The New Role of Pharmacists To Eradicate Substance Abuse or Medicine by Prevention Program, Combating Drug Abuse and Illicit Circulation (P4GN in Indonesia)

Introduction

The behavior of the younger generation is now decreasing. This is because their future is gloomy by negative influences, such as drugs. Drugs are commonly called drugs (narcotics, psychotropic substances and addictive substances). Drug is a group of drugs that are effective in stimulating the central nervous system so that it’s able to calm the body in preventing disease if used in prescribed quantities. However, in large quantities, drugs can cause dependence on addicts. This is called drug abuse. Drug abuse is the using of one or several types of drugs regularly or regularly outside of medical indications, giving rise to physical, psychological and social dysfunction, said Azmiyati, 2014.

People who use drugs are caused by three factors : family, individuals, and access. A perfectionist family, having conflicts that are not completed, and lacking moral teaching causes pressure on individuals who are easily stressed. By stress, they can calm themselves down with negative things without being noticed by parents. Plus, they lacked socialization and education about the types of drugs and their effects. In external scope, Indonesia as a developing country is also a drug syndicate so that illicit substances can circulate freely on the market which makes it easier for them to access. The prevalence of drug trafficking in Indonesia reaches 5 million or 2.23% of the total population aged 10-59 years.

Therefore, there is a need for prevention efforts carried out by the government through the National Narcotics Agency (BNN) in collaboration with IAI (Indonesian Pharmacists Association). There are two ways that can be done starting in the family approach, such as education and rehabilitation. Education is carried out as a primary prevention effort, namely to people who have not or do not use it even do not know drugs. Meanwhile, rehabilitation is carried out as a secondary and tertiary prevention effort. Rehabilitation can work well if there is counseling and pharmacotherapy for drug users. In the medical world, drug users can be said to be "sick" so that they can be referred to as patients. Conditions that require pharmacotherapy in patients are therapy for intoxication / overdose to eliminate drugs from the body and therapy for drug withdrawal symptoms or to prevent the development of increasingly severe symptoms so that patients can be comfortable in stopping the drug.

Programs that are quite successful in carrying out these two methods are the Prevention Program, Combating Drug Abuse and Illicit Circulation or P4GN in Bahasa. The P4GN was formed by the National Narcotics Agency in 2011 to eradicate drug trafficking while returning addicts to activities that involved people's lives. And most importantly, pharmacist candidates have a role in training on drugs containing Narcotics, Psychotropics, addictive substances and their effects. For example, the training facilitated by BPOM as a briefing in knowing the legality of the drugs in circulation so that hoax information about drugs at pharmacies containing drugs can be responded wisely. If there are people who buy drugs with narcotics, pharmacists have a role in limiting access and reporting via the call center to the BNN. Pharmacists are also in charge of education about drugs and checking the originality of recipes because original and fake recipes are quite difficult to distinguish in this modern era. To ensure the authenticity of the prescription, pharmacists must confirm to the doctor as the prescription maker.

Do 21st century pharmacists have the necessary tools to bridge the gap between substance abusers and treatment ?

True, pharmacists will have a link between drug users who are said to be "sick" people with the care provided. Along with the time, pharmacists who previously only took prescriptions and dispensed drugs became a profession that was able to provide an understanding of the composition of drugs and drug dosages for patients based on disease and age due to the existence of "clinical pharmacy". Beside that, it is supported by technological developments that are able to make them able to meet face to face longer with patients than doctors through counseling so that patient care can be more intensive than before.

Prohibited patient users can experience overdoses and discontinuation of the drug so that a suitable pharmacotherapy is needed. By giving it, the drug composition and dosage of drugs especially drugs containing narcotics, psychotropic substances and addictive substances, can be targeted due to strict supervision of pharmacists based on their knowledge.

What strategies should be outlined to promote the rational use of drugs ?

WHO (World Health Organization) has advocated twelve keys in promoting rational drug use, including the establishment of a multidisciplinary national body to coordinate drug use regulations, use of clinical guidelines, development and use of national essential drug lists, establishment of regional and home drug and therapeutic committees ill, includes training on problem-based pharmacotherapy in undergraduate curricula, continuing medical education includes services as requirements for licensing, supervision, audit and feedback, the use of independent information about drugs, public education about drugs, avoiding financial incentives without reason, the use of appropriate regulations and strengthened, and sufficient government expenditure to ensure the availability of medicines and staff.⁸

Are pharmacists giving patients correct and rational advice on managing side effects and encouraging them to preserve with their medication ?

Of course. Pharmacists don't just refuse to check drugs that have arrived from distributors. Pharmacists also need to provide education on pharmacology or management to doctors and nurses in terms of the right drug dosage because the dose determining side effects for patient patients requires doctors not to have differences of opinion in giving drugs and pharmacists will not provide drugs available outside the therapeutic effect. Drugs given outside of these effects cause drug resistance to attack microorganisms or drug abuse if the medicine contains Narcotic, Phsycotropic, and Addictive Substance.

Examples that occur in Indonesia are antibiotics. Today's antibiotics can be sold freely by a doctor. For example, in the case of antibiotic resistance in tuberculolosis patients. "WHO data in 2012 recorded 450.000 patients with multidrug resistance tuberculosis (MDR Tb) who were newly identified in 92 countries," said the Chairperson of the National Pharmacy Committee (KFN), Drs. Purwadi, Apt.,⁹ In fact, antibiotics sold without a prescription will cause an effect on the patient's body in counteracting bacteria that are not on target in the sense of causing antibiotic resistance. Therefore, antibiotics must be given according to the level of bacteria that attacks the patient's body.

This is where the importance of an explanation of side drugs and the use of drugs which need to be spent and which do not need to be spent if the patient has recovered from the disease. The Chairperson of the Regional Management of the Indonesian Pharmacist Association (PD IAI) DIY, Wimbuh Dumadi, S.Si., Apt., seems to improve its role and increase its role together with the community and the community in order to provide informed consent.

How can the primary-care pharmacists support the early detection of substance abuse?

Even though it is not easy to recognize it, but someone with certain characteristics (high risk groups) has greater potential than those who do not have the characteristics of a high risk group.¹⁰ Pharmacists in primary care for substance users who are not familiar with the type and influence of drugs can support early detection through the patient's condition based on the influencing factors of substance abuse such as lack of religious knowledge, broken home families, children who smoke, lack of moral understanding, and always cover yourself from the surrounding environment. This is commonly detected in adolescence because of immature behavior and still needs guidance from parents as the primary educator before the teacher is in the school.

What is the role of pharmacy education and training in the future of rehabilitation the substance abuse victims?

According to KBBI (Kamus Besar Bahasa Indonesia in Bahasa), rehabilitation is recovery to the position (condition, good name) that was previously (originally); repairing disfigured limbs and so on individuals (eg hospital patients, disaster victims) in order to become human beings who are useful and have a place in society.¹¹ Therefore, education and training are the role of pharmacists in providing knowledge about the types of drugs, types, properties in the appropriate composition and the danger or side effects to the body if misused. Examples of activities that can be carried out to provide education are seminars and workshops which are social rehabilitation in the Therapeutic Community Program. The activity was carried out to facilitate substance abusers in undergoing recovery and were able to deal with problems.

What types of board certifications or training programs are available after graduation for pharmacists to specialize in rehabilitation program?

Indonesia does not have a specialist pharmacist. Therefore, Indonesia only relies on a pharmacist's professional certificate for all fields through simultaneous testing. In other countries that have specialist pharmacists, especially in the field of rehabilitation, there is a pharmacotherapy certificate or called BCPS, which is a certificate that is carried out after the test that deals directly with the patient's attention to medical research and drug information needed in the rehabilitation process.

Which are the most common substance use disorders and what novel insights are on the rise?

The most common substance abuse disorder is an anxiety disorder. Anxiety is a type of psychiatric disorder. Based on the experience of the Psychosomatic Clinical Psychiatrist Omni Hospitals, Alam Sutera Dr. Andre, SpKJ, FAPM, psychiatric disorders are divided into two, namely panic anxiety disorder and overall anxiety disorder.

Panic anxiety disorder occurs when patients experience severe panic due to fear of death, for example patients who are afraid of being injected, taken blood, palpitations, and sensations that cause the heart to pound strongly, tightly, and quickly, shortness of breath, cold sweat, nausea and vomiting. However, overall anxiety disorder is caused by an imbalance of the serotonin-dopamine system in the central nervous system because doses of substances (such as methamphetamine) that are not in accordance with prescriptions or drug abuse contain added heavy workloads and lack of physical activity to compensate.

The serotonin-dopamine system that changes the central nervous system arrangement results in sudden stimulation, especially in the cardiac circulatory system even though it has stopped consuming these substances because patients experience the discontinuation of the drug. The patient should be given a depressant drug that is able to normalize the central nervous system.

Image of Dopamine Pathway to Central Nervous System from : https://mediskus.com/dasar/fungsi-dopamin-efek-kekurangan-dan-kelebihan

In Indonesia, prohibited substances causing anxiety are easily accessible to the public. Knowledge about drugs is not only about drugs directly in the form of capsules, powders, tablets, liquids, or other forms. But also drugs in the form of snacks and mixed results with small foods such as sweets, pastries, and wet cakes that are often purchased by children. Therefore, system imbalances in the brain do not only occur in adults too, even now it has spread to children.

Image of the example from snacks which is contained NAPZA from : https://www.tangerangekspres.co.id/2018/02/27/permen-mengandung-narkoba-bnn-segera-cek-lapangan/

To provide information about the dangers of new types of drugs, many parents in Indonesia provide news through social media to remind each other to be careful when buying food outside of school.

What are the most abused/misused medications for illnesses and what measures should be taken to prevent misuse and abuse?

There are three types of drugs that are often misused to cure diseases, namely opioids which are prescribed as painkillers, depressants as tranquilizers for patients who experience anxiety and insomnia, and stimulants as a drug to overcome abnormalities cannot focus because of hyperactivity and obesity.

Image of Opioids from : https://www.healthline.com/health-news/opioids-problems-for-chronic-pain-patients 

Image of Depressants from : https://teens.drugabuse.gov/drug-facts/prescription-depressant-medications

Image of Stimulants from : https://www.recoveryunplugged.com/stimulant-abuse-the-unsung-addiction-epidemic-in-the-united-states/

These three types of drugs are commonly used as disease healers if used according to a doctor's prescription. The fact that happened, did drug abuse because he felt 'high' or addicted. Addiction can be done in a form that has been modified by the patient, for example by mixing alcohol and other drugs simultaneously for consumption. In addition, how to consume these drugs is widely misused, such as inhaled, injected in the form of liquid, chewing, which should only be consumed by swallowing so that the active ingredients of the drug can be slowly received by the body.

In addition, these drugs are used in high doses because of addiction. Not to alleviate the disease suffered by the patient, but can aggravate the situation such as overall anxiety with hallucinations, dizziness, nausea, numbness, stomach pain because stimulating the center of pleasure in the brain becomes a strong desire for the drug.

Finally, patients become more interested in abusing prescription drugs because many young people think that :

1.     Drugs used without prescription or copying from other recipes are not prohibited.

2.     Drugs that can be used by small children, meaning the drug is certainly safe.

3.     Drugs can be used easily because over-the-counter drugs can be used for old drugs at home or other people of the same type.

To prevent drug abuse, consult a doctor immediately if the drug is consumed by the patient according to the procedure but suspect that the patient is addicted and symptoms that lead to addiction occur. Doctors already know how to solve these problems without ignoring the patient's health effects. So, the doctor will change the recipe or cancel it.

In addition, if the doctor has prescribed medication for the patient, the patient must follow the instructions for using the appropriate dosage of the drug, do not receive medication from other people, do not give medication to other people, do not stop using the drug before the patient consults the development of the disease to the pharmacist beside the drug if mixed with other drugs or alcohol from the pharmacist directly, be careful with the effect of the drug if it has indicated the symptoms of addiction to the patient, and if ever misuse the drug can be consulted with the same doctor with the doctor before the patient is prescribed medication.

Conclusion

Abuse of substances or drugs can be overcome if there is a pharmacist who handles the rehabilitation sector considering the large number of drug users or substance abusers so that communication in the form of informed consent is needed after prescribing medicines by doctors, consultation about the progress of the disease or symptoms felt by the patient concerned, and provide education on post-rehabilitation drugs to make substance abusers aware of 'ill' not to abuse substances. When the P4GN program takes effect, pharmacists in the 21st century must contribute to education, especially regarding pharmacology and pharmacotherapy which are included in the field of clinical pharmacy and training in rehabilitating substance abusers. Beside that, pharmacists can deal with false news about drugs that are considered to contain drugs. By this way, Indonesia will produce healthy young people without being addicted to drugs or substances.

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