'Narkoba-like': The Trending Abused of Poli-prescription Drugs among Youth in Contemporary Indonesia

Transcription

1 'Narkoba-like': The Trending Abused of Poli-prescription Drugs among Youth in Contemporary Indonesia Nurul Ilmi Idrus Hasanuddin University Introduction Indonesia: one in Asia which has a long history of drug use. BNN and Puslitkes-UI 2011: The prevalence of drug abuser: 1.9%(2008) 2.2% (2011). In 2008 estimation 3.3 million drug users in Indonesia: one-third: experimental users' two-third: regular users another one-third: addictive. # of experimental users: 850,000 (2008) to 1,150,000 (2011). Projected: 2,8% in The target to make Indonesia 'free from narkoba in 2015 day'. 'a dream in the middle of the Drug use in Indonesia has long been dominated by cannabis (ganja) In the latter half of the 1990 increase in heroin (putaw) use. Amphetamine-type stimulants the most used illicit drugs, taking prescription psychoactive drugs have become more common. These are some of the NEWS

2 Related News Local Newspaper Makassar National Magazine Online News Yogyakarta

3 Research Methods Settings: Makassar & Yogyakarta (destination for studying in the East & West) Informant &recruitment: Informants: Drug users, Puskesma & BNN staff, NGO activist, outreach workers, police. Recruitment: NGO Data collection methods: Interview (HTT) desensitizing the topic & grand tour Chemical Product Probing (CPP) Focus Group Discussion (FGD) Analisys: Nvivo-10 program Identifying themes in the transcripts. Thematik: coba-coba, cocok, campur, enak or bagus, heppi/senang, mabuk, sakaw and creating coding scheme. Iterative: Focused questions based on the transcripts. Ethics: ethical approval (UvA, Unhas, UGM, Provinsi), benefit & risk, recording, confidential, all names are pseudonym. Drug Using Career Most of our informants started their drug using carrier at their teens: smoking alcohol drinks & pills. Late teen: smoking marijuana (ganja) ecstacy (inex), Methamphetamine (shabu-shabu) Heroin (putaw). The transition NOT a linear process. Experimenting (coba-coba) regular user (teratur pakai) addictive (kecanduan). Some drug users initially influence by members of their family, most affect by their peers. Some of our informant begun using narcotics, others with psycho-active prescription drugs. Some has drug injecting experience others hasn't.

4 Some already involve in methadone programs to recover, others relapsed and just use methadone as another option of substance to get high for free. Experimenting drugs: Coba, Cocok, Candu In the last few years, putaw has become less popular among drug users: WHY? Though the circulation is not limited, the authorities' control and the market are stricter, difficult to obtain (langka) and the price is mounting. They correlate putaw with the potential risk of infectious disease (e.g. Hepatitis, HIV, or even death). A survey conducted in big cities in Indonesia: TOP illicit drugs marijuana (64%) shabu-shabu, (38%) ecstasy (18%) putaw (13%) # of IDU: 230,000 (2008) to 70,000 (2011), WHY? According to BNN and Puslitkes-UI (2011): Less supply of heroin from Afghanistan. The existing Subutex/Suboxon and methadone substitution programs. The increase of death rate among IDU because of over dosage and HIV & AIDS. Creativity The scarcity of narcotics, such as putaw or shabu-shabu creativity (producers & drug users). Producers: mixing up putaw or shabu-shabu with other substances to reproduce more quantity and profits the quality is poorer, the price is more expensive. Drug users: to consume alternative drugs (i.e. psychoactive prescription drugs) to get high because the high effect of putaw is lessened (tidak nutup). Most popular PPD in two sites In Makassar: Somadril, Subutex, Subuxon, Calmlet, Tramadol drug users Dextro low class drugs

5 In Yogyakarta: Calmlet and Reclona among narkoba users. Dextro, trihex, Tramadol, Kode-15, Codeine non-narkoba users. Both sites: Calmlet Trihex is less popular than Kode-15 or Codeine because of its side effects (e.g. itchy and dry throat). They have to take high dosage (ranging between 20 to 50 tablets each) to get high with dextro and is not tasty (tidak enak). WHY use/turn to prescription drugs? They is relatively safe (particularly when they have controlled card) or at least less dangerous, cheaper and easier to get than illicit drugs because they believe that prescription drugs are not narcotics and addictive substance (narkoba) and they are abusive drugs instead, and therefore they are not addictive. They think they are not drug users, and the police has no basis to further proceed the case when they are caught of having popular abusive prescription drugs, such as Tramadol, Somadril, Dextro, THD, etc. They can be released after advising them not to take such kind of drugs in the future. Prescription drugs are easy to get using 'floating prescription', from 'naughty pharmacies', drug dealers (bandar), panders (calo, the extension of pharmacies and drug stores), online shop (e.g. jualreclona.blogspot.com; medismaya.blogspot.com) which play a significant role in this 'narkoba-like' business. The dynamic of Experimenting Experimenting prescription drugs for high NOT a new phenomenon, but the experimentation is so dynamic: to try a new one to substitute a drug that is difficult to obtain (susah didapat) or lost from the market (hilang dari pasaran) to find what is suitable (cocok) to get the best for their individual body

6 The dynamic varies: the kinds of drugs they use the dosage the mixture how they do it, the effect they experience. They feel cocok to certain drugs when there has no side effect and when they find the most expected effect. Their creativity is inspired by their peers (inspirasi anak-anak) on the dosage, how they administer, and the availability of money; the trend of drugs changes over time (inspirasi zaman). Tabel 2. The Most Popular Prescription Drugs, Their Functions, and Potential Harm Name of Drugs Content Function Over Dosage Potential Harm Somadril Carisoprodol Pain Killer Respiratory depression, seisures, hypotension, central nervous system disorder, death Calmlet Alprazolam Tranquilizer Parkinson Subutex Subuxon Buprenorphine hydrochloride Buprenorphine and Nalaxon Tranquilizer, to treat opioid addiction Tranquilizer, to treat opioid addiction Tramadol Tramadol hydrochloride Narcotic like pain reliever Trihexypenidyl Artane Anti parkinsonian Reclona Clonazepam Nervous system depressant Triple X Tranquilizer Brain damage, seizure, death Codein Codein in a singleingredient drug and in combination preparations with Pain and cough reliever Anaphylaxis, seizure, acute pancreatitis, and respiratory depression

7 paracetamol, aspirin, or ibuprofen Dextromethorpan Dextromethorpan Cough suppressant and expectorant Kode-15 Dextromethorpan HBr Cough suppressant and expectorant Central nervous system disorder Central nervous system disorder Tabel 3. Prescription Drugs and The Dosage No. Name of Drugs Dosage/each 1. Calmlet Reclona Somadril Subuxon ¼ Subutex Dextrometorphan Trihexipenidyl Tramadol Kode Codeine Dextro plus Mixing Yayan (18, Yogyakarta), who previously used to use marijuana (ganja) and heroin (putaw), did lots of mixing (oplosan). Prescription drugs, such as dextro, trihex, and yolam, are perceived as illusion drug (obat ilusi). The various mixing: Two different brands of cough tablets (dextro & Kode-15) to speed the effect (lebih cepat naiknya) and to get longer effect (lama ilusinya) miss-oriented and acts like a robot. Combining between 20 tablets of Kode-15 and 10 tablets of trihex sleepy

8 Tramadol, Calmlet & local traditional drink (ciu) and he had blood cough and blood vomiting. Combining 10 tablets of double-h, 20 trihex, 2 tablets Kode-15 and 20 tablets dextro unconscious. The combination of ciu (local drink), spirtus (methylated) and 70% of alcohol very high (mabuk berat). The Challenge to 'clean' 'Cleaning' themselves from drugs is a challenging process. Some has strong commitment to 'clean' themselves, considering that they get tired with putaw because the dosage is getting high over time, it costs lots of money and tend to get involved in criminal, others' involvement is just to get high for free BUT the boundary between the two is blurred. They said that putaw users can be recuperated (pulih), but they will never be fully recovered (sembuh), as they can relapse any time, including when they are attached to methadone program. Their suggestion (suges) lead them to perceive that they are not able to handle their (sakaw). Every time their suges emerges, and every time they do not get one or the other drug, and every time they want more and more 'beneficial effects' on the drugs, their creativity comes out. Conflicting Policies Each related institution (e.g. BNN and KPAN) has its own approach on how to deal with drug users and drug abuse. BNN intends to stop them using drugs immediately without intervening process. National AIDS Commission (KPAN) through health centers (Puskesmas) with Methadone therapy program (PTRM), provided with maintenance therapy by continuously supplying methadone with appropriate dosage to prevent them from withdrawl (sakaw). NGO commonly works hand-in-hand with Puskesmas in mentoring the drug users.

9 The conflicting approach between BNN and KPAN has created a significant problem. Puskesmas staff & an outreach worker : Instantaneous terminating approach of BNN, in many cases, did not work out, instead they can easily be relapsed (rileps). Methadone therapy is the bridging program to lessen the drug users' addiction to putaw. Even though drug users are those who are 'self-governing agent' (Connor 1991), they are not the only ones to blame when they suffer as a result of their risky behaviour because there are many institutions involved & responsible to the problem. Harm reduction program only focuses on the putaw injecting users, as this has become one of the significant source of HIV transmission. The problem, however, has become more complex because of the use of prescription drugs becomes more common. Thus, in dealing with drug users' problem, it is not enough to just focus on how to stop needle sharing and HIV and AIDS, we also need to look at in a broader context because there is narkoba-like in the prescription drug.