SUBUTEX ABUSE

SUBUTEX ABUSE:

(Update): 6.

Dr Fatimah Lateef asked the Deputy Prime Minister and Minister for Home Affairs if he will give an update on Subutex abuse since Subutex’s classification as a controlled drug was implemented in August 2006.

Assoc. Prof. Ho Peng Kee (for the Deputy Prime Minister and Minister for Home Affairs): Sir, buprenorphine (which is the active ingredient in Subutex) was made a Class A controlled drug under the Misuse of Drugs Act on 14th August 2006. Between 14th August 2006 and 31st December last year, CNB arrested a total of 347 persons for Subutex-related offences. Of these, 150 Subutex abusers were sent to the Drug Rehabilitation Centre (DRC) for treatment, 55 abusers were imprisoned under the Long Term Imprisonment regime, and 102 persons were sent to Prisons as they were found to have either trafficked or possessed the drug. As for the remaining 40 persons, 22 were given a warning and 18 are pending further investigations.

Since the implementation of tougher measures to counter Subutex abuse, I am happy to report that the situation has improved significantly. To prevent the influx of illicit supply of the drug, CNB is maintaining a watchful eye at the checkpoints as well as on the ground situation. CNB has not detected any signs of a black market emerging and the number of Subutex tablets seized monthly is not high. Between 14th August 2006 and 31st August 2006, 512 Subutex tablets were seized. Although about 1,000 Subutex tablets were seized in September 2006, this is attributed to a single seizure of 884 Subutex tablets, which is the largest consignment seized so far. 319 tablets and 590 tablets were seized in October and November last year

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respectively. In December 2006, only 79 tablets were seized.

Feedback from the public also suggests that the Subutex abuse situation has improved. I am sure Members of Parliament who monitor the grounds will know this. Since September 2006, the monthly number of calls and other feedback from the public on Subutex abuse have declined. We believe that CNB's strong enforcement action has led to a decline in public concern over Subutex abuse.

CNB's intelligence indicates that, while it is likely that a small proportion of Subutex abusers may attempt to illicitly access the drug, the vast majority of ex-Subutex abusers have very likely managed to overcome their Subutex dependence. Thus, CNB's enforcement actions have helped to contain Subutex abuse. Nevertheless, CNB will continue to keep a close watch on the Subutex abuse situation and will press on with vigorous enforcement efforts to detect and deter illicit drug activities, taking firm action against both drug traffickers and abusers alike.

Ms Sylvia Lim (Non-Constituency Member): Sir, since August 2006, based on the information released by the Central Narcotics Bureau on its website, it appears that there have been several operations in which significant amounts of heroin had been seized. And I would like to ask the Senior Minister of State whether he thinks it is possible that there has been a displacement effect from Subutex now that it is controlled and such abusers switching instead to heroin.

Assoc. Prof. Ho Peng Kee: Sir, as I have reported, our assessment is that there has been no displacement effect. Firstly, the number of heroin abusers who have been arrested has remained low. Yes, there was some increase in 2006 over 2005, but not significant in terms of

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the numbers. So that is the key point. Otherwise, you will find the vast number of Subutex abusers on the CARDS system, more than 3,000, if the supply of Subutex is hard to come by, then they would have gone for heroin. But despite vigorous enforcement action, and this is something that CNB has not compromised on just to have nice figures, the number of heroin abusers arrested has not shot up dramatically. The price of heroin on the ground has also remained constant because if the demand is high, the price will go up. These are figures which CNB will monitor very carefully. As for seizure of drugs, I think the number can go up and go down. I think there will be those who may try to bring drugs into Singapore of whatever volume and the bringing of drugs and the seizure of drugs in themselves do not suggest the deterioration of the ground situation.

Dr Fatimah Lateef (Marine Parade): Sir, can I just find out the utilisation rate for the Subutex voluntary rehabilitation programme and the take-up rate since it has been implemented and, also, if the Minister has the data for the ratio breakdown?

Assoc. Prof. Ho Peng Kee: About 3,000 persons signed up for the Subutex programme. Of these, about 2,500 turned up for the first consultation, and about 1,600 completed the medical detoxification phase. So not all have signed up. But I think what is heartening is that of the number of Subutex abusers who were arrested, not more than 170 were people who had gone for the SVRP programme. In other words, a large majority who went and completed it were not arrested subsequently for Subutex abuse. So that is heartening.

Mdm Halimah Yacob: I wanted to ask the Senior Minister of State what is the success rate of the rehabilitation programme because there have been

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newspaper reports that there have been drop outs of this Subutex rehabilitation programme.

Assoc. Prof. Ho Peng Kee: I think we can only go on the figures of the arrestees, the number of Subutex abusers who have been arrested, since we began the programme in August 2006. As I said in my main answer, only about 350 persons have been arrested for Subutex-related offences over the past four or five months. So that signals that when Subutex was legal, people went for it because it was legal and it was accessible. But when the message was sent that Subutex would be illegal and that you should kick whatever habit you may have, whether it is heroin or other related drugs, in a way we have always said should be done, which is zero tolerance, I think the message went to the ground. So that is the current situation.

Mr Low Thia Khiang (Hougang): Sir, why was Subutex not classified as a controlled drug earlier? Why wait until there was widespread abuse, then the Government decided to take action? Secondly, I wonder whether it is a wise decision for the Government in the first place to allow Subutex to be used legally in a way to counter the impact of heroin drugs.

Assoc. Prof. Ho Peng Kee: I think this point has been answered before, principally by the Minister for Health whose officers are in charge of bringing drugs into Singapore as prescription drugs. This was done in 2002. I think the officers at that time felt that this could be part of the overall scheme to help heroin abusers kick the habit. And, indeed, when it was introduced in Singapore, already six countries had it. So it was done. To the credit of the Government, we did not just do it and leave things as they are because we monitored the ground. When CNB fed

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back to MHA that there was abuse on the ground, steps were taken to try to arrest the situation, not immediately by making it a controlled drug but by various measures taken. For example, the CARDS system was started whereby all abusers of Subutex were required to register and this online registry was made available to doctors so that they would know if the abusers doctor-hop. A protocol was started, clinical practice guidelines where doctors were taught and informed, workshops were conducted to tell them what is the proper way to administer Subutex. When these measures were implemented and still did not stem the tide, we felt that we should do more and in a sense reversed the decision and hence we made Subutex a controlled drug.

Mr Zaqy Mohamad (Hong Kah): I would like to go back to the question earlier whether heroin was a substitute for Subutex. If we look at the trend the other way around where Subutex became a substitute for heroin, does the Ministry see any other substitutes? I do not think that they would go to a more expensive substitute but to a cheaper alternative. Do we see a trend with substitute drugs, apart from Subutex, now that we have clamped down on Subutex?

Assoc. Prof. Ho Peng Kee: We do not want to use a drug-substitution approach. This episode shows us that that is not the approach to take. We are, of course, monitoring other drugs. For example, Dormicum is one drug we are monitoring. But unlike Subutex, Dormicum has also other medical uses. It is used for pre-surgery anaesthesia. It can be used to help people who cannot sleep. So, we do not want to just always make a drug a controlled drug when it is abused. The best way is to monitor, work within the framework and make it controlled, if need be.

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Just one other point on my previous answer. The Minister for Health is on record saying that it was a matter of poor judgement on the part of the Ministry of Health for having introduced Subutex. So it is already very widely explained in the media. There is nothing to hide. But to give the Government credit, when we realised that it should not have been done in the first place, we took remedial actions clearly, decisively and, most importantly, as a Government, multi-agencies working together.