KUALA LUMPUR — Every Monday and Thursday morning, the slightly built man rides the bus for an hour and a half from his home on the outskirts of Kuala Lumpur to the Ar-Rahman mosque.
After reciting his prayers, he climbs the stairs to the mosque’s mezzanine level, gives a urine sample and consults a doctor. A pharmacist then gives him a small plastic cup containing methadone, to help wean him from his heroin addiction.
The man, who did not want to be identified because of the stigma surrounding illicit drug use in the Muslim-majority country, said he had injected heroin for seven years before coming to the Ar-Rahman mosque about a year ago. “It makes me no longer take heroin on the street,” he said, referring to the methadone. “It makes me able to work.”
Some Muslim scholars believe that drugs that may prevent Muslims from carrying out their religious duties are forbidden under Islam, and Malaysia enforces strict laws, including the death penalty, for drug trafficking. Penalties for those found in possession of heroin include a fine, up to life in prison and whipping, depending on the amount.
But at Ar-Rahman mosque, doctors from the University of Malaya have succeeded in getting the religious authorities onboard in what the World Health Organization says is the world’s first methadone program operating out of a mosque. Doctors plan to expand the program to two more mosques in Kuala Lumpur in coming months.
Malaysia has an estimated 170,000 intravenous-drug users, with heroin the most commonly used drug. Opiate users accounted for about half of all drug users arrested in 2010, and the amount of heroin seized that year was the highest reported during the past five years, according to a recent report by the U.N. Office on Drugs and Crime. Most heroin in Malaysia is from Myanmar, Laos and west Asia, but some is also processed domestically, the report found.
While some countries have been using methadone to treat heroin addicts for decades, Malaysia introduced a nationwide government-financed program in 2005. Previously, the University of Malaya ran a program where patients had to pay for treatment. The success of that program, combined with the alarming spread of H.I.V. among intravenous drug users, prompted the government to introduce its own program with free dosages in 2005. Clean needle exchanges were introduced the following year.
The number of new H.I.V. infections reached almost 7,000 in 2002; by 2005 that figure had dropped to just over 6,100, with intravenous drug use the main mode of transmission.
Before the introduction of methadone, heroin addicts were sent to government rehabilitation centers for two years where they would go “cold turkey,” an approach doctors said led to a high relapse rate.
But while the number of methadone programs has expanded since 2005, a shortage of clinics with adequate space and facilities meant that many people who might have benefited from the treatment were still missing out, said Dr. Rusdi Abdul Rashid, chief coordinator of the University of Malaya’s Center of Addiction Sciences , which runs the Ar-Rahman program.
When doctors first approached the mosque authorities and the government departments of Islamic Development, which must approve activities in Malaysian mosques, they encountered strong opposition. The authorities feared that methadone was forbidden in Islam, Dr. Rusdi said. But the doctors explained that methadone was different from other drugs because it is a medication and does not give patients a euphoric feeling.
“They agreed to allow us to pilot the program,” Dr. Rusdi said in an interview.
The program, which began in 2010, now has 50 patients whose ages range from 18 to 60. When they first join the program, patients must take the methadone under the watchful eye of pharmacists. After a couple of months and at least two consecutive urine tests that show they are negative for drugs, patients are allowed to take up to three doses home with them.
While the Malaysian methadone program marks the first one based in a mosque, the Islamic authorities have become involved in the fight against drugs in other countries, like China and Indonesia, where some Islamic organizations run rehabilitation centers.
Malaysia’s national Department of Islamic Development said it agreed to allow the methadone program at Ar-Rahman mosque after the National Fatwa Council granted permission for the use of methadone on the condition that it is taken under a doctor’s supervision.
“The use of methadone at Ar-Rahman mosque was permitted by religious authority because it is considered as a type of medicine that can be used as a treatment to drug addicts,” the department said in a statement.
“JAKIM believes this program can make the mosque as a social center for the community,” the department said, using the Malay acronym for its title.
Nizam Yussof, treasurer of the Ar-Rahman mosque, said the mosque committee agreed to host the program because it was helping people change their lives for the better.
“A lot of them are already in good health, already have a proper job, some of them have also married and have a new family,” he said. “I believe what the organization is doing is a good move.”
But not everyone agrees. Mr. Nizam said that some worshipers had expressed concern and wanted to know why the program could not be based in a clinic. “Some of our people look at drug addicts, some people think it’s not good to see them waiting around the mosque,” he said.
Dr. Rusdi said he wanted to continue working closely with the mosque to help remove the stigma surrounding drug users.
In a report released last year , the World Health Organization said while discrimination against drug users remained high in Malaysia, their access to health care had increased in recent years. The report referred specifically to the Ar-Rahman mosque.
Since the introduction of methadone and needle-exchange programs, the number of new H.I.V. cases has dropped by almost half, with the number of new infections in 2009 — 3,080 — the lowest since 1993. However, new infections rose to 3,652 in 2010, the last year for which figures are available, as sex overtook intravenous drug use as the main mode of transmission.
The Malaysian AIDS Council , an umbrella organization of groups working on H.I.V./AIDS issues, says that Muslim men in Malaysia are still most at risk of contracting H.I.V. through intravenous drug use and has strongly supported the Ar-Rahman program.
“We are currently campaigning to other religious authorities and leaders in the country to adopt this program,” said the council’s president, Mohammad Zaman Khan.
At Ar-Rahman mosque, the Ministry of Health provides the methadone dosages for free and pays for the two pharmacists who dispense the methadone while doctors from the University of Malaya and general practitioners attend once a week to assess patients. Each patient pays 15 ringgit, or about $4.90, a week to participate.
Dr. Rusdi said the treatment also involves “spiritual enhancement,” which he said is often a feature of drug treatment programs regardless of the patient’s religion.
In this program, for the first eight weeks patients must perform their prayers before they see a doctor and receive methadone. After that, reciting prayers is not compulsory but Dr. Rusdi said it is encouraged, as is attending weekly religious talks, additional elements he believes may help prevent patients from relapsing.
The Department of Islamic Development was also involved in designing this part of the program.
“We think that spiritual treatment can have a better outcome on top of methadone treatment in terms of retention rates and treatment, H.I.V. risk behavior and also the quality of life,” Dr. Rusdi said.
The University of Malaya is planning to expand its program after receiving invitations from two other mosques in Kuala Lumpur. To save costs, it hopes to begin a mobile service where a van will ferry a doctor and a pharmacist to the mosques to deliver the program. There are also plans to establish a similar program at two Hindu temples in Kuala Lumpur. Dr. Rusdi said he did not know of any temples or Christian churches that currently provide such services in Malaysia.
On a recent Thursday, the men who came barefoot up the stairs to the clinic were a mix of young and old.
A 48-year-old man who gave his name only as Carlos said he began coming to the mosque about a year ago after using heroin for three decades. Carlos, who earns a living performing music on some of the capital’s most popular tourist streets, said that, since he stopped taking heroin, he had been able to buy his family a small house.
“I think it’s very good,” he said of the program, clutching three small bottles of methadone that must last until his next visit. “In Christianity, they have addicts using churches,” he said of programs in other countries. “But Muslims can also use the mosque to help people like us.”
March 28, 2012
By LIZ GOOCH
New York Times - http://www.nytimes.com/2012/03/29/world/asia/malaysian-mosque-is-also-methadone-clinic.html
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