In 2007, Yan-Lung Wong, Secretary for Justice at the time, and also Deputy Chairman of the Fight Crime Committee (FCC), was appointed to lead a high level inter-departmental task force to tackle drug abuse in youths.

Since then, the government has rolled out numerous campaigns to foster a drug-free environment, including the controversial compulsory drug testing scheme and a territory-wide campaign proclaiming the theme “Stand Firm! Knock Drugs Out.”

Despite these efforts, Dr Dicky Wai-Sau Chung, who has more than 20 years of experience treating psychiatric patients in public hospitals, said that drug abuse remains an issue requiring attention, and that it is dangerous to foster an illusion that drug abuse is well under control.

Seasonal factors such as flu outbreaks aside, Chung pointed out that public hospital occupancy rates have occasionally surged from 75 percent, the base maintenance level, to 80 percent or even more than 100 percent during peak periods in the last 1–2 years. The proportion of patients admitted to hospitals due to a past history of substance abuse has also increased from approximately 15 percent 5 years ago to 20–30 percent currently.

In this exclusive interview, Chung shared with MIMS some deeper insights into doctors’ frustrations and challenges in treating drug abusers with psychiatric symptoms, and provided his perspectives on what can be done to win this long-term battle.

Seeing patients again and again due to drug reinstatement

“According to our observations, the number of psychiatric patients who take ketamine has decreased, but the use of methamphetamine [commonly known as ‘Ice’] has increased significantly in recent years. We saw a similar situation in Taiwan when we attended international medical conferences,” Chung said.

This coincides with data from the Census and Statistics Department, which showed that methamphetamine surpassed ketamine as the most popular type of psychotropic substance abused in 2015. “Indeed, some patients have told me they intermittently went to mainland China to take methamphetamine there,” Chung recalled.

“It is not possible to force them to stay in the hospital once they stop displaying psychotic symptoms. We can only provide them with appropriate treatment when they are admitted to hospital again due to a relapse, after ignoring our advice,” he admitted.

For those who refuse to take anti-psychotic medications and have records of violent behaviour and persistent psychotic symptoms after taking methamphetamine, Chung insists on giving them depot injection. This is to ensure the medications are released to cover a longer period of time after discharge from hospital.

When even their families give up on them, what else can doctors do?

While it is known that abuse of psychotropic substances can cause severe mental illnesses, not all drug abusers suffer from harmful effects to the same extent, due to genetic predisposition.

“To highlight any possibility of certain patients being more prone to certain psychotic symptoms, I would first question the reason why they suffer more serious consequences than their peers,” Chung described.

“It is always easier for me to explain the situation if they know of others who have suffered similar psychosis before. Otherwise, without an explicit proof such as an X-ray or a blood test result, patients are capable of coming up with all sorts of excuses to avoid the question,” he added.

However, even though these patients are sufficiently motivated to quit drugs initially, Chung commented that it is extremely difficult for them to stay away if they lack emotional support from their family members.

“Some of their family members have given up on them, refusing to live with them and asking us to keep them in the hospital instead,” said Chung. “Without help from their families, it is difficult for us to provide timely support to the patients whenever they experience negative emotions, triggering a return to non-savoury companions and subsequently drug reinstatement,” he explained.

Looking at the bigger picture, and a bigger mission

It is difficult for doctors to hide their frustration when they see patients repeatedly entering and exiting hospitals despite tremendous efforts spent persuading them to stay away from drugs.

“Some young doctors have shared with me their frustrations after already trying their best. For example, they arrange suitable rehabilitation centres for the patients and ‘beg’ them to stay there, yet many of these patients would relapse upon returning to their original settings,” said Chung.

“As compared to treating other patients, some doctors may lose passion in treating drug abusers, ascribing the psychotic illness instead to personal choice after many disappointments,” he continued.

Being the chief of psychiatry at Tai Po Hospital, Chung is also responsible for training junior doctors in the department. Hence, he understands this frustration. His advice is to look at the bigger picture.

“We usually only see patients with more critical and complicated conditions here in the hospital setting. But in fact, there are many more drug abusers out there currently struggling with the early stages of psychotic illness, managed by outpatient clinics and NGOs – let’s not forget these,” Chung explained.

Currently, substance abuse clinics run by the seven service clusters of the Hospital Authority are allocated a very limited budget, which is said to be barely enough to look after the most complex of these cases. Instead of solely treating the more severe patients, Chung suggests the government to allocate more resources to reach out to those drug abusers with mild symptoms of mental illnesses who are not known to any psychiatric clinics as yet.

Previously, Chung joined the UROK (yoU aRe OK) Clinic at North District Hospital, formed by a team of staff volunteers who wanted to encourage young people to quit drugs. Partnering with outreach workers, they conducted health checks for these youngsters during off-duty hours. A questionnaire was used to find out the mental states of these young abusers, but at the same time avoid implying any stigma, Chung said.

“The proportion of young drug abusers with possible mental illnesses was higher than what we expected. Instead of one in 10 participants, at least three to four participants in 10 assessments were found to have a possible mental illness,” said Chung.

When asked if this mission may be too challenging to doctors, whose primary role is to treat patients, his answer is firm and determined.

“Yes, I admit it’s difficult. But being a doctor doesn’t mean I can neglect what’s happening in the society. I’m not saying we are trying to tackle every drug abuse related issues, but without a well-organized long-term care plan, patients will just spend their lives in and out of hospitals, deteriorating with each cycle and further losing motivation to stay clean,” he said.

“This will continue until their health is irreversibly damaged, whereupon finding patients who can get back on the right track and turn over a new leaf will be impossible – and this would be a sad day,” he continued. MIMS

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