KUALA LUMPUR: Case 1: A successful healthcare worker, active in sports at the department level and well-liked by his colleagues. After a life derailed by drugs, he lost his job and got separated from his wife. Drugs have taken their toll, and a result of years of drug abuse, he fell into depression.

Case 2: A successful entrepreneur who runs a car spray painting workshop with a good number of workers and a happy family. His obsession with drugs left a trail of destruction in its wake - his wife and children left him due to his addiction to "pil kuda" and his workshop was eventually closed down as he could no longer manage his business.

Case 3: A public transport driver had his driving licence withdrawn after he was frequently involved in accidents in which he had been under the influence of drugs and was tested positive for drugs.

These three cases are among the examples of workers who indulged in drug abuse cited by the Director of University Malaya Centre for Addiction Science Studies (UMCAS), Associate Professor Dr Rusdi Abd Rashid during an interview with Bernama recently when he was asked on his thoughts on drug abuse among workers in the country.

Dr Rusdi said some drug addicts were disowned by their family as they kept returning to the rehabilitation centre after a relapse and having faced difficulties in getting a job due to their status as former drug addicts and convicts.

"In the end, they return to addiction as they could no longer cope with the failures in life; some experienced homelessness, and felt powerless to escape their misery," he added.



CAUSES OF DRUG ADDICTION

Stress or pressure from heavy workload brought some workers to take drugs especially stimulants such as methamphetamine (including pil kuda), ecstasy and ketum.

Some workers take drugs on the excuse that they need to stay energised at work as they have to be 'on call' or that they have to work overtime besides being driven towards work performance.

Shedding some light on the issue, Dr Rusdi said, those who take stimulants are usually energetic, loquacious, hyper active and can stay up all night for days.

"At the same time, the pressures of life due to financial and marital problems can lead to drug abuse, risks of depression and suicide.

"Some take drugs to shed unwanted pounds, especially career women, such as young executives who want to look attractive and stay active.

Dr Rusdi, who is also a psychiatrist at University Malaya Specialist Centre (UMSC) said, the profession and sector a person is involved in, are likely to influence the individual to take drugs.

Workers in the plantation, health, entertainment and transportation sectors are more exposed to drug abuse, he said. In addition, hard labourers who need the stamina and energy at the workplace as well as long distance drivers who have to make frequent trips, tend to take methamphetamine especially pil kuda.

The situation is different for workers or healthcare workers as this group has the tendency to use opiate, a substance derived from opium as it is easily accessible from the stock (controlled drugs) at health facilities.

"Generally, stimulants are often used at the workplace. Opiates such as morphine, pethidine and tramadol are commonly used in the health sector, while benzodiazepine which is used as depressant, is prescribed to treat conditions such as insomnia or difficulty falling asleep at night.

"Alcohol abuse is often associated with the entertainment sector at nightclubs particularly among their workers and visitors," he said, adding that students are no exception and some resort to taking methamphetamine to stay awake all night to study before their examinations.



AFFECTS PHYSICAL HEALTH, ECOSYSTEM

Among workers, drug abuse can affect their physical health, their work and other people as well as the ecosystem as a whole.

The short term effects of stimulant drugs are usually drowsiness due to an overdose. The individual tends to be hyperactive, aggressive, easily agitated and are emotionally unstable. Other common short term effects include appetite loss and insomnia.

According to Dr Rusdi, an overdose can lead to high blood pressure, dehydration, heart attack, seizures and stroke.

In some cases, they risk developing psychosis symptoms which can be a danger to self and others.

"Once supply (drug) is cut off, they will develop symptoms such as lethargy, increased appetite, overeating, feeling extremely sleepy, causing them to sleep the whole day and feeling depressed.

"Those who take excessive opiates can suffer from euphoria, breathing difficulties and feeling extremely sleepy. An overdose of opiates (or opiods) can lead to death," he said.

(An opioid is a substance that is derived from opium while an opiate is a natural derivative from the opium poppy. Both are highly addictive).

Long-term stimulant abuse can cause many mental health issues such as schizophrenia, bipolar disorder and depression.

According to Dr Rusdi, overdependence on the stimulant over the long term will affect the individual's performance and productivity at the workplace due to absenteeism, and consequently, he loses his job.

"When used repeatedly or over a prolonged period of time, stimulant addiction can occur. The users continue to consume the substance despite knowing that it will negatively impact their daily lives, job performance, socially as well as their mental and physical health.

"Besides depression, they will become paranoid to the people around them and develop psychosis symptoms, such as delusions and hallucinations. This situation is called stimulant-induced psychosis," he said.



UNITED AGAINST DRUG ABUSE

The government has allocated an annual expenditure of about RM500 million as part of efforts in combating drug addictions through the Narcotics Addiction Rehabilitation Centres (PUSPEN) under the auspices of the National Anti-Drug Agency (AADK).

Nearly 1,000 clinics in Malaysia are used for treatment of addicts nationwide, comprising 500 clinics under the Ministry of Health (MOH) and the rest are private clinics dedicated for such treatment.

Dr Rusdi said the number of addicts at the rehabilitation centres saw a decline from 15,000 to only 2,500 since the government introduced the harm reduction approach in 2005 nationwide.

"The World Health Organisation (WHO) has commended Malaysia as a role model in Asia through the harm reduction approach for drugs and AIDS in 2013. Unfortunately, the authorities are seen to have resorted to the old approach and regard the addicts as criminals and not as patients, and as a result, the outcome has been less effective," said Dr Rusdi, who urged the government to review the situation and seek other suitable options.

He said findings of the study conducted in 2017 showed the effectiveness of the drug treatment and rehabilitation programme among patients. The programme was a combination of medical treatment on a voluntary basis due to the low rate of relapses involving controlled drug abuse cases.

(Relapse occurs when someone returns to substance use after a period of abstinence).

"Employers can prevent the risks of drug abuse at the workplace by continuously promoting health education on the dangers of drugs as well as conducting urine drug tests on a periodical basis. In essence, such programmes are worth the cost of running them to employers. They provide a safer environment for employers and increase the productivity of existing employees, which boosts revenue.

"Healthy work culture should be in place, such as working hours should not exceed eight hours a day, minimum salary which is sufficient for them to cover expenses, and they should be based on zones, especially the Klang Valley where the living costs are on the rise.

"Employers who are sensitive to the needs and problems of their workers can help prevent drug abuse at the workplace from taking place," he said, adding that the medication approach in the treatment of drug addiction coupled with counselling and psychosocial approaches can help addicts overcome addiction especially when they receive similar treatment as other chronic illnesses at hospitals and health clinics.



RECREATIONAL DRUGS, MEDICATION

He said in the past, drugs were used through injection into the bloodstream via a hollow hypodermic needle, which is pierced through the skin into the body. It causes the individual to become weak and "high", but the user can feel calm and relaxed (recreational drug use) or become stronger and energised (stimulant drugs), and some "normalised it" for beneficial or medication purposes.

"There could be some truth....in the light of the current debate on the benefits of ganja (cannabis).Theoretically, users may not be addicted as it is taken for medication purposes and it is also taken based on needs and for recreational use...but our concern is there are those who resort to drug abuse, especially with no conclusive in-depth findings on its effects.

"Maturity, understanding and acceptance of every individual differs. For example, when the use of vape was allowed, many issues have to be looked at. From the aspects of the people's creativity such as making improvements, 'adding value' to the content, taste and for use," said Dr Shawaludin, who is also an occupational health doctor.

He said besides those in the sports field, such as athletes, those in the creative arts who need to produce creative ideas as well as intellectuals are no exception as they risk becoming addicted to drugs due to job demands and workload.

However, there are those who take drugs for recreational purposes and socially. They use drugs "because others are doing it", boredom, lonely as they are living alone and that the drugs serve as sleeping pills, anti-depression or anti-anxiety.

"But heavy workload and work pressure should not be used as an excuse to take drugs, it is still considered drug abuse," he said.



DRUGS UNDER OSHA 1994

Dr Shawaludin said the Code of Practice on prevention and eradication of drug abuse, alcohol and substance at the workplace by the Department of Occupational Safety and Health (DOSH) under the Ministry of Human Resources through collaboration with various agencies including AADK, can help efforts in fighting controlled substance abuse at the workplace.

" A drug-free workplace programme should be introduced by employers and among others, to alleviate the social impact involving the migration of workers hot spots (for drugs) which are likely to influence them to take drugs or workers who were originally from these hotspots but have been placed to sectors which are drug free, which could influence the local community.

"It is crucial for employers to ensure the workplace is free from drugs; if there are workers involved, their own safety and the safety of their own colleagues will be at stake. The company's operations will also be disrupted, as accidents or disasters such as fire breakouts at the workplace due to negligence and neglect on the part of workers who are under the influence of drugs.

"At the workplace, a drug-free policy should be in place. From this policy, employers can conduct risk assessments to ensure workers who report for duty are not involved in drugs, always 'clean (drug free) and are not influenced by the local community," he said.

Among the preventive measures, urine tests should be conducted when workers first reported for duty, later periodically and when incidents due to neglect and negligence occur.

Urine tests can be carried out at random during working hours besides instructing workers with drug addiction symptoms to undergo such tests.

He said companies which conduct social activities should also incorporate in the policy such provisions such as prohibiting workers from drug and alcohol abuse as preventive measures.

Stressing that employers have a role in detecting workers who are involved in drug abuse and are willing to give them a second chance, he said rehabilitation treatment, medications and counselling sessions are among the proactive measures that can be undertaken to help these workers overcome their addiction, recover and resume life and work as normal.

"Sacking workers who are involved in drugs will not solve the problem as they are not given assistance for rehabilitation purposes. Their conditions will worsen, they will return to addiction, unemployed and with no source of income, and these will have devastating effects for them and family.

"They should be given a second chance, such as allowing them a rehabilitation period of six months. Within this period, they will be monitored, given counselling with the hope that they will change and recover. However, if during the treatment period, a worker fails to show any improvement, the possibility of dismissing him from employment can occur," he said, adding that the drug free programme at the workplace, besides controlling risks at their premises, also helps the government reduce the number of drug addicts in the country.

Section 24 of the Occupational Safety and Health Act 1994 requires an employee to take reasonable care of his own safety and the safety of others who might possibly be affected by his work or conduct.

Workers should take responsibility by not being involved in substance abuse at the workplace to help employers discharge their duties iin ensuring the safety and health of their workers.

At the same time, workers should also cooperate and support programmes organised by their employers to prevent drug, alcohol and substance abuse.

-- BERNAMA