Barriers to Treatment are Pushing People to Purchase Drugs Like Dumolid Online

What would you do if you couldn't sleep? For Gerry, a video game designer from Yogyakarta, the answer was "almost anything." Gerry would sit up most nights, struggling with an insomnia that would leave him exhausted but awake. Some nights he would toss and turn until dawn. Other nights he would finally fall asleep, only to wake a few hours later.

Gerry knew he needed help. But instead of turning to a doctor, who would demand multiple visits and charge a small fortune, Gerry did what many Indonesians do when they need cheaper medicine—he went on Instagram.

"Back then I didn't have BPJS [government health insurance], and the insurance from work didn't cover psychiatric treatment," Gerry, who asked to use a pseudonym in this story, told VICE. "From what I heard, a psychiatric session can cost so much. So I chose to get those meds without prescription."

Sleeping pills are hot news in Indonesia right now. Tora Sudiro, one of the country's top celebrities, is facing five years behind bars for the illegal possession of Dumolid, a benzodiazepine commonly used to treat insomnia and anxiety, without a prescription. His wife, fellow celebrity Mieke Amalia, has been ordered to attend rehab for using the same medication.

The South Jakarta Police discovered 30 Dumolid pills during a raid of the couple's South Tangerang home. It's unknown why police were raiding the celebrity's home in the first place, but it was the most-recent in a series of drug busts targeting film and television stars.

"They claimed to take the drugs when they had insomnia," Comr. Vivick Tjangkung, the chief of the South Jakarta Police narcotics unit, told local media. "They also said they did not know that it was [a drug]. All they knew was they took it to help them sleep so they could go to work the next day."

The problem here, police said, was that neither Tora nor his wife Mieke had the required prescription for the medication. Dumolid, like many other benzodiazepines, is commonly abused as a recreational drug—it's quick-acting and leaves users in a relaxed state.

But the arrests and conversation around Dumolid got us thinking. How hard would it be for an average person—not a celebrity—legitimately suffering from insomnia or anxiety to be legally prescribed the drug in the first place?

Indonesia lists all benzodiazepines, including Dumolid, Valium, and Riklona, as category IV psychotropic drugs under its anti-drug laws. But the country's drug laws and medical culture also work together to create a system where benzodiazepines are more easily available online—sold as everything from sleep aids to illegal party drugs like "Happy Five"—than they are at the doctor's office.

Why? Here's what it would take to get legally prescribed medicine for insomnia or anxiety. A person needs to first see a trained psychiatrist and undergo several rounds of therapy and suggested lifestyle changes before doctors prescribe anything. These visits can cost in excess of Rp 500,000 ($37 USD) per session, no small amount in a country where the Gross Domestic Product per-capita is only Rp 47.5 million, or $3,570 USD, per year. Some health insurance covers psychiatric care, but others don't and more than half of all Indonesians don't have health insurance at all.

Once you get prescribed the medication, many doctors, fearful of abuse and addiction, only prescribe just enough to require you to keep coming back for new therapy sessions and new prescriptions.

"Even if you suffer from insomnia, you can't just purchase those meds," Danardi, a psychiatrist at Premier Hospital Jatinegara, in East Jakarta, told VICE. "It's not the solution. Meds would be the last resort if therapy no longer worked. And we will prescribe a small dose first, and under our supervision. Otherwise, it could get out of control and the patient can end up addicted."

These costs alone can deter many from seeing a doctor in the first place. Then there's the stigma associated with mental illness in Indonesia. A person suffering from anxiety or insomnia would first need to visit the local health clinic, or Puskesmas, before being referred up to a hospital or specialist. This process can take weeks and require multiple examinations by medical professionals—a costly and, for some, embarrassing path to treatment.

Meanwhile, the same medications are available on Instagram for as little as Rp 220,000 ($16.50 USD), according to reports in the local media. But, to do so, would be both illegal and dangerous, said Dr. Mahesa Paranadipa, the head of the Indonesian Doctors Association (IDI).

"Doctors prescribe meds for a certain period of time," Mahesa told VICE. "If you decide to purchase just the meds because you don't feel like going back to see your psychiatrist, it will harm you."

But so will getting no treatment at all. It leaves a lot of Indonesians with a difficult choice: pay for the right treatment, break the law, or do nothing. Gerry was too exhausted to continue doing nothing about his insomnia. But his medication was also too dangerous to keep taking without a doctor's oversight.

"I slept really well during the first couples of months I took those pills," Gerry told VICE. "But later, I found myself needing a larger dose. Once I stopped, there was some kind of withdrawal. The side effects of sedatives apparently sucked more [than not being able to sleep]."

Today, Gerry takes a different approach. He doesn't drink caffeine or alcohol and he regularly takes herbal sleep aids to help control his insomnia. The prescription sedatives were too much risk. They required larger, and larger doses to work, and when he ran out the withdrawals were worse than the insomnia. He would rather take a more natural approach. But, even with BPJS, he's still doing it alone.

"I don't want to exaggerate, but I feel a lot healthier without those drugs," he said. "I think I was a little bit depressed when taking that medication. I still care about my life and my future."