The Singapore heroin control programme

Sections

ABSTRACT
Introduction
History of drug use in Singapore
Response strategy
The programme components
Overall outcome of programme
Discussion
Acknowledgements

Details

Author: W. H. McGLOTHLIN
Pages: 1 to 13
Creation Date: 1980/01/01

The Singapore heroin control programme *

W. H. McGLOTHLIN
Department of Psychology, UCLA, Los Angeles, California, USA

ABSTRACT

In 1975 Singapore experienced a sudden heroin epidemic, and within two years an estimated 3 per cent of the males, 15-24, were involved. In 1977 the Government responded with an all-out enforcement strategy aimed at rapid containment. Demand reduction involved the large scale arrest of suspected users, and the immediate commitment of those with positive urines to Drug Rehabilitation Centres. The primary rehabilitation emphasis is on instilling discipline, social responsibility and sound work habits. Releases are placed on two years of compulsory supervision with a 5-day cycle for reporting and urine specimens. Sixty-three per cent show no detected drug use within the first year of supervision. Supply reduction efforts are equally strong and, while these were not immediately successful in limiting availability, heroin is currently very scarce and expensive. While there is some evidence of the substitution of cannabis, psychotropic drugs and alcohol, the number of new heroin cases is minimal. Overall, the epidemic appears to have been controlled.

Introduction

The current Singapore programme to suppress heroin use rivals the well-known Japanese response to the post-World War II methamphetamine epidemic (Brill and Hirose, 1969; Morimoto, 1957; Nagahama, 1968). At the peak of the Japanese epidemic, an estimated 1-2 million persons were involved in parenteral administration of methamphetamine. The all-out response of the Government, and the speed with which the epidemic was brought under control has been described as unique and without historical precedent (Brill and Hirose, 1969). The number of arrests dropped from a peak of 56,000 in 1954 to 271 in 1958. The spectacular success was attributed to a unified government approach employing an intensive public education campaign and strict enforcement measures among a homogeneous population who were traditionally responsive to authority.

The Singapore heroin epidemic began in 1974-1975 but the full control efforts were not initiated until 1977. As in Japan, a co-ordinated plan was implemented which aimed at controlling supply and demand, and influencing public attitude and actions. From the reports on the Japanese measures, it appears that enforcement agencies were relatively successful in eliminating the source of supply, while the Singapore efforts have concentrated more heavily on control and compulsory rehabilitation of the user. The present paper will describe the policies and procedures adopted in the latter programme, along with the results obtained thus far.

* This work was supported in part by grant number K07-DA70182 from the National Institute on Drug Abuse.

History of drug use in Singapore

Leong (1977) cites several references establishing the widespread prevalence of opium smoking during the 19th century. A government monopoly for selling opium was established in 1910, and opium smokers were registered in Singapore, and 28 government retail opium shops. The estimated population at that time was 770,000 for a prevalence figure of about 2 per cent. Based on other sources, Leong estimates the actual prevalence was substantially higher.

During the Japanese occupation of World War II the opium shops were first closed and then reopened. At the close of war in 1946, the British made the use of opium illegal, and in 1954, St. John's Island Treatment Centre was established. Thereafter, addicts arrested under the opium law could be committed to treatment rather than imprisonment. The commitment was for one year, but they were typically released after three to six months. The capacity was around 250 and a minority were volunteers. The typical commitment was male, Chinese, aged 49 with a history of 18 years of opium use-there were a few morphine, but no heroin users (Leong, 1977). After the mid-fifties there were very few young persons initiating opium smoking, and the average age of the opium-smoking population continued to increase.

Around 1970, Leong (1977) estimates there were 7,000-8,000 opium smokers-mostly old with chronic health disorders. A 1966 survey of 4,000 consecutive admissions to a Singapore surgery unit found 1.25 per cent were opium addicts (Tinckler and Baratham, 1966).

Around 1969-1971 the use of cannabis, amphetamine and methaqualone began to appear among the youth. The majority were under 20, and tended to be from the middle and upper socio-economic class. This group bears no relation to the much older opium-using population.

The first heroin case was noted in 1971, although there had been a number of earlier reports of heroin arrests and seizures in Malaysia. The following record of Singapore heroin arrests indicates the rate of spread:

Year

Heroin arrests

Percentage total drug arrests

1972 4 0.1
1973 10 0.4
1974 110 3.4
1975 2 263 54.0

While the heroin epidemic occurred shortly after the onset of the cannabis and psychotropic drug use mentioned above, the groups affected had somewhat different characteristics. The heroin-using group were slightly older-although 90 per cent were under 30-were predominantly male, and tended to be less well educated, more deviant and from the lower socio-economic class. The mode of administration was almost entirely by smoking.

Response strategy

Figure 1 shows the chronology of government responses to the heroin epidemic. The Central Narcotics Intelligence Bureau was formed in 1971, and the Misuse of Drugs Act was passed in 1973. The latter actually pre-dated the epidemic, but contained a key feature permitting the Director or Deputy Director of the Central Narcotics Bureau (CNB) to order a person whose urine was positive for a controlled drug to six months of compulsory treatment in an approved institution without any court or other legal proceedings. When the heroin epidemic became apparent in 1975, the Act was amended to provide the death penalty for major trafficking in heroin and morphine.

By 1975, St. John's Treatment Centre, which was initially established for the treatment of chronic opium addicts, had been converted to a centre for young heroin addicts. At the beginning of 1976 the Government adopted a tough stand with respect to drug treatment and rehabilitation. St. John's was phased out and replaced by a Drug Rehabilitation Centre (DRC) located at a former military centre, Telok Paku, and under the administration of the Prisons Department. Five additional DRCs were subsequently opened.

Figure 1

Actions related to heroin control programme

Full size image: 804 kB, Figure 1

A registry was established in August 1974 for persons either convicted of a controlled drug offence or providing a positive urine. Medical practitioners were also required to report to the registry any person seeking treatment for controlled drug use. In August 1976 a policy of withdrawal without supportive medication ("cold turkey") was established for DRC commitments-those over 55 or certified to be medically unfit for such detoxifications were exempted. Two years of compulsory supervision for DRC releasees was also initiated at this time; however, compulsory urine testing was not added until January 1978.

The full attempt to bring the epidemic under control began in April 1977 under the title Operation Ferret. The strategy was to detect as many users as possible and commit them to the DRCs on the basis of positive urine specimens. A combination of police, Central Narcotics Bureau (CNB) and National Service (NS) * personnel were utilized. The most common operating procedure was the arrest of suspects at gatherings known to be frequented by heroin users. As seen in figure 2, commitments to DRCs jumped from about 100 to 700 per month. During the first nine months of Operation Ferret, 7,725 persons gave positive urine specimens, and this represented about 40 per cent of the suspects tested. Ninety-six per cent were using heroin; 96 per cent were male; and 90 per cent were below 30 years of age (Foo, 1978).

At about the time Operation Ferret was initiated the two clinics providing voluntary detoxification and other forms of treatment were closed. Private medical practitioners were also encouraged to refer drug users to the DRCs for voluntary commitment (Baey, 1979). The rationale for this move was the belief that relatively few voluntarily sought treatment, and that such methods were not effective and sometimes served as a haven for persons attempting to circumvent the anti-narcotics laws.

The rationale behind Operation Ferret was that heroin use was an entirely new phenomenon in Singapore, and was spreading in epidemic proportions through peer group initiation. It was reasoned that a rapid all-out effort to place a maximum number of users under detention would (1) slow the rate of contamination of non-users and (2) help arrest the behaviour in the young population already using before they developed into hard core addicts. Along with Operation Ferret, an intensive campaign was also launched to reduce the supply of heroin. However, these efforts were not immediately successful in increasing the price of street heroin, so primary reliance remained on controlling demand.

A by-product of Operation Ferret was an increased ability to estimate the extent of addiction and monitor the impact of the control measures. The combined data from the arrested suspects, the urine results and the drug registry provided the ratio of new to known users as well as the percentage of arrested known former users who had relapsed. From these data it was possible to estimate the trends in spread to new users, changes in relapse rates and changes in the size of the addict population (Foo, 1978). Using this approach, the heroin-using population in March 1977 was estimated to be 13,000.

*Persons temporarily employed in enforcement duties in lieu of military service requirements.

Figure 2

Quarterly admissions to Drug Rehabilitation Centres

Full size image: 16 kB, Figure 2

Along with Operation Ferret, a number of moves were made to educate the public on the issue of prevention, and to win support for the relatively drastic methods being employed to suppress the epidemic. One approach to the latter objective was to bring the private sector into the decision process by establishing a high-level advisory committee made up of government staff and private citizens (Advisory Committee on Treatment and Rehabilitation of Addicts). Other efforts along these lines included the establishment of a non-governmental review board to determine the time of release for DRC commitments, and a Visitors Board to monitor the DRC operations and handle grievances of committees. Finally the aid of the Singapore Anti-Narcotics Association (SANA) was enlisted to both provide counselling and help win public support for the programme. In addition to the usual arguments on the individual and social harms resulting from drug abuse, a particularly effective theme was the impact on manpower. Since Singapore is a city-state of only 2.3 million, its primary resource is the productivity of its labour force. With an estimated 13,000 active heroin addicts, the prevalence among males 15-24 was 3.1 per cent and for males 20-24, 3.6 per cent. Given this prevalence level, and the very rapid rate of increase, the heroin epidemic was perceived as a serious economic threat.

As Operation Ferret continued, the programme became increasingly strict. Weekly urine testing for supervisees was introduced in January 1978 and subsequently reduced to a five-day cycle. In January 1978 the average length of stay in the DRCs for first admissions was extended from 6 to 12 months with the possibility of 24 months. Relapses were typically retained more than 12 months. Persons relapsing two or more times were typically referred to court, and after the second conviction sentenced to three years in prison followed by another two years of supervision. In July 1978, supervision was made significantly more strict and transferred from the Ministry of Social Affairs to the Central Narcotics Bureau. Supervisees showing a positive urine were returned to the DRCs without exception. The only reversal in this trend of increasing penalties is the day-release programme initiated in September 1979. After six months in the DRC, first commitments may now be assigned to outside work during the day and permitted to stay at home on weekends.

The programme components

Arrests of users

On arrest, suspects provide a urine specimen and sign a bond to return for the results after seven days. The urine specimen is split into two samples, and if the analysis of the first is positive, the individual is typically committed to the DRC without further legal proceedings. If the results are challenged, the second sample is analyzed.

At the beginning of Operation Ferret, 43 per cent of suspects had positive urines. By 1978 this had dropped to 20-30 per cent and by June 1979, the percentage of positive urines was only 8 per cent. Some former heroin addicts are now substituting cannabis, barbiturates, tranquillizers and alcohol. At one point there was significant use of Rohypnol (containing flunitrazepam), but this subsided after it was placed on the list of controlled drugs. In an effort to control substitution of other drugs, some suspects with negative urines are now being sent to the DRCs for clinical observation. Suspicion of manipulating the urine specimen is another reason for such referrals. From February to April 1979, 19 per cent of the 1,091 commitments were made on grounds other than urine results. Also the Central Narcotics Bureau (CNB) has initiated computer monitoring of prescriptions in an effort to discourage excessive prescribing of psychotropic drugs.

As heroin suspects have become scarce, there is an increasing tendency for those with positive urines to be opium users. In the first nine months of Operation Ferret, only 3 per cent used opium compared to 35 per cent of those for the period January-April 1979. Part of this is due to heroin users switching to opium, but there has also been a recent tendency to arrest a higher percentage of older traditional opium users. During the first period only 3 per cent were over 40 years of age compared to 28 per cent for the latter period. Similarly, the Chinese, who were the traditional opium smokers, now constitute 78 per cent of those with positive urines compared to 49 per cent in the earlier period. Interestingly, the opium users now being detected almost all consume the drug by eating rather than the traditional smoking. Possible explanations are that eating is less observable, and is also considerably more efficient than smoking now that opium as well as heroin is very expensive.

While opium use comes under the same control as heroin and morphine, it was not the original intent to focus the control attempts on the older traditional opium users. However, some were inevitably caught in the net, and it was also administratively difficult to distinguish the two groups in the intermediate age range. Current guidelines provide that persons over 55 may be charged for possession of opium but not for simply a positive urine test. Those aged 50-55 with a positive test are typically fined, and persons over 50 are not subject to supervision.

Drug Rehabilitation Centres

While there have been some changes in the length of stay, the procedures and general philosophy of the DRCs have remained fairly constant since their initiation in 1976. Basically, the emphasis is on instilling discipline, social responsibility and sound work habits. Counselling and other therapeutic endeavours play a minimal role. All male commitments initially go to a reception centre for the first three months. During the first week detoxification is accomplished in locked cells and without supportive medication except for those over 55 or medically exempted. Public accounts of the programme have emphasized the "cold turkey" withdrawal which is seen as a deterrent to future relapse. In actuality, the term is more symbolic of the overall tough approach. Withdrawals are not typically severe, and many use various medications during the seven-day interval between arrest and the obtaining of urine results to reduce the impact of the centre withdrawal.

The second week is devoted to recuperation and orientation. During the third week the committee is subjected to intensive exhortations concerning the evils of drug use, the realities of life and their responsibility to society. The remainder of the three months is devoted to a military type programme aimed at inculcating discipline and physical development. Military drilling and calisthenics are the main activities.

At the end of three months, inmates are sent to one of four centres where they are employed 44 hours per week in industrial workshops (female commitments occupy a sixth centre). First offenders are segregated as well as those designated hard core addicts. One centre has a full-time study programme for those lacking a basic education. The work programme is aimed at instilling disciplined work habits rather than developing skills. The work involves mostly repetitive manufacturing tasks, and in many of the workshops the training and equipment are provided by outside firms. In some instances the individual may continue to work for these firms after release, but again, the primary intent is inculcating discipline rather than continuity of employment. The staff : inmate ratio is 1:10.

Religious counselling is provided on weekends and 85 per cent participate for an average of two hours per week. There is also limited counselling by Singapore Anti-Narcotics Association (SANA) personnel in the evenings as well as pre-release counselling. Visitors are restricted to close relatives.

Up to January 1978, the maximum stay in the DRCs was six months for almost all users, with about 10 per cent given earlier releases. Efforts were made to prevent discrimination on rehiring after release and, in a few instances, companies continued pay during the confinement. Commitment to the DRC is not counted as a criminal record. The length of stay in DRCs extended in January 1978 has substantially increased the time spent in workshops.

Inmates are reviewed by an outside board after three months, and at periodic intervals thereafter. A few older addicts and others involving exceptional circumstances are released after the initial review.

In September 1979, a day-release programme was established which provides outside employment at selected factory jobs during the day with return to DRCs at night. Transport is provided by the DRC and daily urine testing is employed. Participants are permitted to spend the weekends at home. Originally, only first offenders who had spent six months in the DRC were eligible; however, the programme has received strong support from the public, employers and the parents of addicts, and has now been extended to relapsed cases. Employment opportunities in Singapore are excellent, and the demand for employees has exceeded the availability. The two years of compulsory supervision are still required after discharge from the day-release programme.

The total number in the DRCs peaked at 3,900 in October 1977. The population dropped to about 2,800 in mid-1978 where it has remained because the extension in stay has offset the declining admissions. There are some 600 other heroin users in prison, about 400 of whom were sentenced under the mandatory three years for a second drug conviction (DRC commitments or returns do not count as a conviction). Finally, there are approximately 200 in the military drug centre.

Supervision

Since August 1976 some 10,400 supervision orders have been issued for DRC releasees. Only about 400 have absconded and not been apprehended-many of these are thought to have gone to Malaysia or other countries. As of April 1979, there were 5,641 on active supervision, 94 per cent of whom were male.

At the time of DRC release, the supervisee is instructed to report to the police station nearest his or her home on a five-day cycle for urine testing. The days of the month and time are specified-usually during the evening. In addition, the supervisee must allow the supervision officer to visit his or her home, must not change residence without approval, and must inform the officer of changes in employment. There are eight police centres monitoring supervisees. Urine collection procedures are highly routinized, and elaborate precautions are taken to avoid errors in labelling or other misidentification. As in the case of Operation Ferret arrests, the sample is split, and the supervisee places the two specimens into separate locked boxes. The second sample is stored for 21 days in case the results of the first analysis are challenged.

Excused absences from reporting are primarily limited to illness and overtime work. Medical certificates are required for illness and, if the employer is aware of their status, a letter is required confirming overtime work. Two unexcused absences in a three-month period result in the placement on a two-day reporting cycle for the next three months. Further reporting violations result in referral to court where the usual disposition is a $500 fine. * Violations of supervision regulations without evidence of drug use are not sufficient reason for return to the DRC. Unexcused absences or evidence of intoxication is often followed by home visits and surprise urine tests.

During the month of April 1979, 31 or 0.5 per cent of those on supervision were detected with positive urines from the regular reporting. However, an additional 145 supervisees (2.6 per cent) were detected with positive urines by Operation Ferret. While the five-day urine testing should detect any readdiction to opiates, the analysis screening level is such that use much more than 24 hours before the specimen is obtained is unlikely to result in a positive urine. Operation Ferret is now relying heavily on intelligence for apprehending users, including information on borderline negatives from the scheduled urine testings. About 35 per cent of current relapses show no clinical signs of withdrawal.

In addition to providing a urine specimen, National Service (NS) personnel counsel the supervisee for 5-10 minutes at each visit. These counsellors work one evening every 10 days and interview some 20 supervisees. Since the reporting interval is five days, each supervisee has two counsellors. At each centre there are four full-time CNB personnel who maintain the files and supervise the NS counsellors. The brief counselling session is directed primarily toward monitoring the individual's behaviour and providing warnings of the certainty with which relapse to drug use will be detected. At present counsellors are emphasizing that the prohibition on drug use applies to all drugs-not just narcotics. The counsellor also inquires as to any problems being experienced or the need for employment. About 90 per cent are classified as employed, although only 50 per cent have permanent jobs as opposed to irregular day labour. Any further counselling or employment needs are referred to the private Singapore Anti-Narcotics Association (SANA), which will be described in the following subsection. The NS personnel give warnings concerning appearance, the need for haircuts, etc., and note any evidence of intoxication. They are also instructed to seek intelligence on drug trafficking activities but these efforts have been largely unsuccessful. In March 1980, the NS supervisors were replaced by full-time CNB personnel.

Studies of relapses found substantially higher rates of relapse among those unemployed. As a result, in March 1980, the urine testing cycle was reduced to two days for those supervisees who were unemployed. Those reporting for one year who were regularly employed were changed to a 15-day reporting cycle for the second year.

*One Singapore dollar = $US 0.45.

SANA counselling

The Singapore Anti-Narcotics Association (SANA) was in existence prior to the current drug programme but was not utilized for counselling of DRC releasees until August 1977. Recruitment of volunteer counsellors was initially from religious groups, and later from trade unions, universities, teachers and community centres. Sixty-five per cent are retired (retirement age is 55). Ex-addicts are not used as counsellors, but are utilized for training and prevention lectures. Volunteers are screened for suitability as counsellors and 40 per cent rejected. Training consists of nine lectures over two months. Currently, about one-third of the total 5,600 supervisees are receiving SANA counselling. Most counsellors only have a single client and the overall mean number of clients per counsellor is 1.4. Releasees are referred to SANA by the formal supervisor, the DRCs, family and others. Eighty-five per cent report employment, and the highest success is achieved among those with a history of only casual drug use.

As mentioned earlier, another important role of SANA is to encourage acceptance of the drug control programme with the public, and to serve as watchdog against abuses. Since the control programme is exceptionally tough, it is considered preferable for public relations to be largely directed by a private as opposed to a government organization. SANA has a paid full-time staff of 50 and one third of the funding is from the Government and two thirds from the private sector.

Urine analysis

The urine analysis for the programme is conducted under the Ministry of Science and Technology, and is totally separated from enforcement. Elaborate precautions are taken to avoid labelling or other errors, and the procedures are designed to prevent false positives. From 1,200 to 1,500 analyses are performed per day at a cost of 1.20 Singapore dollars each. Urines are screened for morphine (heroin) by immunoassay techniques (cut-off level 300 ng/ml) and thin layer chromatography is used for confirmation. At present there is no testing for other drugs. About one-third of positive results are challenged and 10 per cent of these are reversed on the analysis of the second sample. This should not be interpreted as an indication of initial error rate, since it is primarily related to minor fluctuations above or below a high cut-off level. As mentioned earlier, lists are kept of borderline urine cases and this intelligence is supplied to the Central Narcotics Bureau at the rate of about 100 per month as an aid to apprehending suspected users for surprise urine tests.

Supply reduction

While the reduction of heroin availability was a major goal of the Central Narcotics Bureau (CNB) from the beginning, street prices remained at about 6 or 7 Singapore dollars for one-quarter straw (200 mg) of No. 3 heroin (35-40 per cent pure) until mid-1978. Leong (1977) estimates that a relatively new user smokes around 0.4 to 0.8 g per day, so the cost was about $20 per day or $600 per month compared to the minimum labourer's monthly wages of $250. More recently, new users are estimated to use no more than 0.2 g of No. 3 heroin.

Arrest rates for trafficking have been at a rate of 200-300 per year since 1977, and about 60 per cent are addicts. The death penalty was enacted in 1975 for trafficking in more than 15 g of pure heroin or 30 g of pure morphine, and five persons have been executed. Most persons arrested for trafficking are held in detention camps on an indefinite basis rather than being brought to trial. This strategy was adopted to expedite the incarceration of traffickers and avoid threats to witnesses. An early problem was users going into Malaysia and returning with small amounts of heroin. This was reduced in early 1978 by removing the passports of persons on supervision after release from the DRCs.

By mid-1978 intelligence sources had been developed to the point that traffickers were detected and arrested within a short time of beginning sales activities, and the result has been a rapid rise in prices. In June 1978, the price of pure heroin increased from the previously stable price of $0.09 per mg to $0.23. At the beginning of 1979 it had increased to $0.30 and, partly because of the drought and poor opium crop in Burma, it later rose to $2.00 per mg before falling to around $1.20 in July 1979. The long-term capability of CNB to control the availability of heroin in Singapore will not be known until the outside sources of supply return to normal. However, at the present time, heroin appears to be very scarce and beyond the economic means of many users.

Overall outcome of programme

As of April 1979 there were approximately 20,000 on the drug registry, of whom some 15,000 were classified as heroin users. Of these, 4,300 were in DRCs, prison or detention camps, and another 5,600 were on active supervision. The number of new heroin users being added to the registry was down to about 30 per month. As seen in figure 2, the rate of commitments to DRCs, including relapses, had dropped to less than 200 per month.

Table 1 shows the rate of relapse for DRC releasees over a period of approximately one year. If those transferred out of the programme, temporarily suspended, etc., are deleted, the relapse rate after one year is 37 per cent. This is substantially lower than the rate experienced by most heroin treatment programmes in the West. In particular, it is approximately one-half the one-year relapse rate observed for a compulsory programme in California employing similar supervision and urine testing subsequent to release (McGlothlin et al., 1977).

Table 1

Status of February-July 1978 DRC releasees as of April 1979

Status

Number

Per cent

Released
3 036 100
Transferred to military, temporarily suspended, died, etc.
244 8
Active supervision
1 752 58
Relapsed
1 040 34
Returned to DRC
828 27
1st conviction
86 3
2nd conviction (prison)
126 4

The programme has not yet achieved a level of success comparable to that of the Japanese, where a major post-war methamphetamine epidemic was virtually eliminated. However, it is clear that the Singapore heroin epidemic has been controlled. Should the present success in controlling the supply of heroin continue, heroin use can be expected to continue to decline. It would be unrealistic to expect that other drug usage will not at least partially replace the heroin problem. The Japanese success with methamphetamine control was closely followed by a heroin epidemic involving an estimated 50,000 persons at its peak; significant abuse of sedatives beginning around 1961; and a large outbreak of lacquer sniffing among juveniles around 1968 (Brill and Hirose, 1969). At the present time there is, again, a significant amount of intravenous amphetamine abuse in Japan. Statistical data are not available, but many of the former Singapore heroin addicts are thought to be substituting cannabis, barbiturates and tranquillizers to some extent. Should the psychotropic drug problem be considered sufficiently severe, it could likely be controlled by including them on the controlled drug list, as well as the urine screening for supervisees and Operation Ferret suspects.

Discussion

After at least one and one-half centuries of relatively permissive toleration of opiate use, the Singapore Government responded to a youthful heroin epidemic with an all-out enforcement strategy aimed at rapid containment. The foremost explanation appears to be the significant threat posed to the economic prosperity of the society. Young persons had not found opium smoking attractive for at least 20 years, and the sizable, but aging, opium-using population was generally regarded with indifference. On the other hand, the sudden heroin-smoking epidemic addicted over 3 per cent of the young male population within two years, and there was no assurance that the numbers affected might not rise to 6 or even 10 per cent. Meanwhile, Singapore was experiencing unprecedented economic growth and prosperity based on the productivity of an industrious and efficient society. Since Singapore is a city-state of 2.3 million, it is essentially dependent on the productivity of its fully-employed workforce. The threat of a sizable percentage of its young males becoming unproductive liabilities as a result of heroin addiction was considered a compelling argument for drastic action. Furthermore, the fact that heroin use was very new and spreading in an epidemic fashion through peer contact made the model of isolation and prevention of contamination of non-users an attractive approach. Finally, it was argued that through rapid and comprehensive compulsory rehabilitation, it would be possible to change the behaviour of those already affected before it resulted in hard-core addiction.

Two other factors were important in terms of the feasibility of the approach adopted. First, Singapore is a very small compact geographic area with a relatively homogeneous society. Each individual carries an identification number, and it is difficult to escape the surveillance of enforcement agencies. This helped make the system of signing a bond to return for urine results feasible, and is also responsible for the remarkably small number of absconders from supervision who remain undetected. The second factor contributing to the acceptability of the tough enforcement strategy was the pre-existing political climate. The present Government came into power in 1959, and is noted for having created one of the more closely regulated societies in South East Asia. This undoubtedly resulted in the heroin control policies being more acceptable than would have been the case in a larger, more heterogeneous and less regulated society.

In the programme to suppress the heroin epidemic, the Government adopted a clear and unequivocal position. As one official phrased it, "The message to the heroin user was either opt out of drugs or opt out of society". The medical approach to treating drug abuse was abandoned to the point of closing the existing facilities for voluntary detoxification and other forms of drug treatment, and adopting "cold turkey" withdrawal within the DRCs. Aside from the potential for the abuse of power over the individual, this approach carries with it some other possible counter-productive effects due to the lack of flexibility. It does not provide for drug dependence beyond the individual's control; the stigma of detention and the close contact with more deviant groups may be harmful to the youth who is only marginally involved in drug use; and the programme has undoubtedly resulted in overly severe sanctions against some older traditional opium smokers who did not pose a threat to society. Since the behaviour being suppressed is heroin smoking, there is also the issue of forcing usage into the more detrimental intravenous mode of administration. While this has been one of the results of suppressing opium smoking in some other Eastern countries (Westermeyer, 1976), the signs of injection marks would probably mitigate against this in Singapore as long as users are so closely monitored.

In summary, it was the purpose of this paper to describe the procedures employed to suppress the Singapore heroin epidemic, and the extent to which the objectives have been accomplished. It was not the intent to enter into a discussion, or take a position, with respect to the merits of enforcement versus other approaches to dealing with drug dependence. The threat to the Singapore society posed by the heroin epidemic was real and immediate, and it could probably not have been resolved as expeditiously by other methods. On the other hand, such an approach may be unacceptable or unworkable in other settings for a variety of reasons, including the political philosophy and the extent to which drug use is perceived as threatening the welfare of the society.

Acknowledgements

This paper is based on material collected by the author during a visit to Singapore in July 1979. Although conducted with the approval and co-operation of the Ministry of Home Affairs, the opinions expressed are the views of the author and do not necessarily reflect those of the Ministry. The author is especially indebted to Mr. Lum Choong Wah, Permanent Secretary, and Mr. Foo Chia Chow, Statistician, Ministry of Home Affairs, for their generous co-operation.

Bibliography

Baey, L. P. Drug abuse in Singapore-Rehabilitation strategy. Singapore Anti-Narcotics Association, March 1979. (Occasional Papers, No. 2.)

Brill, H., and T. Hirose. The rise and fall of a methamphetamine epidemic: Japan 1945-55. Seminars in Psychiatry. 1:2:179-194, 1969.

Foo, C. C. Use of law enforcement statistics in drug abuse assessment. Paper presented at the Colombo Plan Workshop on Reduction of Demand for Illicit Drugs in Southeast Asia, Penang, Malaysia, May 1978.

Leong, H. K. Drug dependence in Singapore: Present status. Proceedings of the Symposium on Our Environment, Institute of Natural Sciences, Nan Yang University, Singapore, October 1977.

Personal communication, July 1979.

McGlothlin, W. H., M. D. Anglin and B. D. Wilson. An evaluation of the California civil addict program. Washington, Government Printing Office (NIDA Services Research Monograph Series, DHEW Publication No. (ADM) 78-558), 1977.

Morimoto, K. The problem of abuse of amphetamines in Japan. Bulletin on Narcotics (United Nations publication), 9:3:8-12, 1957.

Nagahama, M. A review of drug abuse and counter measures in Japan since World War II. Bulletin on Narcotics (United Nations publication), 20:3:19-24, 1968.

Tinckler, L. F., and G. Baratham. Opium addiction and surgery. British Journal of Surgery (Bristol), 53:576, 1966.

Westermeyer, J. The pro-heroin effects of anti-opium laws in Asia. Archives of General Psychiatry (Chicago), 33:1135-1139, 1976.