Compulsory drug detention centres: Time to question their continued use?
In the Lancet Global Health, Martin Wegman and colleagues present their study of opioid use in opioid-dependent individuals released from compulsory drug detention centres (CDDCs) compared with those from voluntary methadone treatment centres (VTCs) in Malaysia. This study was the first prospective observational study to compare drug-use outcomes between the two facility types. The investigators showed that opioid-dependent individuals in CDDCs were significantly more likely to relapse to opioid use after release than opioid-dependent individuals receiving methadone in VTCs (in unadjusted analyses, CDDC participants had significantly more rapid relapse to opioid use post-release compared with VTC participants [median time to relapse 31 days {IQR 26–32} vs 352 days {256–inestimable}, log rank test p<0·0001).
As such, the findings of this study make another contribution to the growing literature base on the ineffectiveness of CDDCs in treating drug dependence.2, 3, 4, 5 The study also builds on an expanding evidence base of scientific research into the effectiveness of pharmacological drug dependence treatment approaches. These findings are an important addition to the many reports on CDDCs6, 7undertaken mainly by non-governmental organisations committed to promoting human rights of marginalised and vulnerable individuals, but which at times have not contained the scientific rigour needed to warrant government attention, especially from governments that do not welcome criticism of the CDDCs' approach to curtailing drug use and drug dependence.
It is important to be cognizant of the different drugs of choice in countries in which CDDCs operate, especially since proponents of CCDCs in countries where amphetamine-type substances are the main drug of choice argue that CDDCs are required in the absence of a pharmacological treatment approach for dependence on amphetamine-type substances.
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