percent.
Nationally, nearly 60 percent of new reported drug cases in 2017 involved meth, nearly four times what it was in 2013. And last year alone, authorities seized more than RM 110.78 million ($26.7 million USD) worth of crystal meth in drug busts.
The center is struggling to adapt to Malaysia's new drug problem, Lee explained. Kenosis sustains itself with donations from churches and whatever residents can earn from community projects, like collecting scrap metal. But with its new clientele and the falling price of scrap metal, the old methods of raising money just aren't working anymore.
“For ice addicts, they cannot work," Lee said. "When we take them out to work, they will be sitting down [and] staring into space even after a few months [of therapy]. Those who can work, their minds are wandering about and they can’t focus. If they cannot work, how are we going to find the resources to support our ministry?”
Kenosis now charges patients around $380 USD per-month, a high cost for someone who is unable to work, but still far less than the ritzy rehab clinics that have cropped up in KL in recent years.
The Wave Youth Clinic is one of these new "luxury," rehab clinics. It charges clients—as the clinic calls its patients—a whopping $4,200 USD a week for a wide range of therapy options. Most of its clients are wealthy teens and young adults from abroad, all who go through an intensive 10-week abstinence-based program that focuses on the biological, and psychosocial, aspects of treatment. And like Kenosis, the vast majority of its clients are addicted to methamphetamine.
The Wave advertises individual therapy sessions to deal with childhood trauma, group therapy to work out relationship issues, indoor rock climbing, and, of course, an intensive detox program. It's the detox program that has proven the hardest to adapt to the needs of meth addicts, explained Fiona Markham, a clinical director at The Wave.
That's because meth withdrawals are several levels worse than with patients addicted to heroin, Markham said. It all starts with what’s called a “methamphetamine crash” as soon as a patient stops using. Some might sleep for a whole week, only waking up to go to the bathroom or have something very small to eat, Markham explained. For patients addicted to a meth-benzodiazepine cocktail, the detox process can take several weeks.
“Their bodies feel like they're being crawled all over by animals," Markham said. "It’s not uncommon for people to have visual or auditory hallucinations at that time… They smell and taste things that are not there. Their body feels like there are animals crawling and nipping on them. They have all sorts of indigestion, stomach cramps. It's very uncomfortable."
Heroin detox comes with similar issues, Markham told VICE, but with meth, it's more difficult to manage. In some instances, meth withdrawals can last up to a full year, according to Dr Mahmud Mazlan, a consultant psychiatrist who did his fellowship in addiction medicine at Yale University's School of Medicine.
It’s a complex process with several ups and downs that could derail recovery, he told VICE. After the initial crash, patients are usually hit with depression around the three-month mark and an inability to focus from months nine to 12. And a lack of interest in sex, and life in general, can last an entire year. Compared to heroin, “the emotional component of recovery from meth addiction is so great,” Dr Mahmud explained.
Another complication that can arise are the high risks of heart problems, some of which can be fatal. Dr Mahmud said this is the main reason why he's now accepting fewer meth addicts at his 11 rehab centers around West Malaysia.
Malaysia has more than 70 private rehab centers, of which only 54 are actually registered to provide treatment. And though the country’s National Anti-Drugs Agency’s existing rehab centers— the ones where a court can order you to go— now include harm reduction clinics and provide more specialized treatment offerings, there is still no data available showing whether these centers, private or otherwise, have been sufficient in dealing with the country’s meth crisis.
Dr Mahmud told VICE that, according to reports from the ground, it doesn't look good.
The situation, he said, is “getting out hand,” citing reports of users in the country’s poorer, East Coast states increasingly injecting horse pills as a cheap way to stretch the effects of one pill into four. Malaysia could be facing another public health crisis if nothing is done, he said.
“The whole idea of methadone treatment is to reduce the epidemic of HIV, he said. "Now with meth pills being injected, we're arrive back at the HIV and Hepatitis C problem.”
The meth epidemic in Malaysia also plagues other Southeast Asian countries like Thailand and Myanmar, so much so that the United Nations has found that the trafficking of methamphetamine was rising at "alarming levels."
There is no simple narrative as to how Malaysia got here or how it will get out of it, regardless of what the local press says. Treating addiction is a complex process, Dr Mahmud explained, one which requires medical, psychological, and specialized knowledge in addiction medicine.
The majority of the public rehab centers lack this knowledge and policymakers' narrow approach of relying on more enforcement and incarceration is only making the crisis worse. Last month, a 29-year-old medical marijuana distributor was sentenced to death for possessing, processing, and distributing cannabis oil for medical purposes. More than half of Malaysia's prison population are currently behind bars on drug-related crimes. Meanwhile, root causes of drug abuse, from poverty to a lack of opportunity and poor education system, remain sorely absent from national discussion.
And with newer, cheaper psychoactive substances like mephedrone entering the local market, Dr Mahmud is fearful that the near future is going to look even worse.
“Oh man," he said. "This is going to be a big problem."