Pharmacist’s take on war on drugs

President Duterte has famously said, “My God, I hate drugs.”

As a pharmacist, I couldn’t agree more. Pharmacists do take it literally because of the large number of drugs in the market that have to be memorized and studied, especially now that there is a continuous manufacture of new drugs.

To the layperson, a drug is a substance that can treat, cure, mitigate, or prevent diseases. An illegal drug is any substance that is prohibited by law because it is known to have psychoactive effects and addicting potential. Illegal drugs are not prescribed by a physician or bought from a drugstore; they are unlawfully sold in streets and other places with corresponding code names such as “shabu” for methamphetamine hydrochloride or “MJ,” “weed,” or “chongki” for marijuana.

Actually, many legal drugs are psychoactive and can cause addiction as well. These include the sedative-hypnotics, the antiseizure drugs, the anesthetics, and others that target the brain. These are dispensed legally by pharmacists in drugstores through the so-called “yellow prescription,” which a doctor can get from selected Department of Health distribution sites.

Republic Act No. 9165, or the Comprehensive Dangerous Drugs Act of 2002, was enacted to combat illegal drugs in the Philippines. The Dangerous Drugs Board (DDB) and the Philippine Drug Enforcement Agency (PDEA) are the two agencies mandated to enforce the law: The first is the policy-making and strategy-formulating body in the planning and formulation of policies and programs on drug prevention and control; the second is the implementing arm. Both agencies are under the supervision of the Office of the President.

Unfortunately, RA 9165 needs amending, to include the new psychoactive substances that can act like the dangerous drugs listed in the law. Drug syndicates cleverly circumvent the law by dealing in compounds that are not listed in RA 9165. Worse, they are combining these compounds with no known basis or studies.

A well-known illustrative case involved the open-air concert in Pasay City last May, in which five people were killed. It was said that they had ingested “Green Amore,” supposedly a combination of methamphetamine, methylenedioxy-methamphetamine (MDMA, also known as “ecstasy”), and Chinese Viagra (“Cialis”). In fact, the three substances can both enhance and antagonize each other’s effects. Methamphetamine and MDMA are similar compounds with only a slight variation in the chemical structure; they have the same effects and are both stimulants and vasoconstrictors, which means that together they can elevate blood pressure and provoke a heart attack. Viagra, which is used to treat erectile dysfunction (impotence) in men, has somehow slithered its way into the recreational drug pool as an add-on, supposedly to induce a sexual charge to ride that amphetamine high. Cialis, a milder version of Viagra, can cause the opposite—vasodilation—which can lead to a drop in blood pressure.

It is said that syndicates dealing in illegal drugs grind the three together using a mortar and pestle and then pulverize the mixture further with a blender, for final repacking into green capsules. Coupled with alcohol, which is a diuretic, this drug mash-up fast-tracks the human body into dehydration. Unfortunately, this cocktail of drugs is now available online.

Other illegal drug combinations are rampant and continue to be produced and upgraded. Some come in different forms, such as lollipops. Some are no longer injected or snorted, and instead are conveniently taken orally.

With the drug syndicates leveling up in the manufacturing process, so, too, must the government in order to stop them.

On the other hand, as suspected drug traffickers are gunned down and drug users surrender to authorities in increasing numbers, the question is what to do with the drug addicts. Presenting themselves to the police is not the end of the problem for them. They are still dependent on drugs, and this means they need treatment and rehabilitation—which can be costly, financially and otherwise, both for them and their families.

Treatment of serious drug addiction is never easy. There are those who cannot handle the effects of drug withdrawal and would choose to die than endure the pain.

There are 45 rehabilitation facilities in the Philippines; of these only 18 are government-run. There are also two private and one state-funded outpatient centers. The DDB describes as a “happy problem” the phenomenon of running out of rehab centers for drug dependents who have surrendered to authorities. Another emergent question is: Can the government support the administration’s war on drugs with measures to boost treatment and rehab facilities? Such rehab centers are supposed to be sanctuaries that promise a better life for drug dependents, and not places of misery marked by congestion and lack of treatment facilities.

Also, it may be strange to many, but some healthcare professionals such as doctors and pharmacists can be involved in the unlawful use or dispensation of dangerous drugs. A duly licensed doctor can prescribe a psychoactive drug to a drug dependent for nonmedical purposes. A pharmacist can dispense a drug even without a yellow prescription.

These are against the law. In such cases, the Philippine National Police or the PDEA should form a task force to go after unethical professionals in the healthcare field.

Teresa May B. Bandiola, 26, is an assistant professor at the National University’s College of Pharmacy and a graduate student at the University of Santo Tomas.