Use and Abuse 2

I did not expect the Central Narcotics Bureau (CNB) to respond the the letter by Dr Soo which we discussed in this post two weeks ago, but they did so in a letter to Today today.


Providing substitute drugs will only prolong addiction

Letter from Dawn Sim
Public Affairs, For Director
Central Narcotics Bureau

WE REFER to the letter "Drug for heroin dependence can turn lives around" by Dr Soo Inn Choong (July 10).

Abusing drugs such as heroin is a deliberate act of taking a psychoactive substance against the law.

Drug addicts must account for their actions and take personal responsibility to stop their undesirable habits which have serious repercussions on their lives, careers and families.

Providing addicts, who are unwilling to take personal responsibility, with a substitute drug merely encourages them to prolong their addiction from one drug to another.

In our experience, rehabilitating drug addicts can only be achieved through a comprehensive programme of treatment through rehabilitation and aftercare. Unless they are compelled to stop and supported to take responsibility for their actions as part of a holistic rehabilitation programme, many will continue to dither and languish in the embrace of one drug or another.

For every case cited by Dr Soo, we know of many others who have thoroughly cleaned themselves from their addictions and lead healthy and productive lives without the need to be under the bondage of any drugs.

It is with this approach that we have managed to keep Singaporeans relatively drug-free. The Central Narcotics Bureau and the Ministry of Health have been monitoring the Subutex situation closely.

The two agencies are also working together to assess if additional measures are needed.


We are presented with two different views of the same 'problem', which likely stems from the fact that the CNB and Dr Soo probably see two rather different groups of addicts in the course of their work - the one with addicts who did not voluntarily seek help, and the other with those who came forward willingly, after the decision to quit.

Dr Soo sees addiction to heroin as 'a disease that should be treated like every other'.

The CNB sees addiction to heroin as 'a deliberate act... against the law'.

Of course, there is no reason why it can't be both.

But Dr Soo also sees Subutex as a medication, and he believes that '(i)n the same way that people with other mental disorders such as schizophrenia or depression need medication, so do those with heroin dependence.'

Whereas the CNB believes the use of Subutex 'merely encourages (addicts) to prolong their addiction from one drug to another'.

Well, these two positions are a little harder to reconcile, but there is no reason why it cannot be the case of the former in some people, and the case of the latter in others. In fact, that is almost certainly the reality, since we know some people quit their heroin addiction with Subutex, and some people abuse Subutex.

Addiction is a complex phenomenon involving many aspects of a person, including genetics, biology and psychology. Add to that the social implications or stigma of the term 'addiction', and the picture gets even more complex. There probably isn't a one-size-fits-all solution to heroin or Subutex addiction, not to mention other forms of addiction. The 'best' solution depends on which spectrum of the 'problem' you have to deal with.

As politically-incorrect as it seems, angry doc tends to agree with the idea that taking personal responsibility is an important step in quitting any addiction (or controlling many chronic medical conditions, for that matter). While we may argue over individual susceptibility to addiction and what the best method of quitting is, I believe one thing all successful 'quitters' must have had in common was the personal decision to quit, and the continued decision to see the rehabilitation process through, be it cold-turkey, or drug-assissted.