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Pre15-16 – International Drug Prevention And Rehabilitation Conference (Prevent 2015)
HEALTH RISK AND CRIMINAL BEHAVIOR AMONG SUBSTANCE ABUSER IN MALAYSIA: A NARRATIVE REVIEW
Muhammad Farid Ahmad, Nazir Mohamad, Mohd Norbayusri Baharudin, Helmi Ibrahim [email protected]
ACREDA
Universiti Sains Islam Malaysia
ABSTRACT
Objectives: This narrative review was done to summarize the findings of related research in the area of health risk and criminal behavior among substance abuser in Malaysia. This in depth review may lead to positive impact in enhancingthe knowledge of society on substance addiction. Another purpose of this review is to reduce the number of drug abusers which can lead to lower the numbers of health risk and criminal behavior, indirectly.
Background: Health risk and criminal behavior is common among substance abuser. Theseare complex and interrelated problems that give effect significantly to the country. It creates a serious health challenges in Malaysia especially in rising number of overdose death, HIV and Hepatitis C infections. The link between health risk and criminal behavior among substance abusers also need to be highlighted.
Methodology: The researchers searched selected articles which are related to health risk and criminal behavior among substance abuser in Malaysia through various search engines including Google, scholar and Ovid. Only the best 12articles were reviewed excluding case series, case report and reports. Research reviewed includes the relationship between health risk and criminal behavior among substance abuser in Malaysia that includes its definitions, epidemiology, genetics and issues of treatment center in Malaysia.
Discussion: Types of health risks and criminal behavior among substance abuserare depends on their age, region, type of drug misuse and others. Most of the reviewed literatures suggest that there is significant association of health risk and criminal behavior with various substance abusers in Malaysia, which also happen in other countries.
Conclusion: Further study is required to determine future consequences of health risk and criminal behavior among substance abuser in Malaysia.
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INTRODUCTION Background
The purpose of this article is to describe and discuss the health risk and criminal behavior among substance abuser. It also provides basic information as a guideline especially to the beginners that deal with substance abuser. It is important to note that health risk and criminal behavior are the major problems appear among them. Substance abuser in Malaysia is commonly used marijuana, inhalation types, heroin, amphetamine, methamphetamine, alcohol and ketum where affect their daily life. Therefore this narrative review addressed the major health risk and criminal behavior among substance abuse when they misuse drugs. Another aim is to examine the result from previous researchers because the finding design may affect differently at ind the various characteristic misuse type of drugs in Malaysia that bring health risk and criminal behavior among substance abuse. The authors noticed drug abuse is a global issue need to be tackle and cause of concern to all nations all over the world including Malaysia either in undeveloped countries or developed countries because it is lead to the social problem.
The health risk of substance abuser is quite different from other addiction because it can even change a body system and brain in ways that last long after the individual has stopped taking drugs and maybe even permanently. Substance abusers also have a big potential to twist their behavior to criminal behavior because of drug misuse. As mentioned by (Norliza Chemi, 2014) there is a great concern over drug addiction in Malaysia. In fact substance abuser has huge consequences to the health risk of individuals and devastating impact on his or her physical and mental health as well as their psychosocial well-being and exist criminal behavior. Malaysia government faces a heavy burden because a lot of budget is needed to treat it. The government needs to put a budget on rehabilitation, enforcement, education prevention program and the money come from the tax paid by us. Therefore this article review will highlight on health risk and criminal behavior among substance abuser in Malaysia as a guideline and knowledge on how to minimize this issue. For the counselors it is guidance for the session with the client who involve with substance abuse, for the rehab center management it will save valuable time for manage their client accommodation and as an indicator to predict and to prepare the treatment plan of the client.
The authors undertook the task of reviewing some studies describing the impact of drug abuse in Malaysia where the population of interest includes either by injection or non-injection. The authors believed it is important to attempt and tackle this issue to minimize health risk and criminal behavior among substance abuser although some works has been done but it is not up to the standard.
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METHODOLOGY
The authors compared and contrast studies done by previous literature reviews to note how different and similar their views compare with the authors views. The authors also read some journals, books, statistics and articles that relate to expand knowledge. Information gained to write narrative review came from the 12 literatures review in Malaysia as listed in Table 1. In addition the authors also referred statistic by National Anti Drug for the year of 2013.
TABLE 1 - SOURCES USED FOR THIS OVERVIEW
1) A Review of Substance Abuse Research in Malaysia (2014)
2) Associations between Personality Traits and Aggression among Malay Adult Male Inmates In Malaysia (2014)
3) Drug Abuse and Criminal Behavior in Penang, Malaysia (2005)
4) Factors Influencing the Quality Of Life In Patients With HIV In Malaysia (2011) 5) Substance Abuse and Personality Disorders In Relation To Aggression among
Malaysian Juvenile Offenders (2011)
6) Pattern of Substance and Drug Misuse among Youth In Malaysia (2010) 7) Substance Abuse and Violence Behavior (2010)
8) Treating Heroin Addiction: Bridging the Past and Future – A Malaysian Experience (2011)
9) Improvement of Quality Of Life Following 6 Months of Methadone Maintenance Therapy In Malaysia (2011)
10) Malaysian Drug Treatment Policy: An Evolution from Total Abstinence to Harm Reduction (2010)
11) Heroin Addiction: The Past and Future (2012) 12) Drug Abuse in Kuala Lumpur Malaysia (2014)
DISCUSSION
The Malaysian government declared a national emergency to against drug issue in 1983. The maximum sentenced to death for those convicted of trafficking drugs depending on the amount of drugs stated in Drug Dangerous Act. Although the law is to be hanging until dead, drug problems still the issue need to be highlight. The National Anti-Drug Agency (AADK) has been on track to get rid of the drug problem in Malaysia by 2015. Unfortunately drug problem still appear until today. The Director General of AADK Datuk Abdul Bakir Zin, has pointed out that AADK have helped out around the country to bring addicts to their rehabilitation centre. He has said that the centre spends around RM 300 million which is AADK annual budget which is nearly spent on prevention, treatment, rehabilitation of addicts and enforcement operations (News Straits Times, 2010) Issue of drug abuse has led to an alarming increase of social ills in the society including health risk and criminal behavior among substance abuser and as a result will effects the country. Addicts cannot function as normal people. They have criminal behavior such as neglect or abuse their families and eventually require expensive treatment or hospitalization to treat their health risk.
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Health Risk among Substance Abuser in Malaysia
The authors believed the health risk among substance abuser in Malaysia influenced by type of drug misuse by them. According to the report of the year 2013 by National Anti Drug of Malaysia (AADK) as showed Table 2, opiate leads the statistics by 16,035 substance abusers, followed by Methamphetamine 2,901, marijuana 1,885, ATS pills 476, psychotropic 48 and others 16. The total numbers are 21,361 of substance abuser recorded based on the case report to AADK. In fact the numbers of substance abuser actually are more than that.
The major health risks among substance abuser in Malaysia are HIV/AIDS, Hepatitis C, brain damage, impaired liver function, psychotic and other health risk according to the previously literature reviews. (Vicknasingam B, 2009), stated that substance abusers who were not in treatment, they had a high prevalence of contracting the Hepatitis C virus and this prevalence was higher in those who injected drugs. Meanwhile (Nizam B, 2012) studied chronic infections and management setting in drug addicts of MMT program in Penang found the prevalence of blood-borne chronic infections. From their studied 2.3% were HIV/AIDS, 76.3% were Hepatitis C, 3.3% were Hepatitis B and 38% got impaired liver function. For the detainees in treatment centers were identified to have chronic infection and infectious diseases such as HIV, and Hepatitis B as founded by (Al-Darraji HA, 2014) and his colleagues on their study of 196 patients in one drug treatment centre in Malaysia in 2013. They found 4.6% were HIV-infected and 86.9% were prevalence of positive tuberculin skin test (TST).
HIV/AIDS - HIV is a Human Immunodeficiency Virus. Commonly many people notice that substance abuser of intravenous when sharing needle can transmit HIV. HIV virus severely damages the immune system and it can cause AIDS (Acquired Immune Deficiency Syndrome) where a condition that defeats the body’s ability to protect itself against disease. HIV inflicts this damage by infecting the cluster of differentiation (CD4+) T cells, the immune cells of substance abuser bodies that essential for fighting infections. A study done by C.I. Hasanah, Table 2 - Statistic of Substance Abuser in Malaysia
TYPE OF DRUG MISUSE 2013
Opiate (Heroin & Morphine) 16,035
Methamphetamine 2,901
Marijuana 1,885
ATS pills (Ecstasy & Amphetamine) 476
Psychotropic 48
Others (Cocaine, ketamin & Codeine/Cough medicine) 16
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2010 found the patients who had infection of HIV disease more than 12 months got poorer of physical functioning. Substance abuser with HIV virus converted the CD4+ T cells into factories where later on it produce more of the HIV virus and infect the other healthy cells and also destroying the CD4+ T cells. When CD4+ T cells are missing the immune system will be weak. Therefore substance abuser becomes more flat to illnesses and involve with common infections. This situation be diagnose as AIDS when substance abuser has one or more of these infections and when a CD4+ cell count of less than 200.
According to B.Vicknasigngam, & M. Mazlan (2009) in (Norliza Chemi, 2014) heroin and injection drug are the major public health risk cases cause of HIV/AIDS recorded in Malaysia.
They found between the year of 1998 to the year of 2006, roughly 300,000 individuals were registered as persistent drug abusers in Malaysia where represent 62.6% of the total abusers.
Therefore, the author can describes those finding similar with the finding by AADK in the Table 2 above. When substance abusers exposed with heroin automatically have a big potential to enclose HIV/AIDS because they sharing syringes and injection of paraphernalia that have been used by infected abuser. Rather than that situation although some of substance abuser did not exposed with syringes and injections they still infected of HIV/AIDS because of their lifetime dealt with homosexual or bisexual through unprotected sexual contact with an infected person.
Hepatitis C – The disease of hepatitis; Hepatitis A, B, C commonly can cause inflammation of the liver once the virus becomes active in the body of substance abuser. The different between Hepatitis A, B and C can be identifying from how the virus go into the body and the types of symptoms that appear. The substance abusers normally affected by Hepatitis C where syringe injections or injection drug users (IDUs) are one of the main ways it’s transmitted from abuser to abuser. The study done by (C.I. Hasanah, 2010) to find the socio demographic, clinical and psychological factors that influence quality of life patients with HIV/AIDS, found one quarter of them infected with tuberculosis and nearly half got Hepatitis C. Hepatitis C come into the body through the bloodstream and later on go to the liver. Study also showed it only takes one situation of sharing a syringe with an infected abuser to contract the virus therefore this easy transmission route makes hepatitis C contraction a major risk factor for injection substance abusers. The author believed abuser with Hepatitis C experienced some other disease because of this virus. Study by (C.I. Hasanah, 2010) stated abuser with hepatitis B or C got a range of symptoms and for those recently diagnosed the symptoms are often mild or nonexistent. The substance abuser may experience flu like, pale bowl movement, fatigue, nausea, jaundice, loss of appetite, dark colored urine and pain in upper abdomen. Worse come to worse if for the abuser with chronic hepatitis virus they may have big potential to get liver cancer.
Brain damage – It is one of the health risks among substance abuser in Malaysia and other countries. This is because drugs contain chemicals that connect into the brain communication system of abuser where disrupt the way nerve cells. The functions of the way nerve cells are to send, to receive and to process any information. Some of the common drugs such as marijuana and heroin may cause disruption either by over stimulating the reward circuit of the brain or by imitate the brain natural chemical messengers. A study by (Mahmood Nazar Mohamed, 2008)
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showed some drugs use by abuser in Malaysia have a quite same structure to neurotransmitters the chemical messengers. The neurotransmitter naturally produced by the brain. That is why drugs can activate nerve cells to send abnormal messages and can fool the brain receptors. The author agreed with the studied because the substance abuser acts abnormal in their daily life.
The long term causes of abuse may changes other brain chemical systems. Substance abusers who had misused for the long time period may causes changes in other brain chemical systems which damage cognitive function. Their brain area of decision making, memory and learning, critical to judgment and behavior control totally change and not function as normal person.
Mental Health Problem –Studied by Ahmad Hatim (2013) in (Norliza Chemi, 2014) found patient that previously as methamphetamine abuser got high risks of psychotic and non psychotic disorders. They acclaimed most patients of poly drug user for longer period and in the higher amount of drugs. Meanwhile researched by Chan, Maniam and Suriati in (Norliza Chemi, 2014) stated susbtance abuser in Malaysia involved with suicide behavior such as suicidal ideation, suicidal plan and deliberate self harm. Muhammad Muhsin (2010) found infection excessively or mental illness prisoner with drug misuse problem, psychiatric disorders and HIV infection. For (Affizal Ahmad, 2011) acclaimed in their studied among juvenile offenders with drug problem as a result, high prevalence of mental health problems had been identified. They have co-occurrences of multiple mental disorders related to recidivism and might often lead to violent and aggressive behaviors. From the literature review by (C.I. Hasanah, 2010) found 38.4% of the substance abuser had depression, anxiety or both and for misuse of cannabis experienced mild hallucinogen.
Others Health Risk – A study in one of the Kelantan rehab center among female on sexually transmitted diseases (STDs) found woman substance abuser experienced syphilis as mentioned by (Rusli, 2001) in (C.I. Hasanah, 2010). The study also stated some of them misused heroin during pregnancy appeared result in neonatal abstinence syndrome (NAS) where effects the baby such as fever, excessive crying, irritability, diarrhea and vomiting, and possibly death. The Malaysian Psychiatric Association (2006) in (UKessays.com, 2013) cited fetal abnormalities appear for early pregnancy of the pregnant women substance abuser. Meanwhile alcoholics may get bronchitis, emphysema and bronchial asthma. For short time period of cocaine misused their health risk such as reduced the appetite, increased blood pressure, mental alertness, increased heart rate and increased body temperature and the long time period misused they have big potential to get restlessness, mood disturbance and irritability.
Criminal Behavior among Substance Abuser in Malaysia
To discuss on this issue the authors reviewed previous journal and articles done by other researchers and found criminal behavior appears to the substance abuser in Malaysia. Most of the previous researchers concluded etiology of criminal behavior among substance abuser appear because of some reasons as stated in a statistic of ((AADK), 2014), Table 3 below.
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Table 3 - Statistic of Substance Abuser in Malaysia
Reason Start Abuse 2013
Influence By Friend 11,935
Feeling To Try 3,824
Pleasure 1,663
Depress 2,566
Stimulant 185
Stop the Pain 458
Inadvertent 19
Others 711
TOTAL 21,361
Based on the statistic showed that influence by friend leading by 11,935 substance abusers, followed by feeling to try 3,824, depress 2,566, pleasure 1,663, others 711, to stop the pain 458, stimulant 185 and inadvertent 19 of abusers. The total numbers are 21,361 of substance abuser recorded based on the case report to AADK. In fact the numbers of substance abuser actually are more than that. Even though law in Malaysia is very strict on illegal drugs but substance abuser still continue to misuse either for their own used or as an illegal business. In fact government had declared war against drug as a threat to national security but the prevalence of it increased substantial. As a proof early government response to overcome it by the formation of the national anti-drug task force to control trafficking, enlarge and enhance rehabilitation center and maintain legislation where mandatory death sentence for those smuggling more than stated by Dangerous Drug Act. Mahmood (2002) in (Mahmood Nazar Mohamed, 2008) found youth always been influence by their peer group and it is lead to the criminal behavior and drug misuse for misbehaviors. The finding is relevant with the statistic above. Studied by Navaratnam and Foong (1996) in (Usman A.K., 2005) showed that 51.5 % of substances abuser in Penang abused because influence by their peer group friend that using drugs. The other study by Navaratnam (1990) in (Usman A.K., 2005), 30 % from his samples got friend that alcoholic while 38% heroin or other opiates user. The authors strictly believe peer group of substance abuser friends play important role for them involve with drugs as mentioned in a statistic on table 3 above.
The previous researchers identified criminal behavior appeared among substance abuser in Malaysia. Studied by (Mohammad Rahim Kamaluddin, 2014) among the male inmates with substance abuse problem previously found that the aggression of hostility appear such as rude, thoughtless and have a quick temper with other. It is also the highest score compare with other
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subscales. Meanwhile for ( Usman A.K., 2005), stated in his research the previous study showed there is a relationship between substance abuser and involvement with criminal. He also added previous studied by Clinard and Meier (1995) substance abuser not only focuses on manufacturing, selling and using drugs illegal, but there are also involved with crime activities to maintain abuse. A connection between them with criminal behavior includes euphoric feelings that result from abusing certain substances, property and economic associated crimes involved by substance abuser in order to uphold their addictions to drugs and mostly violent related crimes which result from them. Criminal behavior among substance abuser in Malaysia mostly abuse heroin as the primary drug as found by Navaratnam (1990) in ( Usman A.K., 2005).
Navaratnam (1992) and Mustapha (1996) also acclaimed heroine and cannabis as the highest use by abuser in Malaysia. It showed a similar result by studied of (Mohammad Hussain Habil, 2010) where majority of substance abuser in Malaysia appear violent behavior and it is differ by the amount, type and how they abuse drug. In their research found 60% of violent offender positive with illegal drug. They also stated illicit substance abuser normally related to criminal behaviors such as robberies and they involve with crime especially frequently during periods of their heavy drug use. (Affizal Ahmad, 2011), mentioned among the juvenile as a sample found drugs and alcohol are unquestionably the more likely precursors to crime where drunk of alcohol leads to violence and criminal behavior among juveniles. Meanwhile Penang Police Department reported half of the 120,000 properties related offences are committed by hardcore drug addicts in The Star (2001).
Factors – There are several factors why substance abuser in Malaysia involved with crime. A study made by (Mohammad Hussain Habil, 2010) highlighted on psychosocial factors had strong correlation with violence among substance abusers suitable with developmental in origin.
Majority of them came from poor and dispossessed family background where lived in unlawful resident area which high rates of crime and substance used. It is a similar with researched done by (Usman A.K., 2005) where highlighted socio-economic factors such as poverty, broken home, unemployment, urbanization and rural of urban migration might influence substance abuser involved with drugs and crime.
In addiction substance abuser deals with criminal behavior when faced with challenging life situations such as live in a big city of Kuala Lumpur as mentioned by (UKessays.com, 2013), they need to face a lot of challenges such as unemployment, loss of a loved one or poverty.
Therefore it is commonly cause to drug abuse and criminal behavior. (Mahmood Nazar Mohamed, 2008), acclaimed they found family members influenced the adolescence development in a negative way where the eldest indirectly acting as a model for adolescence to coping criminal behavior and substance abuse.
(Mohammad Hussain Habil, 2010), also found broken family as a factor because the substance abuser got lack of attention and supervision by their parents and harsh discipline and family aggression where exposed them to both violent and substance used disorder. Where else direct
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drug effects to the brain as possible factors for criminal behavior especially violent among substance abusers in Malaysia. This is because the modulation of monoamines and reward system which often altered by drugs. Rather than that a drug withdrawal syndrome had been identified as substance abuser desperate effort to get drugs might make them to act of criminal behavior especially violent as to get money for buying drugs. (Usman A.K., 2005), found that aggressive behavior among juveniles significant with their previous substance abuse, antisocial and borderline personality. The study also shown substance abuse contributes to physical aggression and anger among abusers where they may involve with crime. The authors believed substance abusers may express their aggression when dealt with their victims in order to fulfill their needs.
CHALLENGES AND RECCOMENDATION
The National Anti-Drug Agency (AADK) had put RM 300 million as a way of prevention, rehabilitation and treating substance abuser in Malaysia. The effort of Malaysia government indirectly will help to reduce health risk and criminal behavior among substance abuse in Malaysia. According to director of the agency Datuk Abdul Bakir Zin the numbers of abuser increase and the agency alert on it where on 2009 there were 11 395 addicts had been rehabilitated in the centers but only 51% of the substance abusers are recovery as reported by News Straits Times (2009) in (UKessays.com, 2013). From the report it showed the challenges to fight against drugs in our country.
Norliza Chemi et al (2014), suggested collaboration between law enforcement especially Police and National Anti Drug Agency (AADK) should be enlarge as a way to establish data on prevalence of ATS, and other drugs abused in Malaysia. They also believed attention from the government needed on studying special populations of drug abused such as prisoners, woman and homosexual or bisexual abusers because it may give a beneficial data to prevent health risk and criminal behavior among drug abuser in Malaysia especially on HIV/AIDS and mental health issues. The outcomes of treatment also need to be focused by government as a way to evaluate and ensure the effectiveness of their approaches. As an alternative a new approach of treatment modalities need to be exploring because drug issues may become complicated from day to day.
Meanwhile (C.I. Hasanah, 2010) suggested to improve a Quality of Life (QOF) of substance abusers in a harm reduction orientation, a wellness and insight in a psychological intervention module will go a long way. This is important because many of abusers only rely on their doctors’ advice and doctors only see solutions in the form of pills and injections. Therefore psychological part that related with the health risk and criminal behavior did not been tackled and may become worse. They also persuaded a module of cognitive behavioral intervention and psycho education should be given in order to educate the substance abusers. It is similar with recommended by Norliza Chemi et al (2014) where the management treatment resources of drug addicts for chronic infection need to be producing necessary such as female drug abusers go thorough screening for STD, establish the TB screening, continuation of care for infectious
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disease and treatment programs in treatment rehabilitation center as well as enhance the effectiveness of Alcoholic Anonymous (AA). (Noor Zurani, 2008), suggested for practitioners they need to expand their knowledge on substance abused especially on kratom and betel quid.
They need to find the possibility of using kratom as a drug replacement therapy for opiate dependency as a way to prevent health risk among substance abusers.
As a way to detected criminal behavior among substance abuser in Malaysia (Mohammad Rahim Kamaluddin, 2014) recommended individual with high risk of criminal involvement should be detect of the early signs of aggressive, hostility and anxiety. This is important because it is as a way of enable proactive intervention and reduces their exposure to risky activities especially when they involve with abuse. Meanwhile Datuk Lee Lam Thye as the Deputy Vice Chairman of the Malaysian Crime Prevention Foundation mentioned by putting the hardcore substance abusers in prisons and holding them for more than two years at treatment center by AADK, it will decreased drug related crimes in the country (Mazlan, 2010). Navaratnam (1988) in (Noorzurani Robson, 2011) for heroin addiction who had settled their two years treatment, they had no chances for them to get a job and that’s why they commit with crime again. Later on the substance abusers relapsed to their previous usage especially heroin. This supports the idea that forced abstinence while in rehabilitation centers does not sustain abstinence from drug misuse when they go back to society as mentioned by Mazlan et al., 2006 in (Noorzurani Robson, 2011)
CONCLUSION
The misuse of drug by substance abusers in Malaysia has existed a health risk and criminal behavior among them. It also may threat to public health and social security, particularly through drug abuse-related crime and HIV transmission among substance abusers. The government spent millions of money to reduce and overcome it with has undergone various processes recently such as short-term treatment, long-term maintenance programs, imprisonment and has introduced new policies involving harm reduction programs including methadone substitution therapy and counseling. This is a way on how to reduce health risk and criminal behavior among substance abusers. Therefore as citizens we need to give a hand and support that we capable to do so in order to make sure the health risk and criminal behavior among substance abusers can be managed properly to prevent the risk that appear to our nation Malaysia.
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