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Internet addiction (IA) is a growing issue with evidence of negative health and social outcomes to the user. However, data is lacking for younger children. This study determined the prevalence of IA among primary school students and its associated factors. A total of 178 school-children aged 11 years old and their parents consented to fill the validated Malay version of the Internet Addiction Test (MVIAT). The prevalence of IA among school-children and parents was 23.0% and 15.7%, respectively. In children, Internet usage was higher during school holidays (120 min/day) than during schooling day (60 min/day). There is a positive and significant correlation of MVIAT scores between children and their parents (r = 0.28, p

Little is known about the perceptions of harm and benefit associated with the use of e-cigarettes in Malaysia. This was a cross-sectional analysis of a nationally representative sample comprising 1987 males (≥18 years of age). Current, former, and never users of conventional cigarettes and/or e-cigarettes participated in a questionnaire study conducted via face-to-face interviews. The relationship between participant characteristics and perceptions of harm and benefit of e-cigarettes were determined with multivariable logistic regression. There were 950 current, 377 former, and 660 never users of e-cigarettes. Government employees (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.29-2.66, P = .001), private sector employees (OR = 1.67, 95% CI = 1.27-2.18, P = .001), and the self-employed people (OR = 1.68, 95% CI = 1.31-2.17, P = .001) were more likely to perceive e-cigarettes as more harmful than conventional cigarettes compared with respondents who were not wage earners. All current users in the form of e-cigarette users (OR = 7.87, 95% CI = 3.23-19.18), conventional cigarette smokers (OR = 1.80, 95% CI = 1.39-2.33), and dual users (OR = 8.59, 95% CI = 4.76-15.52) were more likely to perceive e-cigarettes as useful in quitting conventional cigarette smoking compared with former and never users. Our findings constitute an important snapshot into the perceptions of e-cigarette harms and benefits, which could inform targeted public health messaging strategies.

The public health burden of dengue is most likely under reported. Current dengue control measures only considered symptomatic dengue transmission. Hence, there is a paucity of information on the epidemiology of inapparent dengue. This study reports that many people have been unknowingly exposed to dengue infection. Almost 10% and 70% of individuals without any history of dengue infection and living in a dengue hotspot, in Selangor, Malaysia, were dengue IgM and IgG positive respectively. When dengue-positive mosquitoes were detected in the hotspot, 11 (6.3%) of the 174 individuals tested were found to have dengue viremia, of which 10 were asymptomatic. Besides, upon detection of a dengue-infected mosquito, transmission was already widespread. In a clinical setting, it appears that people living with dengue patients have been exposed to dengue, whether asymptomatic or symptomatic. They can either have circulating viral RNA and/or presence of NS1 antigen. It is also possible that they are dengue seropositive. Collectively, the results indicate that actions taken to control dengue transmission after the first report of dengue cases may be already too late. The current study also revealed challenges in diagnosing clinically inapparent dengue in hyperendemic settings. There is no one best method for diagnosing inapparent dengue. This study demonstrates empirical evidence of inapparent dengue in different settings. Early dengue surveillance in the mosquito population and active serological/virological surveillance in humans can go hand in hand. More studies are required to investigate the epidemiology, seroprevalence, diagnostics, and control of inapparent dengue. It is also crucial to educate the public, health staff and medical professionals on asymptomatic dengue and to propagate awareness, which is important for controlling transmission.

The elbow is composed of three bones namely humerus, ulna and radius which their movements are provided by three separate joints: ulnohumeral joint, radioulnar joint and radiohumeral joint. Rheumatoid arthritis is one of the most common causes of elbow arthritis. Three major events, i.e., proliferative synovitis, destruction of articulation cartilage and destruction of medial and lateral collateral ligament complexes are observed during the progression of this disease. Finite element analysis method has been shown to be a reliable tool for investigative purposes. The aim of the present study was to determine the disease progression of rheumatoid arthritis disease involving the elbow. An elbow affected by rheumatoid arthritis was simulated incorporating the three previously described characteristics. Three dimensional of healthy and rheumatoid arthritis elbow bones were constructed. The models were analyzed using computational software. Bones, ligaments and cartilages were considered linear and therefore were categorized as isotropic materials. The distal humerus was fixed while the values of muscle force used in this study were obtained from previous experiments. Result showed changes in the biomechanical behavior of rheumatoid elbow as compared to healthy elbow. In both elbow models, the stress distribution was in the region of the proximal ulna: an average of 17.5 Mpa in the rheumatoid elbow and 2.5 Mpa in the healthy elbow. However in the cancellous bones, rheumatoid elbow experienced stress distribution of 4 Mpa on average, while in the healthy elbow the magnitude of stress was on average 3 Mpa. CONCLUSION: The present study demonstrates that the rheumatoid elbow joint model is subjected to higher stresses as compared to healthy elbow joint.

Malaysia, with a population of 28.25 million, consists of Peninsular Malaysia and the Borneo states of Sarawak and Sabah. Substance abuse has been prevalent in Malaysia since the 19th century. In the early 20th century, the main drug of abuse was opium, which was primarily restricted to Chinese and Indian immigrant laborers who were introduced by British colonialists to work in Malaya (Noorzurani et al., 2008). However, the pattern of consumption changed in the 1970s when heroin became the abused substance of choice and Malays were the main ethnic group involved in heroin abuse compared to other ethnic groups, namely the Chinese and Indians (Noorzurani et al., 2008; Rusdi et al., 2008). By the 1980s, heroin use among Malaysian youth reached national crisis proportions (Navaratnam, 1988; Chawarski et al., 2006). A total of 194,897 drug dependents were registered by the National Anti-Drug Agency (NADA) in 1988; however, at the end of 2004, the numbers of drug dependents were estimated to be between 202,075 and 607,647 (Mahmood et al., 2005). By 2009, the cumulative number of confirmed drug addicts exceeded 300,000 (Sangeeth et al., 2009; Narayanan et al., 2011).

The purpose of this systematic review was to analyze and determine the effectiveness of autologous chondrocyte implantation (ACI) when compared with other treatment modalities, which includes microfracture, mosaicplasty, abrasionplasty, bone marrow–derived mesenchymal stem cell (BMSC), and matrix-assisted autologous chondrocyte implantation (MACI). Literature search using online databases PubMed, Scopus, National Institute for Clinical Excellence and Cochrane controlled trial register regarding all cell-based therapies and other interventions for chondral lesions was explored. Data on clinical outcome and repair quality were analyzed. Duplicates and irrelevant articles were omitted. Seventeen (n = 17) studies were included in this review. Among the four trials on ACI versus mosaicplasty, two studies showed no differences in clinical scores, one suggested similar performance while the other suggested better results in tissue quality for ACI. A systematically performed assessment comparing ACI with microfracture shows better clinical outcomes and higher tissue quality after ACI. Studies comparing ACI with MACI or BMSC demonstrated similar results. Although many of these studies had substantial flaws, on the overall, the evidence comparing ACI with other treatment modalities shows better clinical outcomes and higher tissue quality. Despite significant differences between the methodologies employed by different researchers, we can conclude that all except two studies demonstrated ACI being the better treatment for cartilage defects. However, final conclusions regarding long-term effects are still difficult, and therefore, future studies are needed to answer the long-term effects of ACI.

Smoking is a major cause of cardiovascular diseases, respiratory diseases and cancer. Despite the high prevalence of smokers worldwide, smokers are often neglected and not offered effective assistance with quitting their habits. In order to overcome this public health burden, effective treatment is needed to help smokers stop smoking. Among the pharmacological treatments available, nicotine-replacement therapy (NRT), when prescribed in combination with behavioural support, has been proven to be effective in helping a wide range of smokers to quit. NRT helps smokers during the withdrawal process by replacing a proportion of the nicotine formerly obtained from cigarettes. NRT is available in many formulations. The commonly prescribed formulations are nicotine gum, nicotine patches, nicotine inhaler and nicotine nasal spray. The choice of which NRT to prescribe depends on the patient's condition, established guidelines and protocols and availability. This article aims to review the role of NRT in smoking cessation. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down.

Purpose: To report a case of adverse reaction to nicotine gum in a Chinese female with poor nicotine metabolic status after chewing a piece of 2 mg nicotine gum (NG). Background: NG is prescribed in smoking cessation programs to help individuals stop smoking. In smoking cessation treatment, the dose of NG should control withdrawal symptoms but avoid adverse effects. Case results: We describe a case of an adverse reaction following the administration of 2 mg NG to a female Chinese subject. This study compared a single dose of 2 mg NG with a single low dose cigarette (0.7 mg nicotine). Blood (5mL) was collected at baseline and 2h post exposure to NG. Blood pressure and pulse rate were also recorded. Nicotine metabolic rate was determined by calculation of the ratio of plasma cotinine (ng/mL)/plasma nicotine (ng/mL). The subject developed nausea and severe vomiting with raised blood pressure and pulse rate following administration of NG. The ratio of plasma cotinine/nicotine was 0.4 indicative of poor nicotine metabolic rate. Exposure to nicotine using the subject's normal cigarette did not produce similar adverse effects. Conclusion: NG may be associated with adverse reactions in smokers with low nicotine metabolic rate. Physicians in smoking cessation programs should be aware that some individuals may not tolerate this form of pharmacological treatment.

Purpose: Worldwide advances in microsurgery have made salvaging of amputated hand via replantation and revascularization common procedures. The present study examines the outcome of these procedures in a tertiary hospital in Malaysia. Methods: Patients with hand amputation who underwent replantation or revascularization from 2005 to 2012 were identified and reviewed for patient characteristics, amputation characteristics and survival rates. Successfully treated patients were interviewed to assess the functional outcome using Quick Disability of the Arm, Shoulder and Hand (Quick-DASH) questionnaire and Michigan Hand Outcome Questionnaire (MHQ). Statistical analysis was performed to evaluate outcome and elicit predictive factors. Results: Fifty-five patients were enrolled: 37 (67.3%) underwent replantation and 18 (32.7%) underwent revascularization. The overall success rate of 78% ( n = 43) was within the range of previously reported data (61.6% to 96.0%). Ischaemic time

Objectives There is evidence that smoking behaviour differs by ethnicity. This study aims to compare smoking behaviour characteristics between Caucasian and Malay smokers. Methods A cross sectional survey, involving 175 smokers attending smoking cessation clinics at the Institute of Psychiatry, London, United Kingdom and University Malaya, Kuala Lumpur, Malaysia between May 2005 and February 2007. Data on demographics, smoking history, nicotine dependence and smoking behaviour were collected. Results All participants were males, mean age 30.7 ± 10.3 years. Caucasians initiated smoking significantly earlier (mean age 14.8 ± 2.8 years) (p = 0.001) and smoked regularly significantly earlier (mean age 17.3 ± 3.5) (p = 0.003) than Malays (mean starting age 16.9 ± 4.4 years and mean age regular use 19.5 ± 4.5 years), respectively. Caucasians smoked less for social integration than Malays (p = 0.03) but smoked more for regulation of negative affect than Malays (p = 0.008) and smoked more for hedonism than Malays (p Conclusion Malays smoke as a means of socially integrating. This has important public health implications. Social reasons and the social environment play a role in smoking uptake, smoking maintenance and smoking cessation and this should be borne in mind for strategies planning to promote smoking cessation.

Recent advances in the fields of organ donation and organ transplant have introduced new hope for the treatment of serious diseases. However, this promise has been accompanied by several issues. The most common issue raised is ethical implications, but in a multicultural society like Malaysia, additional concerns arise pertaining to social and religious issues. These concerns needs to be addressed as attitudes toward and acceptability of organ donation varies according to social, culture, and religion. The diverse cultural, religious, and traditional concepts pertaining to organ donation may hamper its acceptability and cause a lack of willingness to donate organs. The purpose of this article is to briefly explore the ethical issues involved in organ transplant and the various religious opinions on organ donation. It is hoped that this knowledge and understanding may benefit both health care providers and patients in a multicultural society like Malaysia.

Background: The transition of drug policy from prohibition to harm reduction has never been easy. The deeply entrenched belief in prohibition shared by policy makers and religious leaders provided little room for alternatives, and change came only slowly. The non-governmental organisations (NGOs) in Malaysia played a pivotal role in effecting such a change. Understanding how they did so may be instructive for other similarly placed countries. Methods: Data collected via reviews of published secondary sources, media reports and in-depth interviews with pioneers of harm reduction drawn from NGOs, medical practitioners and the police were analysed to construct the paper. Results: The policy change was the outcome of competition between three groups in the drug policy subsystem - the state, the Muslim religious lobby and the NGOs. Developments such as the poor outcomes from the prohibition programmes and the outbreak of HIV/AIDS did not change policy but did lead to a rethink of core beliefs in the state alliance and spawned a state-NGO partnership. The subsequent failure to meet the Millennium Development Goal with respect to HIV/AIDS in 2005 - was seen as a failure of the Health Ministry which then led the final charge for a policy change arguing that a health crisis was imminent. The NGOs played a pivotal role in this process by educating their partners in the state coalition, by drawing academics and medical practitioners into advocacy and by engaging the religious lobby (albeit with varying success). They were also frontline players in implementing harm reduction programmes and successfully deflected criticisms from unconvinced Islamic groups away from the state. Conclusion: Given their central role in the needle-syringe exchange programme, the NGOs are well positioned to convince injecting drug users to opt for voluntary medical treatment. This can potentially reduce both the harm from drug use and the prevalence of it. (C) 2011 Elsevier B.V. All rights reserved. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down.

Background: The transition of drug policy from prohibition to harm reduction has never been easy. The deeply entrenched belief in prohibition shared by policy makers and religious leaders provided little room for alternatives, and change came only slowly. The non-governmental organisations (NGOs) in Malaysia played a pivotal role in effecting such a change. Understanding how they did so may be instructive for other similarly placed countries. Methods: Data collected via reviews of published secondary sources, media reports and in-depth interviews with pioneers of harm reduction drawn from NGOs, medical practitioners and the police were analysed to construct the paper. Results: The policy change was the outcome of competition between three groups in the drug policy subsystem - the state, the Muslim religious lobby and the NGOs. Developments such as the poor outcomes from the prohibition programmes and the outbreak of HIV/AIDS did not change policy but did lead to a rethink of core beliefs in the state alliance and spawned a state-NGO partnership. The subsequent failure to meet the Millennium Development Goal with respect to HIV/AIDS in 2005 - was seen as a failure of the Health Ministry which then led the final charge for a policy change arguing that a health crisis was imminent. The NGOs played a pivotal role in this process by educating their partners in the state coalition, by drawing academics and medical practitioners into advocacy and by engaging the religious lobby (albeit with varying success). They were also frontline players in implementing harm reduction programmes and successfully deflected criticisms from unconvinced Islamic groups away from the state. Conclusion: Given their central role in the needle-syringe exchange programme, the NGOs are well positioned to convince injecting drug users to opt for voluntary medical treatment. This can potentially reduce both the harm from drug use and the prevalence of it.

Recent advances in the fields of organ donation and organ transplant have introduced new hope for the treatment of serious diseases. However, this promise has been accompanied by several issues. The most common issue raised is ethical implications, but in a multicultural society like Malaysia, additional concerns arise pertaining to social and religious issues. These concerns needs to be addressed as attitudes toward and acceptability of organ donation varies according to social, culture, and religion. The diverse cultural, religious, and traditional concepts pertaining to organ donation may hamper its acceptability and cause a lack of willingness to donate organs. The purpose of this article is to briefly explore the ethical issues involved in organ transplant and the various religious opinions on organ donation. It is hoped that this knowledge and understanding may benefit both health care providers and patients in a multicultural society like Malaysia.

Background: Cigarette smoking causes significant morbidity and mortality and is a major public health concern worldwide. Primary care doctors are in a unique position that enables them to promote smoking cessation, as smokers are more aware of their health at the time of their clinic visit. It is thus important to offer effective treatment to help smokers stop smoking. Methods: A search of PubMed was done up to 16 December 2009, using the keywords "varenicline" alone, "varenicline" and "family medicine", and "varenicline" and "primary care". The search produced 426 articles on varenicline. The articles that were chosen were case reports, meta-analyses, review articles and clinical trials published in English. Results: A new drug called varenicline has recently been introduced to assist smoking cessation. It is an α4β2 nicotinic acetylcholine receptor partial agonist. Varenicline has a unique action that relieves the cravings and withdrawal symptoms that occur during smoking abstinence, while blocking the receptor and preventing any reward from additional smoking. It has been shown to be efficacious for smoking cessation in normal smokers; however, its safety in smokers with mental health problems needs to be elucidated. Conclusion: The currently available data support the effectiveness of varenicline to treat nicotine dependence, but caution is needed in smokers with mental health problems. Thus, primary care doctors have a new pharmacological option to offer smokers who wish to stop smoking. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down.

The growing use of illicit ketamine among young adults poses a public health concern in Malaysia. In contrast to medical use of ketamine, illicit use has been reported to produce adverse effects on the urinary tract and, in particular the bladder. This case report describes a young Malay woman who developed severe bladder symptoms (urinary frequency) after consuming illicit ketamine. A history of illicit ketamine use was initially missed, and she was consequently diagnosed and treated for a urinary tract infection. Her symptoms persisted despite several courses of antibiotics. The patient was subsequently referred to an urologist where cystoscopic examination and biopsy of the bladder found changes consistent with interstitial cystitis. This was despite the absence of haematuria. Renal function was normal. The patient's ketamine use was the most likely cause for the urinary symptoms and bladder changes. Illicit ketamine use may lead to severe urinary tract problems that can be irreversible even after ketamine has ceased. Early diagnosis is critical although difficult when ketamine use is not divulged during the consultation with the physician. Physician consideration of this new clinical entity is important, particularly in cases where the symptoms do not resolve with usual treatment.

Issues. Methadone, a pharmacological agent used to treat heroin dependence is relatively safe, but may cause cardiac arrhythmias in the concurrent presence of other risk factors. Approach and Key Findings. This case report highlights the risk of Torsade de Pointes, a life-threatening cardiac arrhythmia, in a heroin-dependent patient receiving methadone substitution therapy who was prescribed itraconazole for vaginal thrush. The patient presented to the accident and emergency department for chest discomfort and an episode of syncope following two doses of itraconazole (200 mg). Electrocardiogram monitoring at the accident and emergency department showed prolonged rate-corrected QT interval leading to Torsade de Pointes. The patient was admitted for cardiac monitoring, and electrocardiogram returned to normal upon discontinuation of methadone. Implication. This cardiac arrhythmia was most likely as a result of a drug interaction between methadone and itraconazole because the patient presented with no other risk factors. Conclusion. Given the benefits of methadone as a substitution treatment for heroin-dependent individuals, the association between methadone and cardiac arrhythmias is of great concern. Physicians treating heroin-dependent patients on methadone substitution therapy should therefore be cautious of the potential risk of drug interactions that may lead to fatal cardiac arrhythmias.

Despite being a common skin dermatosis in the tropics, physicians in the tropics may miss the diagnosis of cutaneous larva migrans for other pruritic skin manifestation. This is especially in those who live in urban housing with no history of travel. Cutaneous larva migrans, an intensely pruritic skin pathology is mainly contracted by people with history of beach holiday or contact with moist soft sand which had been contaminated with dog or cat faeces. This article reports a patient who presented with intensely itchy papular spots over the dorsum of his foot after walking barefooted in an urban toilet soiled with cat faeces. The patient had initially seen an urban general practitioner who diagnosed the papular skin lesion as an allergic reaction, and prescribed antihistamines. The patient subsequently developed creeping skin lesions and was seen by the author who prescribed albendazole 400 mg twice daily for three days. The patient reported reduction in itching after two days of albendazole treatment and a follow up at ten days revealed a healed infection.

Smoking cessation programmes have been available for almost 2 decades in Malaysia. However the programmes have mainly focussed on outpatient primary care settings. More attention is needed to address and treat smokers presenting to hospitals with acute and chronic medical illness as hospitals provide good settings to implement smoking cessation intervention. For instance, a tobacco related medical illness may boosts a smoker's motivation to stop, especially when the smoker perceives smoking as the cause of his illness and understands the gains achieved by smoking cessation. Besides bringing a smoker in contact with health personnel who may offer assistance to a smoker to help him stop smoking, a hospital stay also provide an opportunity for the health carer to initiate and practice the government policy of no smoking in the hospitals. This article addresses the importance of having a hospital-based smoking cessation programme for the Malaysian hospitals. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down.

There is a growing trend of methamphetamines use in Asia-Pacific region. This has affected many new drug users. There are closed link between methamphetamine use and mental illness. Dual diagnosis among users are very common. It is a common encounter in clinical practices patients who took methamphetamines presented with psychotic disorders. Persecutory delusions and tactiles hallucination are common phenomena in this group of patients. These have contributed increase in aggressiveness among methamphetamines users too. In addition to psychotic, mood symptoms may also be parts of its presentation. Reduced sleep and high risk behaviour are among the known effects of methamphetamines use. In the case of methamphetamines dependence, there are users who experience dysphoric mood. This experiences may mimic the presentation in major depressive disorders. In this presentation, more details of these linkage between methamphetamines use are described.In conclusion the complexity of mental illness and methamphetamines use would need comprehensive assessment among methamphetamines users. Challenges in effective management of methamphetamines include to address both mental illness and methamphetamines abuse.

IntroductionIn Malaysia, MMT started with low regulated model since year 2002 to address increasing prevalence of HIV/AIDS among intravenous drug users. However, fear of widespread diversion and overdose death forced the government to implement high regulated MMT model. Universiti Malaya conducted both model among self-sponsored(low supervision) and government-sponsored(high supervison) program.ObjectivesTo investigate the biodemographic profiles, psychosocial correlates, pattern of substance use, methadone dosing and client satisfaction level among the two groups.MethodsWe conducted a cross sectional study involving 50 clients from each model. The inclusion criteria inludes opiates dependents age > 18 years and above with written consent using convenience sampling from October to December 2008. Semistructured questionare for demographic and pattern of substance use interview, MINI Neuropsychiatric interview for psychiatric morbidity and CSQ-8 for client satisfaction measurement. Analysis was done using SPSS version 16.ResultsAll the participants are males with the mean age of 40 years. 61% are married and 90% are employed during the interview. 80% received MMT more than one year and 65% achieved maintenance dose more than 50mg daily. 68% used substance more than 10 years prior to the MMT and 73% starts using heroin below age of 20 years old. 57% have comorbid psychiatric illness(anti-social personality, major depression and psychotic disorders) and 33% have medical illness(HIV+, Hepatitis B/C and tuberculosis). There were no significance difference in demographic profiles, pattern of substance use, psychiatric/medical comorbidities and clients satisfasfaction level between the two groups.ConclusionBoth group are similar from the clients satisfaction perpectives.

Salivary nicotine and salivary cotinine is widely used in clinical and epidemiological studies to validate smoking cessation. However, the reported collection for salivary nicotine and salivary cotinine vary by technique and duration. This study investigated the influence of salivary collection by unstimulation and stimulation technique of the concentration of salivary nicotine and salivary cotinine. It was found that unstimulated technique produced the highest salivary nicotine concentration, whereas stimulated technique produced the highest salivary cotinine concentration. The results of this study suggest that it is important to standardise salivary nicotine and cotinine collection technique. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down.

IntroductionThe smoking rate among Malaysian aboriginal people is double the rate of other Malaysians. Smoking is a major cause of morbidity and mortality in aboriginal people but smoking cessation among this population is very low. At present, pharmacotherapy for smoking cessation is not subsidised in the health services.Objective and aimThe study aimed to explore potential reasons for the underutilisation of drug therapy for smoking cessation among aboriginal and non-aboriginal smokers.MethodsA cross-sectional study was conducted among aboriginal and non-aboriginal smokers in the state of Selangor between March 2010-August 2010. Participants were asked to complete a questionnaire on demographics, smoking behaviour, physician counselling on smoking cessation and perceptions about drug therapy for smoking cessation.ResultsThe overall response rate was 85% (250 Aboriginal smokers and 105 non-aboriginal smokers). Majority of smokers reported smoking cessation or reduction in the previous 6 months (Aboriginal 62% vs non-aboriginal 68%). Aboriginal participants were less likely to seek physician services (p = 0.001) and less willing to use nicotine replacement therapy (p = 0.01) or varenicline (p = 0.001). Among all smokers, having to buy the medication and price of the medication was the most important factor associated with less willingness to use the drugs but advice from physician was associated with willingness to use the drugs.ConclusionsRegardless of ethnic origin, smokers were interested to quit smoking, but cost of medication may explain their lower uptake of drug therapy. Malaysian policy makers should consider making the drugs for smoking cessation freely available in the Malaysian health services.

The history of substance abuse in Malaysia can be divided into pre- and post-independent era. In preindependence, the main drug of abuse was opium which was initially consumed by immigrants from China who were introduced by the British colonialist to work in Malaya. The post-independence era began in the 1960s when young adults were influenced by the “Hippy” subculture. At this time, consumption patterns changed where more Malays were involved in drug abuse compared to other ethnic groups (1, 2).By the early 1980s, the prevalence of drug addiction increased and this increasing trend made the Malaysian government consider heroin addiction as a national threat. The national anti-drug task force was formed to control trafficking and to rehabilitate addicts who were involved in heroin addiction (3). Legislation was introduced where mandatory death sentence was implemented for those who smuggled more than 15 grams of heroin. Drug addicts found to be positive for heroin were forced to undergo compulsory rehabilitation for two years (4). Nationwide, up to 28 government drug rehabilitation centers were established, and at any particular period, each center accommodated up to 500 inmates. Approximately RM50 million a year was spent to run these centers (5). The centers were initially managed on a total abstinence philosophy; however this approach produced poor results. The latest survey showed that 85% of drug addicts relapsed after completing their rehabilitation at these centers (4, 6). In view of the poor results, substitute treatment with methadone was introduced recently to these centers (7).One of the visions of the Malaysian government was to create a drug addiction free nation by the year 2015. However, the increasing number of drug addicts has caused a surge in demand for rehabilitation centers, resulting in the inability of these centers to cope. For example, the number of drug addicts increased by 1% from year 2001 to 2002, but the number of drug addicts detected in year 2003 was 36,996, a 16% jump from the previous year (31,893). Furthermore, the National Drug Agency reported that 45% of the cases were repeat addicts. As for distribution of new cases, by ethnic group the Malays constituted 71%, Chinese 10.6% and Indian 8.2%. The majority (70%) were in the socially and economically most productive age group (20-39 years) and almost 98% of the addicts who occupied these rehabilitation centers were male. Currently, the number of drug users in the country is estimated to be 250,000 but the number is predicted to reach half a million by year 2015 (3, 8-10). The resulting economic, human resource and social loss is not quantifiable as the vacuum left by these people in various employment sectors are currently being filled by migrant workers. Thus, it is evident that the increasing trend in drug addiction poses a threat to the future of the nation (1, 6, 9).