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Psychrotropic substance abuse

Introduction

Psychotropic drugs are medicines which have the potential to change and affect the thoughts, emotions and behavior. Psychotropic drugs can be classified into several types such as anti-anxiety, anti-psychotic and sedative-hypnotics. It is commonly used for the treatment of insomnia and mental disorders.

The usage of psychotropic drugs should be controlled to overcome abuse. For example, taking anti-anxiety and sedative-hypnotics from benzodiazepines group more than 2 weeks (eg midazolam) can cause dependence, tolerance and withdrawal symptoms. (Martindale 36th edition and package insert Dormicum).

When It Should Be Taken

Psychotropic medication should be taken on the advice of a registered medical practitioner (doctor). Listed in the table below are examples of how psychotropic medications should be taken accordingly.

Active Ingredients
Class
Indication
Dose
Duration
Midazolam
  • Benzodiazepines (short-acting)
  • Sedative-hypnotics
  • Short term treatment insomnia
  • Sedation in premedication
  • 7.5-15mg (tablet)
  • 1 mg by slow IV in 30sec
Not more than 2 weeks
Alprazolam
  • Benzodiazepines (short-acting)
  • Anti-anxiety
  • Short term symptomatic relief of excessive anxiety
  • Management of mixed anxiety-depression
  • Management of panic disorder
Initial dose

  • 0.25 – 0.5mg tds
  • 0.5mg tds
  • 0.5 -1 mg tds

Avoid doses >2mg daily

2-4 weeks
Triazolam
  • Benzodiazepines (short-acting)
  • Sedative-hypnotics
  • Short term treatment insomnia
Normal dose

  • 0.25mg before bed
  • 0.125mg with low body weight Reserve 0.5mg for exceptional cases only in which patient does not respond adequately to a lower doses

7-10 days
Zolpidem
  • Imidazopyridine (non-benzodiazepine short-acting hypnotics)
  • Sedative-hypnotics
  • Short term treatment insomnia of occasional & transient insomnia
  • Sedation in premedication
10mg before bed 2-5days
Lorazepam
  • Benzodiazepines (Intermediate-acting)
  • Anti-anxiety
  • Sedatives
  • Short term symptomatic relief of anxiety
  • Anxiety component in psychotic states & severe depression when adjunctive therapy is indicated
  • Surgical premedication
Initial dose

  • 2-3mg in divided doses
  • 1-2mg at bedtime (insomnia due to anxiety)
  • 2-4mg night before surgery
2-3 months includes tapering
Diazepam
  • Benzodiazepines (long-acting)
  • Anti-anxiety
  • Anticonvulsant
  • Short-term symptomatic relief of excessive anxiety
  • Symptomatic relief in acute alcohol withdrawal
  • Adjunctively for relief of skeletal muscle treatment
  • Short term adjunctive therapy in convulsive disorder
  • 2-10mg, 2-4 times daily
  • 10mg, 3-4 times during first 24hours, reducing to 5mg, 3-4 times daily as needed
  • 2-10mg, 3-4 times daily
  • 2-10mg,2-4 times daily
7-14 days

Abuse

Pharmaceutical Services Division, Ministry Of Health Malaysia (MOH) has received numerous complaints regarding the misuse of psychotropic substances. As a measured step in reducing crime towards the implementation of Government Transformation Plan; Pharmaceutical Service Division, MOH has carried out psychotropic substances auditing as its core business.

During 2011, 254 private clinics were audited. Its findings showed psychotropic substances, especially Midazolam is abused and are being supplied unethically, not for the purpose of medical treatment. In most cases it used to ease the addicts’ craving.

Alprazolam, triazolam, zolpidem, diazepam and phentermine are among the favoured-types of psychotropic substances which are often abused. The findings showed that some of the medical practitioners has been supplying a large number of psychotropic substances for a long period of time. Polypharmacy of psychotropic substances (eg mixing Methadone with psychotropic substances) also has been found.

The audit which were carried out onto private clinics enable law enforcement officers involved, educating medical practitioners and patients about the misusage of psychotropic substances.

Provisions Of The Law

On 27th of July 1986, Malaysia has made an agreement to manage psychotropic substances effectively in United Nation Convention on Psychotropic Substances 1971. This action showed Malaysia are commited in handling issues related to psychotropic substances seriously.

In Malaysia, psychotropic substances are controlled under the Poisons Act 1952 and Poisons (Psychotropic Substances) Regulations 1989 and is listed under the Third Scedule, Poisons Act 1952. The psychotropic substances can only be provided by a registered medical practitioner and available at the pharmacy with a prescription.

Poisons (Psychotropic Substances) Regulations 1989 outlines all matters relating to the importation, exportation, manufacture, procurement, sales, recording, and storage of psychotropic substances. Among those listed are :-

  1. Regulation 4 – control of import and export of psychotropic substances
  2. Regulation 11 – control on the sale and supply of psychotropic substances for the purpose of treatment
  3. Regulation 19 and Regulation 22 – recording and maintenance of register book
  4. Regulations 24 – psychotropic substances storage
  5. Regulations 28 – labelling for treatment.

Any violations that occur can cause individuals prosecuted. If convicted, can be fined not exceeding RM10,000 or imprisonment not exceeding four years or both, as specified under section 30 (5) of the Poisons Act 1952.

Last Reviewed : 01 June 2015
Writer/Translator : Muhamad Syanizam bin Kassim
Accreditor : Halimi bin Mat Piah

 

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