Students@SPM 2024: Stigma to Support – Decriminalisation in Public Health

Group 2 had the incredible honour of leading a presentation on the decriminalisation of drugs as part of our Master of Public Health (MPH) Global Health Seminar. We are deeply grateful to our insightful lecturer, Associate Professor Dr Tharani Loganathan, for curating this valuable learning experience. We extend our heartfelt thanks to the esteemed Dr Norsiah Ali, a Consultant Family Medicine Specialist and Addiction Specialist who led the Malaysian Methadone Treatment Outcome Study (MyTOS), Mr Palani Narayanan, the Director of the Drug Policy Program at the Malaysian AIDS Foundation, and his dedicated team (Mrs Nur Khaulah Fadzil, a Senior Technical Officer and Atlantic Fellow for Health Equity SEA; Mr Dharin Ethan, Cara Officer; and Ms Riaan Ramachandran, Intern, both from the Malaysian AIDS Foundation’s Drug Policy Reform Program) alongside Dr Sangeeth Kaur, the Clinical Coordinator at Harapan II, for so generously sharing their extensive expertise and on-the-ground perspectives.

In the seminar, we talked about rethinking the way we approach drug use and shifting the focus from punishment to harm reduction for improving individual and community well-being – it is a game changer! Prior to this experience, we, like many others, held a rather narrow and outdated perspective on the issue of substance use. Shaped by the pervasive stigma and criminalisation that has long dominated societal attitudes, we viewed drug use through a lens of moral failure and law enforcement. However, this seminar has shattered that myopic worldview, compelling us to consider an entirely new approach to this complex public health challenge. 

What became strikingly clear is that the punitive, criminal justice-oriented model has been a resounding failure. Far from curbing addiction and improving societal well-being, this outdated paradigm has only served to exacerbate harm, fueling societal stigma, overcrowded prisons, and limited access to essential treatment and support services. In stark contrast, our group’s exploration of successful decriminalisation models implemented in countries like Portugal, Thailand, and the Netherlands has been eye-opening. These pioneering efforts have demonstrated the remarkable potential of a harm reduction-focused approach that prioritises individual and community well-being over punishment. 

By redirecting resources away from the criminal justice system and towards evidence-based treatment, education, and public health initiatives, these global trailblazers have achieved remarkable outcomes. Overdose rates have plummeted, treatment engagement has skyrocketed, and the pervasive stigma surrounding drug use has begun to slowly erode. Most importantly, these policy reforms have ushered in a profound cultural shift, one that views substance abuse as a public health challenge rather than a criminal one. 

As we contemplate the implementation of drug decriminalisation in Malaysia, the panellists emphasised the vital importance of contextualising policy reforms to our unique socio-cultural landscape. Thoughtful adaptation and nuance will be key to ensuring the success and sustainability of any such efforts. While the successes of drug decriminalisation in other countries provide important lessons, it is crucial that we also examine the potential pitfalls and failures. The example of Oregon’s drug decriminalisation efforts is particularly instructive. Despite the groundbreaking policy change, Oregon has faced significant challenges in implementation, such as a lack of investment in harm reduction services and treatment infrastructure. This has led to continued barriers for individuals struggling with substance use disorders, and an increase in overdoses – a concerning mismatch between the intended goals and the reality on the ground.

This experience in Oregon highlights the vital importance of ensuring that drug policy reforms in Malaysia are accompanied by a comprehensive, well-resourced public health framework. This means not only removing criminal penalties but also dedicating sufficient resources to evidence-based treatment options, expanding harm reduction programs, and engaging in robust community outreach and education. Through collaborative efforts, research, and creative communication, our seminar addressed a complex public health issue and facilitated a thought-provoking discussion on a potential pathway towards a healthier future for Malaysia. We and our classmates emerged from the seminar enlightened about this important yet often under-discussed public health issue – the decriminalisation of drugs. 

Furthermore, we outlined a practical framework for implementing the decriminalisation of drugs in Malaysia in our Policy Brief (see photo). This roadmap encompassed legal reforms, the establishment of a dedicated commission, bolstering treatment infrastructure, and public awareness campaigns. The key takeaway that truly resonated with us students is the vital need for us, as aspiring future public health leaders, to fundamentally shift our mindset. We must start viewing drug use through the lens of public health, rather than criminal justice. Developing this critical understanding will empower us to make truly informed, evidence-based decisions when it comes to drug policy. Moreover, it will equip us to effectively advocate for progressive reforms that can positively transform community health and social equity outcomes.

In fact, we found the discussion and insights shared during the seminar to be truly eye-opening and invaluable. Engaging directly with Mr Palani and his team really helped contextualise the complex realities surrounding drug decriminalisation in a profound way. Their knowledge and experience have undoubtedly enriched our own understanding and reinforced our determination to be a champion for compassionate, health-focused drug policies in the years to come. As the proverb goes, “Knowledge is power,” and we are deeply grateful to have been entrusted with this platform to share our learnings. We look forward to continued growth and dialogue on this crucial topic. 

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