Prevalence of Drug and Substance Use among Malaysian Youth: A Nationwide Survey

Implementing Family on Alert Program to Address Drug Abuse in Malaysia: A Qualitative Exploratory Study

Drug misuse causes serious health problems, including the increased risk of addiction, particularly among adolescents. Hence, a family-based drug prevention program is designed to reduce problems among youth and encourage positive development at the family level. This study aims to explore the effectiveness of the Family on Alert (FoA) program implemented by the National Anti-Drug Agency in Malaysia. A qualitative method was used employing Focus Group Discussion (FGD) with 18 informants from NADA's state officers of Kuala Lumpur Federal Territory, Selangor, Johor, Kedah, and Sabah. Thematic analysis was used to systematically organize the data by coding and coordinating the data into themes. Findings demonstrated that the FoA program implemented by the National Anti-Drugs Agency in Malaysia has positively impacted the participants. Additionally, strategic partnerships with other government and non-government agencies have improved FoA achievement across hot-spot states in Malaysia. This study could give valuable input for the government to develop and implement policies supporting family-based approaches to drug prevention in the future.

Prevalence of psilocybin use in vaping and associated factors: a study among amphetamine-type stimulants (ATS) use disorder in Malaysia

BACKGROUND

The emergence of New Psychoactive Substances (NPS), including synthetic psilocybin, has raised concern among health experts due to the numerous health and socioeconomic consequences. The current trend is shifting to the hazardous use of synthetic psilocybin in vaping, and little is known about the prevalence of use, specifically among amphetamine-type stimulants (ATS) users.

METHODS

Interviewer-administered questionnaires were conducted in drug detention centers between March and October 2022. The study was conducted using ASSIST 3.0 and obtained information on the respondents' socio-demographic characteristics and clinical profiles. N = 355 ATS users were enrolled in this study.

RESULTS

The results show a high prevalence of psilocybin vaping among ATS users (182/355, 53.1%). Most of the respondents were males (85.1%) and unmarried (69.3%), with a mean age of 29.2 (SD = 7.3). Across all respondents, five factors were associated with psilocybin vaping: tobacco smoking, aOR =5.790 (95% CI: 1.723, 8.183); cannabis uses, aOR= 9.152 (95% CI: 2.693, 10.396); and alcohol use, aOR= 3.137 (95% CI: 1.461, 5.817). Respondents of the Malay race had higher odds of being involved in psilocybin vaping compared to other races, with aOR= 1.638 (0.043, 2.459). Meanwhile, a reduction in age by 1.9 will increase the likelihood of involvement in psilocybin vaping with aOR = 1.897 (95% CI: 0.857, 1.938).

CONCLUSION

Psilocybin in vaping is growing among ATS users and across all populations. Unfortunately, knowledge regarding the long-term effects on health is limited. Further studies should highlight the harmful effects of psilocybin and the potential risk of psilocybin vaping among the younger population.

The development and validation of a knowledge, attitude, and practice questionnaire of methamphetamine use

Methamphetamine is a synthetic psychostimulant that is showing a rising trend of usage among adolescents and youths. Its harmful side effects and high risk of developing addiction is a public health problem. Recognizing the knowledge, attitudes, and practices (KAP) on methamphetamine is critical in the planning of an intervention strategy. Currently there is a lack of KAP questionnaires on methamphetamine. The study aims to develop and validate a KAP questionnaire on methamphetamine-use for use among Malaysian adolescents. Following an extensive literature review, face and content validity were carried out among healthcare workers, the public, students, and local subject matter experts. A pilot study was conducted amongst 50 students to assess the test-retest reliability. The questionnaire was then distributed to two groups of 269 and 331 individuals for the Exploratory (EFA) and Confirmatory Factor Analysis (CFA), respectively. The internal reliability was also assessed among these groups. The content validation consisting of Item Content Validity Index (I-CVI, ranging from 0.875 to 1.00), and Scale Content Validity Index (S-CVI/Ave = 0.941) both showed good validation scores. Test-retest reliability showcased an Intraclass Correlation Coefficient (ICC) of > 0.7, indicating its reliability. The model was constructed via the EFA resulting in four constructs, and the model's goodness of fit was confirmed with CFA. An internal reliability was calculated with Cronbach's Alpha and showed acceptable reliability (α-values > 0.6) for all constructs. The KAP questionnaire of methamphetamine use is a valid and reliable tool that can be used among Malaysian adolescents. The model arising from this study, can also be used as a guide for future intervention models for adolescent methamphetamine-use disorder.

A Geospatial Drug Abuse Risk Assessment and Monitoring Dashboard Tailored for School Students: Development Study With Requirement Analysis and Acceptance Evaluation

BACKGROUND

The enormous consequences of drugs include suicides, traffic accidents, and violence, affecting the individual, family, society, and country. Therefore, it is necessary to constantly identify and monitor the drug abuse rate among school-going youth. A geospatial dashboard is vital for the monitoring of drug abuse and related crime incidence in a decision support system.

OBJECTIVE

This paper mainly focuses on developing MyAsriGeo, a geospatial drug abuse risk assessment and monitoring dashboard tailored for school students. It introduces innovative functionality, seamlessly orchestrating the assessment of drug abuse usage patterns and risks using multivariate student data.

METHODS

A geospatial drug abuse dashboard for monitoring and analysis was designed and developed in this study based on agile methodology and prototyping. Using focus group and interviews, we first examined and gathered the requirements, feedback, and user approval of the MyAsriGeo dashboard. Experts and stakeholders such as the National Anti-Drugs Agency, police, the Federal Department of Town and Country Planning, school instructors, students, and researchers were among those who responded. A total of 20 specialists were involved in the requirement analysis and acceptance evaluation of the pilot and final version of the dashboard. The evaluation sought to identify various user acceptance aspects, such as ease of use and usefulness, for both the pilot and final versions, and 2 additional factors based on the Post-Study System Usability Questionnaire and Task-Technology Fit models were enlisted to assess the interface quality and dashboard sufficiency for the final version.

RESULTS

The MyAsriGeo geospatial dashboard was designed to meet the needs of all user types, as identified through a requirement gathering process. It includes several key functions, such as a geospatial map that shows the locations of high-risk areas for drug abuse, data on drug abuse among students, tools for assessing the risk of drug abuse in different areas, demographic information, and a self-problem test. It also includes the Alcohol, Smoking, and Substance Involvement Screening Test and its risk assessment to help users understand and interpret the results of student risk. The initial prototype and final version of the dashboard were evaluated by 20 experts, which revealed a significant improvement in the ease of use (P=.047) and usefulness (P=.02) factors and showed a high acceptance mean scores for ease of use (4.2), usefulness (4.46), interface quality (4.29), and sufficiency (4.13).

CONCLUSIONS

The MyAsriGeo geospatial dashboard is useful for monitoring and analyzing drug abuse among school-going youth in Malaysia. It was developed based on the needs of various stakeholders and includes a range of functions. The dashboard was evaluated by a group of experts. Overall, the MyAsriGeo geospatial dashboard is a valuable resource for helping stakeholders understand and respond to the issue of drug abuse among youth.

Research and publication gaps on kratom and kratom products: a scoping review of current literature

PURPOSE OF REVIEW

Kratom plant, products derived from the plant, and plant phytochemicals are of great interest among researchers, clinicians, and consumers. However, there is a paucity of rigorously collected scientific data on their risk/safety profile and public health impact. This scoping review discusses original research articles published between 2022 and 2023. It focuses on identifying publication gaps on topics related to epidemiology, public health, and risk/safety profiles comparing evidence collected by researchers from Southeast Asia and the West.

RECENT FINDINGS

Our review of the Scopus database identified a total of 55 publications, including clinical case reports and case series reports, surveys, studies enrolling human participants, and publications based on large-scale national surveys or large-scale national or international health system database records.

SUMMARY

Overall, there is dearth of reliable data on key epidemiological factors, including the prevalence rates, and on objective and reliable indices of the risk/safety profiles. Rigorous and systematic studies including improved epidemiological surveillance, human laboratory, and controlled clinical studies are urgently needed to advance our understanding of public health consequences of consuming kratom and kratom-derived products and to improve our understanding of their risk/safety profile and additional analytical studies to better inform development of needed regulatory oversight.

Predictors of drug and substance abuse among school-going adolescents living in drug hotspot in Malaysia

This study explored the pressing issue of drug and substance abuse (DSA) among adolescents in drug hotspots in Malaysia. The Malaysian Anti-drug Agency (AADK) has identified 155 hotspot areas across Malaysia, of which 78 were randomly selected as the study sites. These areas were identified as having extreme drug-related activities such as drug trafficking and drug-related crimes. According to the literature, several factors influence adolescents to be involved in DSA. Therefore, understanding the risk factors in the context of Malaysian school-going adolescents is of utmost importance. The study examined, in particular, a wide range of potential predictors, including socioeconomic factors, peer influence, family dynamics, educational experiences, drug access, and community characteristics. Adolescents in the hotspot areas were selected by means of a cross-sectional survey design with a cluster sampling method. The sample comprised 3382 school-going adolescents, and the data were collected through face-to-face interviews. The logit model method with STATA software was used to analyse the data. The findings of the study revealed that school-going adolescents with disciplinary issues face a two-fold increase in the risk of becoming current drug users compared to their peers. Further, those exhibiting externalising behaviours, such as aggression and rule-breaking, also face greater odds of becoming involved in DSA. Drug pushers were identified as the most significant risk factor, with adolescents exposed to them being 46 times more likely to become current drug users. The factors of friends and family also contribute significantly to adolescent drug involvement. However, adolescents with academic-related issues may be less involved if they have the protective factor of better coping skills. These findings will contribute to efforts to mitigate drug addiction and drug-related activities, particularly in high-risk communities, as well as help policymakers and healthcare professionals develop targeted interventions and generally promote the well-being of adolescents.

An Adaptation and Validation of Cocaine Craving Questionnaire for Malaysians Who Use Amphetamine-Type Stimulants

Introduction

Cases of amphetamine-type stimulants (ATS) use have been increasing over the past decade. Cravings are considered a causal factor for recurrent relapses in ATS use cases. The absence of questionnaires measuring cravings for ATS in the local population necessitates the creation of one, especially considering the rising number of cases.

Objective

This study aimed to adapt and validate the Cocaine Cravings Questionnaire into a questionnaire suitable for measuring cravings for ATS in the local population.

Methodology

The original questionnaire was adapted by substituting "cocaine" with "ATS". The process involved a back-to-back translation, followed by a round of face and content validation. The participants included people who use drugs (PWUD) with a history of ATS use recruited from rehabilitation centers in Malaysia. A set of questionnaires consisting of demographic items and the adapted ATS Cravings Questionnaire (ATS-CQ) were given.

Results

This cross-sectional study recruited a total of 205 PWUD, mostly single men, with a mean age of 33.32 (s.d.=13.14). The mean age of ATS initiation was 22.89 (s.d.=9.39), with a median duration of ATS use of 60 months (IQR=24.00, 120.00). The adapted questionnaire received a good score for content validation. Unlike the original, this adapted version was found to have only three factors showing good internal consistency, ranging from 0.707 to 0.918 for all three factors. Test-retest reliability also showed good results, with an interclass correlation coefficient of 0.875 (95% CI=0.835, 0.905).

Conclusion

The translated ATS-CQ has been finalized and deemed valid and reliable for use among Malaysian substance users to measure ATS cravings.

Drug addictions in Malaysia: a mini-review on drug types, rehabilitation centers and therapeutic programs

Drug addiction remains one of the most complex social problems worldwide that has yet to be resolved. In Malaysia, abuse of various types of drugs has been reported which warrants the government to take immediate strategies in managing drug addicts. Despite implementing various strategies to treat drug addiction, statistics show the number of relapses continues to skyrocket over the years. This calls for urgent attention to improve the effectiveness of substance abuse treatment services in Malaysia. Moreover, emerging evidence shows a change in trend in the type of drug being abused. This factor could potentially contribute to the ineffectiveness of the strategies employed in the treatment of substance abuse. Therefore, this review provides an overview of the major types of drugs commonly abused in Malaysia. Additionally, in an effort to search for ways to improve the effectiveness of substance abuse treatment services, we identified the public institutions responsible for managing drug addicts in Malaysia and discussed the therapeutic programs offered at the institutions. Review findings support the need for future research on the effectiveness of these therapeutic programs and recommend the implementation of evidence-based programs to improve the effectiveness of substance abuse treatments in Malaysia.

Psychosocial Risk Factors Associated with Lifetime Amphetamine-Type Stimulants (ATS) Dependence in Drug Detention Centres: Perspectives from the Multiethnicity Study

ATS dependence in Malaysia is growing tremendously across multiracial Malaysian groups, increasing concerns among public health experts and the community. This study highlighted the chronicity of ATS dependence and factors associated with ATS use. Interviewer-administered questionnaires were administered using ASSIST 3.0. A total of N = 327 multiracial people who use ATS were enrolled in this study. The study findings show that 190/327 (58.1%) respondents were ATS dependent. Malays reported the highest number of ATS-dependent (55.8%), followed by Bajau (21.6%) and Kadazan-Dusun (16.8%) ethnic. Across all races, three factors were significantly associated with the ATS dependence: respondents who had a lifetime history of needle sharing aOR = 0.023 (95% CI: 0.003, 0.183) and a lifetime history of heroin use aOR = 0.192 (95% CI: 0.093, 0.396) were at a reduced odd of ATS dependent. Meanwhile, being married reduced the likelihood of becoming dependent on ATS with aOR = 0.378 (95% CI: 0.206, 0.693) compared to being single or divorced. This study revealed that the use of ATS among multiracial Malaysians is alarmingly high, including those in detention centers. Comprehensive harm reduction strategies are urgently needed to prevent the spreading of infectious diseases and other negative health consequences associated with ATS use.

Patterns of polysubstance use among adults in Malaysia-A latent class analysis

INTRODUCTION

Polysubstance use is the use of more than one non-prescribed licit or illicit substance at one time. This is a common phenomenon, but little is known about the severity and the various substances used by adults in Malaysia.

OBJECTIVE

To determine the pattern of polysubstance use and its associated factors among general adults in Malaysia.

METHODOLOGY

This was a secondary data analysis from the National Health and Morbidity Survey (NHMS) 2019), a cross-sectional population survey with a two-stage stratified random sampling design. A total of 10,472 Malaysians aged 18 years and above participated in this survey. Polysubstance use was defined as concurrent use of more than one substance, either alcohol, tobacco, or drugs (opioids, marijuana, amphetamine/ methamphetamine or kratom). A latent class analysis (LCA) was used to identify the membership of polysubstance groups. The association of class membership with demographic profiles was examined using Multinomial Logistic Regression analysis.

RESULTS

Fit indices (AIC = 16458.9, BIC = 16443.6) from LCA supported 3 classes solution: Class 1; "moderate-drug" group primarily combination used of tobacco and alcohol (2.4%), Class 2; "high-drug" group using multiple substance including kratom (0.3%) and Class 3; "low-drug" group reporting minimal alcohol and tobacco use or non-user (97.3%). The multinomial model showed young adults (18-40 years) had a higher likelihood of being polysubstance users both for moderate-drug class (OR = 4.1) and high-drug class (OR = 3.9) compared to older age (≥60 years). Chinese (OR = 18.9), Indian (OR = 23.3), Indigenous Sabah & Sarawak (OR = 34.6) and others ethnicity (OR = 8.9) showed higher odds of being moderate-drug users than Malays. The greater odds of moderate-drug use for males (OR = 35.5), working groups (OR = 1.5) and low education level group (OR = 3.2).

CONCLUSION

Our study highlights patterns and demographics related to the use of polysubstances among adults in Malaysia. These results would help formulate specific prevention programmes for these high-risk groups.