Failure to Treat

Forced detention of persons with opiate addiction in Asia is ineffective, UF researcher show

By Diana Tonnessen

Facilities commonly used to reduce rates of drug addiction in Asia are ineffective, with the relapse rates of the detainees more than six times that of patients at voluntary treatment centers in the region, according to a study by a University of Florida researcher.

Compulsory drug detention centers, or CDDCs, were introduced in Malaysia in 1978 in response to a heroin epidemic. Yearly in Asia, more than 600,000 people are detained in CDDCs. Because the centers essentially provide no evidence-based addiction treatment, and because of documented human rights abuses in these centers, many international agencies, including the United Nations, have called for their closure.

Martin Wegman, an NIH Ruth L. Kirschstein National Research Service Award recipient and M.D.-Ph.D. candidate at UF, is the lead author of the first study to demonstrate that the CDDCs are ineffective in the treatment of opioid addiction. The findings were published in December in The Lancet Global Health, published by the British medical journal The Lancet.

“This study is the first to examine the risk of relapse from compulsory centers and concludes that they have no role in the treatment of opioid addiction,’’ The Lancet Global Health said in a news release. “It strongly supports international calls for all countries to eliminate compulsory drug detention centers and scale up evidence-based treatments such as methadone in voluntary community treatment settings.”

The article was based on research Wegman conducted in Malaysia, along with Yale University professor Frederick Altice, M.D., and Adeeba Kamarulzaman, M.D., the dean of the University of Malaya Medical School in Kuala Lumpur. Wegman’s research in Malaysia was funded by a Doris Duke Charitable Foundation International Clinical Research Fellowship.

Wegman has focused his research broadly on understanding the impacts of programs and policies targeting marginalized populations. His dissertation examines changes in Medicaid health care delivery for persons with both mental and physical illness, in collaboration with Betsy Shenkman, Ph.D., chair of the department of Health Outcomes & Policy at the UF College of Medicine and director of the Institute for Child Health Policy.

In the study, Wegman and his colleagues compared the drug rehabilitation outcomes of patients in two types of government-supported programs: compulsory drug detention centers and voluntary drug treatment centers. Services at the detention facilities consist of compulsory abstinence, forced work and athletic drills. The voluntary drug treatment centers provide methadone maintenance therapy on a voluntary inpatient basis.
From August 2012 to September 2014, the researchers used urine tests to screen 168 detainees at CDDCs and 113 inpatients at voluntary treatment centers immediately upon their release and again at one month, three months, six months, nine months and 12 months after their release. They compared relapse rates of 89 individuals from CDDCs and 95 individuals from voluntary treatment centers and found that those who had participated in the voluntary program were significantly more likely to remain drug-free than those who had been confined.

One month after their release, 90 percent of those from voluntary centers were drug-free, compared with 51 percent of those from CDDCs.
After six months, 69 percent of individuals from voluntary centers remained drug-free, compared to 19 percent of those from CDDCs.

In a linked comment to the Lancet Global Health study, Gino Vumbaca from Harm Reduction Australia wrote, “Evidence on the effectiveness of compulsory and voluntary drug dependence treatment in the Asian region has been scarce, and this study is a much-needed addition to the evidence base that is required to inform policy making. The study provides solid evidence in support of an urgent need to expand availability of and access to evidence-based voluntary drug dependence treatment approaches to all who are affected by drug dependence.”

Wegman said that although the recent study was observational, it provides clear evidence that CDDCs are ineffective.

“Publishing in The Lancet Global Health underscores the rigor and importance of this work, which we hope will translate into a reformulation of regional drug policy for the benefit of all members of society,” said Wegman. “Thanks to my Malaysian colleagues, the findings from this study are already beginning to reach key Malaysian drug policy makers.”

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