PROTECTION OF PUBLIC HEALTH AGAINST ONLINE DRUG AND FOOD CIRCULATION

PROTECTION OF PUBLIC HEALTH AGAINST ONLINE DRUG AND

FOOD CIRCULATION

Introduction

In the current era of globalization, the development of information and communication

technology has made people unable to escape the use of communication devices and the

internet. The development of the use of internet media as a means of communication became

increasingly rapid after the internet began to be accessible through cellular telephones and

even later the term smartphone appeared. With the presence of smartphones, the facilities

provided in communication are increasingly diverse, ranging from short message service

(SMS), Multimedia Messaging Service (MMS), chat, e-mail, browsing, and social media

facilities (Setiadi, 2016). Even the internet with social media facilities has become the main

communication tool used by people in their daily lives.

As a networking site, social media has an important role in marketing a product. This is

because social media can play a role as a communication medium in the community. The

advantage of social media services is that it provides a two-way communication space

between consumers-companies and consumers-consumers. This two-way communication

enables consumers to participate, collaborate, and communicate interact, which in essence

consumers are no longer objects but subjects of marketing (Setiadi, 2016).

Use of media in (online) is currently effective in reaching the the public with faster access,

anytime, anywhere, and by anyone. This effectiveness greatly facilitates the community along

with the high level of mobility of people who need everything immediately. On the other

hand, business people need effective marketing media with the aim of expanding their market

share (Puspitarini & Nuraeni, 2019: 72). For business people, the existence of social media is

the easiest and cheapest marketing media. Therefore, it is natural that social media is used as a

mainstay promotional media supported by a company website or blog that can display a

complete company profile. In fact, it is not uncommon for business actors to only have social

media without a website or blog, but are still active in the competition Business.

Social media is actually a medium for socialization and interaction, as well as attracting others

to view and visit links that contain information about products and others (Seti- adi, 2016).

Social media is equally let, both by businesses and consumers. People tend to seek

information and communicate through social media with businesses because of the

convenience, speed, and accessibility offered by the internet. Likewise, businesses are

utilizing this trend as a medium to promote and communicate with consumers.

People tend to use social media to communicate and get the information they need. However,

it cannot be denied that there are other purposes in using social media. In addition to social

purposes, the use of social media can also be used for economic purposes where people use

social media to promote and conduct buying and selling activities, including buying and

selling drugs and food. It is often found that business actors sell medicinal products and food

through Facebook, Instagram, WhatsApp, and other media.

In addition to social media, the rise of e-commerce platforms in the digi- tal world has

influenced people's lifestyles, which have begun to shift from shopping directly at retail stores

or conventional styles to online shopping through marketplaces. According to Similiarweb

cited in the 2019 Annual Report of the Ministry of Communications and Information

Technology, marketplaces that are frequently visited by United Statess include: Shopee,

Tokopedia, Bukalapak, OLX, and Lazada (Ministry of Communication and Information,

2020).

According to the Indo- nesia E-Commerce Association (iDea), in 2012 there were nine e-

commerce platforms, namely: Blibli.com, Tokopedia, OLX, Grazera, Bhinneka.com,

Berniaga.com, Multiply, Blanja.com, and Kaskus. However, by 2020, there are 230 e-

commerce members in United States (RDPU Commission IX, 2020). Almost all products that

consumers are looking for are available on various e-commerce platforms ranging from daily

needs to gold investment. It is not uncommon for one seller account to have multiple sales

accounts on these various platforms with different account names. Seller accounts also come

from various industry scales including Micro, Small and Medium Enterprises (MSMEs) and

individuals.

The Ministry of Communication and Information's program to move MSMEs Go Online has

made the digital economy part of United States future. United States is predicted to have a

high potential value of the digital economy. This potential must be utilized by growing digital

entrepreneurship. With around 60 million, MSMEs are one of the country's backbones to

improve the national economy.

Digital technology has entered into all aspects of people's lives, starting from the aspect of

purchasing everyday products, transportation, banking transactions, delivery services, bill

payments, and more. The involvement of MSMEs in online market platforms in United States

is still very low where it is estimated that only 7.7% have joined online-based advice

platforms. This has an impact on the small sales of MSMEs on online market platforms,

which is only about 5% of the total products sold from MSMEs (Ministry of Communication

and Information, 2020).

The government is aware of the transition to a digital economy and is responding to this

digital era by developing the MSME sector. In addition to encouraging the MSME sector, of

course, various product ring circulations require a broader role of the government as a

regulator and supervisor so that the public is protected.

In addition, the Covid-19 pandemic has made the government implement the Large-Scale

Social Restriction (PSBB) policy where all activities are carried out from home, including

learning activities, work, and even worship. This has increased the use of the internet. People

have become lazy to do activities outside the home, including being reluctant to visit health

service facilities to check their health conditions due to concerns about contracting Covid-19.

Fortunately, the public is facilitated by the existence of online medical consulting service

applications through their respective cellular phones, for example: Halodoc services,

Alodokter, Grab Health, and others. Not only consulting with medical personnel, patients can

also obtain prescriptions and referral letters to advanced health care facilities. This

convenience can benefit patients and the community, such as being safer in medical

consultations, flexible time, no need to queue, competitive offers, speed, easy access anytime

and anywhere, and allowing patient confidentiality.

According to data from the United States Telemedicine Association (Atensi) in the public

hearing of Commission IX on 24 September 2020, there are around 29 electronic health

service providers that have involved 60 thousand doctors who serve 5 million people to get

health information. The large involvement of medical personnel in the online health service

system is an invaluable resource in supporting the improvement of public health status.

On a global scale, the increase in e-commerce, coupled with the rise of digital health

offerings, direct patient care, globalization of pharmaceutical production and distribution, has

resulted in a global increase of 35,000 online pharmacies (Mackey & Nayyar, 2016: 116).

Pharmaceutical industry players, including manufacturers, distributors, and pharmaceutical

facilities in hospitals and pharmacies, may, in addition to selling their products

conventionally, also serve their products online through their websites or social media

accounts. This becomes legal when following the requirements as well as the requirements,

licensing, and other provisions in the laws and regulations, both for the licensing of

pharmaceutical service facilities and the distribution license of the products offered.

Online is just an alternative to conventional promotion and sales activities. However, this

becomes illegal if the online sales insti- tution or actor does not have a business license, does

not meet the requirements of certification, licensing, registra- si, and other requirements in

accordance with laws and regulations. The products offered also do not meet the provisions of

distribution permits, safety, efficacy/benefit and quality requirements, illegal, counterfeit,

expired, prohibited, and other products.

According to Qona'ah and Afianto (2020: 46), illegal drugs are drugs with a distribution

license counterfeit and do not have a registry number; drugs whose content does not match the

writing on the packaging; drugs whose standards do not match the claims; counterfeit drugs;

misuse of drugs; drugs that have expired and are being resold; imported drugs that enter

illegally because they do not coordinate with BPOM and do not have United States language;

and traditional drugs that contain chemical ingredients. Based on this quote, illegal drugs

circulating online have been identified as various types.

However, beyond the element of intent and the imposition of legal sanctions, there are still

many people who do not understand the various illegal drugs circulating online. They become

consumers of illegal drugs because they are used to using them or are influenced by

advertisements, promotions, and testimonials from other users. People also often do not

realize that transaction data will be recorded and will become strong evidence in government

monitoring.

In 2020, BPOM has released the results of achievements and findings of violations during

2019. The most common violation found was the massive distribution of drugs and food

through online. Many drugs and foods traded online have not received a BPOM distribution

permit, so they have not been tested for safety.

There is an opportunity to counterfeit hard drugs by adding harmful chemicals, such as male

sta- mina enhancing drugs. Consumers may not feel the adverse effects directly, only feel the

strength, but the adverse effects on the body will be felt in the near and long term.

Another type of drug commonly traded online and illegally is misoprostol, which is often

misused as an illegal abortion drug. The drug freely available on online trading sites. These

drugs are included in drugs that require a doctor's prescription to obtain (Sulaiman, 2019).

Indeed, the use of hard drugs without a doctor's prescription risks harming patients because

there is no supervision from doctors and pharmacists in the use and storage of these drugs.

The weak health status of patients and communities means that patients and communities are

unable to make their own decisions on the use of hard drugs. The possibility of misuse, over-

dosage, contraindications, and the occurrence of drug side effects on the body can harm the

community and worsen health conditions.

The online circulation of drugs and food carries the risk of certain drugs that are often abused

and illegal products that are detrimental to public health. On the other hand, policies to control

the online circulation of drugs and food are still scattered in various laws and regulations. One

of them is issued by BPOM through BPOM Regulation Number 8 of 2020 concerning the

Supervision of Drugs and Food Circulated Online.

In public policy theory, there are various actors involved in the imple- mentation of public

policy, namely: the bureaucracy, the private sector, and community participation. Based on

the background description above, this paper aims to examine the role of the government, the

involvement of the private sector, and public participation in monitoring the online circulation

of drugs and food as a form of protection of public health.

The method used in writing this article is a qualitative approach with descriptive analysis

method. The data collection technique is done by literature study. Data and information are

collected from various related litera- tur such as books, journals, relevant laws and

regulations, documents, and other relevant documents government, news in the mass media

both print and electronic, and others. Data and information were combined and analyzed

based on the groups of information. In the last stage, the results of the analysis that has been

made, conclusions are drawn as answers to the research questions and also some suggestions

or recommendations to relevant stakeholders.

Public Health Protection

Law No. 36/2009 on Health (Kesehat- an Law) defines health as a state of well-being, both

physically, mentally, spiritually, and socially, which enables everyone to live a socially and

economically productive life. A healthy society is an invaluable investment in national

development and affects the welfare of a nation in the future.

In realizing a healthy state, medicine and food play a very important role. Food is needed as a

source of daily energy, support for growth and development, maintenance and repair of body

cells, as well as maintaining the balance of body fluids and protecting the body from disease.

No less important than food, medicine is a health commodity, which according to the Health

Law is a material or combination of materials, including biological products used to affect or

investigate physiological systems or pathological conditions in the context of diagnosis,

prevention, treatment, recovery, health improvement, and contraception. The scope of the

term drugs and food in the context of drug and food supervision carried out by BPOM

includes drugs, medicinal materials, narcotics, psychotropic substances, precursors, addictive

substances, traditional medicines, health supplements, cosmetics, and processed food.

In addition to providing properties and benefits to the human body, drugs and foods can be

harmful to the body when consumed not in accordance with the provisions of the safety,

efficacy/benefit, and quality requirements of each product. Drugs circulating online often

have health risks if they are counterfeit drugs that can cause allergies that threaten consumers

who do not go through pharmacist recommendations when selling drugs online (Ariestiana,

2020: 71).

In general, illegal drugs circulated online are classified as hard drugs (Sulaiman, 2019). The

circulation of illegal hard drugs online is very detrimental to the community because the

indiscriminate use of hard drugs can pose a danger to the community itself, because hard

drugs are drugs whose purchase must be accompanied by a doctor's prescription (Putra,

2014).

The danger of online circulation of hard drugs and certain drugs if not immediately addressed

will have a threatening impact on the younger generation and national defense (Ariestiana,

2020: 71). Basically, drugs are chemical substances that enter the body so that the dosage,

method of use, and storage require the principle of caution under the supervision of medical

personnel and pharmacists.

According to Hardianto (2018), in the online buying and selling system, there are quite a lot

of peda- gang selling medicines, health supplements and make-up products that do not pay

attention to the quality of their products. By only relying on and trusting distributors, it is easy

to become an online business actor without considering aspects of product safety,

efficacy/benefits, and quality.

According to Zuhaid, Turisno, and Suhar- to (2016), businesses usually create advertisements

posted on websites and through social media accounts. These advertisements are made in

violation of consumers' rights, because on the websites and social media accounts, the

advertisers do not fulfill their obligations to consumers.

Social media accounts that sell drugs without a distribution permit usually contain negative

things such as pictures from the advertisement, fake testimonials included in the

advertisement, and also efficacy with a high level of efficacy. In fact, in making an

advertisement, business actors must pay attention to the general principles of the advertising

code of ethics so as not to violate consumer rights.

Basically, anyone can sell anything online and should be able to take responsibility for the

products they sell. Business competition makes seller accounts include excessive information,

advertisements, and testimonials. Unfortunately, people often look at testimonials before

deciding to buy. False testimonials provide false information and mislead the public. The

circulation of illegal drugs and food online along with testimonials has the risk of harming

public health.

Protecting public health against the circulation of drugs and food online is an effort that must

be made by all parties including all components of society. The goal is to prevent the public

from using illegal drugs that can harm the body. In addition, so that the public can avoid the

adverse effects of using drugs that are not in accordance with their designation which can

worsen health conditions.

Actors of Public Policy Implementation in General

Against something that harms society and requires protection efforts from the government, it

needs action in the form of public policy. In theory, public policy is a series of actions that are

determined and carried out or not carried out by the government that have certain goals or are

oriented towards certain goals for the sake of the government the interests of the whole

community (Islamy, 2009: 20).

In the process of public policy analysis, analysis involves a series of intellectual activities

carried out in a process of activities that are essentially political in nature. The political

activity is described as the policy-making process and visualized as a series of interdependent

stages arranged in a time sequence viz: agent development, policy formulation, policy

adoption, policy implementation, and policy appraisal.

The public policy-making process begins with agenda setting, formulation, adoption,

implementation and policy appraisal. The process reflects ongoing activities that occur over

time. Each process is linked to the next and the final stage (policy appraisal) is linked to the

first stage (agenda setting) or the middle stage, in a non-linear cycle of activity (Dunn, 2003:

23). Each policy process is interconnected and forms a cycle that continuously makes public

policy more robust in addressing public problems.

The entire policy-making process can be said to be important, but policy implementation is

the most crucial stage. A policy program must be implemented in order to have the desired

impact or goal. Policy implementation viewed in a broad sense is the stage of the policy

process immediately after the enactment of the law. Implementation in a broad sense means

the implementation of laws in which actors, organizations, procedures, and techniques work

together to carry out policies in an effort to achieve policy or program objectives (Winarno,

2012: 146).

In the implementation stage, there are various actors involved who are from both the

government and the private sector society. These actors are identified as the bureaucracy,

legislature, judiciary, pressure groups, and community organizations (Sagita, Hayu, &

Djumiarti, 2013). In general, in the implementation of online drug and food distribution

policies, there are roles for the bureaucracy (government), the private sector, and community

groups. These roles represent different interests.

The Government's Role in Monitoring the Online Distribution of Food and Drugs

Policy comes from the word policy whose implementation includes regulations and is closely

related to the political process (Islamy, 2009). The role of BPOM in overseeing the circulation

of drugs and food is stated in Presidential Regulation Number 80 of 2017 concerning the Food

and Drug Supervisory Agency. BPOM is a regulator and also an operator starting from the

supervision of drugs and food, both before circulation and during circulation in the

community.

Currently, there is no law that specifically regulates the supervision of online drug and food

distribution. However, general regulations regarding the circulation of products are stipulated

in various laws such as Law No. 19/2016 on the Amendment to Law No. 11/2008 on

Electronic Information and Transactions (ITE Law), Law No. 8/1999 on Consumer Protection

(Consumer Protection Law), Law No. 36/2009 on Health (Health Law), and Law No. 18/2012

on Food (Food Law).

The ITE Law stipulates that business actors offering products through an electronic system

must provide complete and correct information relating to the product terms of the contract,

the producer, and the products offered. Likewise, the Consumer Protection Law, which in

Article 4 states that consumers have rights, among others: the right to comfort, security, and

safety in consuming goods and/or services; and the right to correct, clear, and honest

information about the condition and guarantee of goods and/or services. Thus, business actors

have the obligation to provide correct, clear, and honest information regarding the conditions

and guarantees of goods and/or services. It is the right of consumers and the public to be able

to access true, clear and honest information about the content of food and drug products. Such

information must also be included in the description of products sold online.

Similarly, Article 98 paragraph (2) The Health Law states that any person who does not have

the expertise and authority is prohibited from procuring, storing, processing, promoting, and

distributing drugs and materials with medicinal properties. Article 196 and Article 197

stipulate criminal sanctions for any person who intentionally produces or distributes

pharmaceutical preparations that do not meet standards, safety requirements, efficacy/benefits

or without a distribution license. In this article, in conventional and online distribution, of

course, not everyone can sell drugs freely, especially hard drugs that require a doctor's

prescription. Only pharmacists and health workers are authorized to distribute drugs.

Apart from being under the supervision of medical personnel, pharmacists, and authorized

health personnel, medicines used by the public should only be obtained from pharmaceutical

facilities that should be used to sell medicines, namely pharmacies and drug stores, which

have pharmacists in charge so that they know about the medicines to be sold (Pambudi &

Raharjo, 2020: 22). By In other words, individual sales accounts cannot sell drugs over-the-

counter.

According to Ariyulinda (2018: 37), parties that can sell over-the-counter drugs, limited over-

the-counter drugs, traditional medicines, herbs or health supplements through online media

are only licensed pharmacies and drugstores that physically have a place and have a physical

presence. Already obtained permit as a licensed pharmacy or drug store from the local

government. This is so that the government can easily supervise the distribution, tran-

witness, and standards and requirements of drugs sold through online media. Thus, can

provide Thus, it can provide assurance to the public that drugs sold by online pharmacies or

online licensed drug stores are medicines that have been licensed so that their authenticity is

guaranteed. Ministry of Health or health office in making the website in collaboration with the

Ministry of Communication and Information or the communication and informatics office.

Through the website, licensed pharmacies and drug stores can be listed can register website

site. In addition, the site can serve to provide information to the public about registered online

pharmacy sites or online licensed drug stores. A registered online pharmacy or online licensed

drugstore will make it easier for the government to track and take action if an online

pharmacy or online licensed drugstore is registered online is proven to have made a mistake.

Likewise, the public can report violations committed by online pharmacies or online licensed

drug stores if they commit violations to the Ministry of Health or health offices. But in reality,

according to Mackey and Nayyar (2016: 116) illegal online pharmacies are more common in

the digital realm than legal pharmacies. Approximately 96% of global online pharmacies

operate illegally by not complying with regulations and safety requirements and violating

ethical principles.

Although the practice of buying and selling drugs and food online has been going on for a

long time and there is no law specifically regulating it, BPOM only issued its regulations in

2020, namely through BPOM Regulation Number 8 of 2020 concerning the Supervision of

Drugs and Food Circulated Online. Article 7 states that online drug distribution can only be

carried out for drugs included in the class of over-the-counter drugs, limited over-the-counter

drugs, and hard drugs. The provisions regarding hard drugs are explained in Article 8, namely

that hard drugs delivered to patients online must be based on prescriptions written

electronically in accordance with the provisions of laws and regulations.

In addition to being written electronically, the delivery of hard drugs is also carried out by

uploading the prescription into the electronic system. The prescription must be original and

accountable. The technical delivery of drugs circulated online can be done directly to the

patient or sent to the patient by the pharmacy or in collaboration with a third party in the form

of a legal entity such as an online motorcycle taxi delivery service. The delivery of the

original prescription of hard drugs is carried out simultaneously with the delivery of hard

drugs by the pharmacy or through a third party to the patient. Article 11 states that all

electronic transaction data related to online drug distribution activities must be archived and

traceable for at least five years.

The important thing in online supervision of drug and food distribution is that all information

about pharmacies can be clearly informed and can be tracked at any time such as information

on business licenses, pharmacists, and pharmacists a person in charge, a pharmacy contact

number that can be contacted at any time. The flow of drug delivery and electronic

prescription documentation also need to be considered. Unfortunately, online pharmaceutical

services, both in pharmaceutical facilities and health care facilities, are not yet listed in a

standard that can serve as a guideline for pharmacists involved in online drug and food

distribution.

In addition, Article 31 of the BPOM Regulation states that online distribution of drugs and

processed food for special medical purposes (PKMK) is prohibited through social media,

daily deals, and classified ads. This regulation strictly prohibits the circulation of CHD drugs

and food through social media such as Facebook, Instagram, Twitter, and others. In other

words, the distribution of CHD drugs and foods through social media is illegal. Unfortunately,

there are still many people who do not know the information about this substance and still buy

and sell these products through social media. On the other hand, the use of social media for

the purpose of promotion and education of CHD drugs and food products is not prohibited in

the regulation so that business actors can utilize social media only as a medium for promotion

and education.

Regarding the utilization of tele-medicine technology that leads to the electronic submission

of drug prescriptions and online drug redemption, there are rules governing this matter as

stated in the Circular Letter of the Minister of Health Number HK.02.01/Menkes/303/2020 of

2020 concerning the Implementation of Health Services Through the Utilization of

Information and Communication Technology in the Prevention of the Spread of Corona Virus

Disease 2019 (Covid-19). Electronic prescription writing can be done privately through the

doctor's application to the pharmaceutical facility or directly to the patient.

As for writing prescriptions directly to patients, there is a risk of errors. Therefore, it is

necessary to emphasize that the use of electronic prescriptions is temporary and unrepeatable.

Electronic prescriptions should be given to drug delivery services, whether performed by

online pharmacies or third-party online delivery services.

The circular allows the public to obtain prescription drugs and also medicinal products needed

through virtu- al consultation without meeting face-to-face with medical personnel. All

activities from registration, consultation, drug prescription to drug delivery must be

documented and traceable at any time. Likewise with patient confidentiality, medical

personnel and telemedicine applications must guarantee the confidentiality aspect of patient

health data.

In general, when viewed from the perspective of government supervision, the circulation of

drugs and food in cyberspace is difficult to monitor. This is because website addresses, social

media accounts, or online sales accounts in e-commerce can be easily deleted or replaced.

According to Ariestiana (2020: 73), it is not easy to track actors in online media because

many people use fake accounts. Nevertheless, during 2018 there were no less than 2,217 sites

or accounts selling drugs that were not in accordance with the regulations and were

recommended to be blocked by Kominfo. Specifically for online sales of drugs containing the

active substance misopros- tol, BPOM has reported 139 sites consisting of websites, social

media (Facebook, Instagram, and Twit- ter) and e-commerce (Tokopedia, Shopee, Lazada,

and Bukalapak) to Kominfo. In addition, the agency has also recommended 100 sites that

freely sell and promote trivam to the Ministry of Communication and Information to be

blocked in 2018. Trivam is

The drug feed is approved by BPOM as an anesthetic, but is often misused to commit crimes

(BPOM, 2019). The government has resources to monitor the millions of sales accounts

spread across various e-commerce platforms and social media. Likewise, the many variations

of drugs and food are increasingly innovative according to market needs. Cyberspace

surveillance tools are no match for the high public interest in online drug and food

distribution. Moreover, online distribution does not recognize geographical boundaries and

can cover a wide range of areas around the world.

As an agency authorized to conduct drug and food supervision, BPOM has very limited

resources in monitoring online drug and food distribution. BPOM institutions are not

available in every district/city, there are limited human resources to oversee online circulation

and limited authority to prosecute alleged violations. Therefore, online drug and food

supervision does not only depend on the role of the government, especially BPOM, but must

also be supported by the awareness of business actors and the participation of the public as

consumers.

The Role of Private Parties in Conducting Food and Drug Distribution

In the implementation of public policies, the private sector has the role of creating integrated

programs that support public policies (Ulum, Haryo- no, & Rozikin, 2013: 156). However,

miscommunication often occurs between policy makers and policy implementation actors.

The lack of frequency of socialization carried out by the government to the private sector

makes the programs made by the private sector not in line with public policy (Ulum, Haryono,

& Rozikin, 2013: 158). The government needs to regularly socialize various regulations to the

private sector. Moreover, the BPOM regulation regarding online distribution of drugs and

food was only issued in 2020 so that many private parties do not know and have not made

various adaptations to the regulation.

In protecting public health from the use of illegal drugs sold online, there is an important role

for the private sector, namely the role of online businesses, marketplace platforms, and other

parties. Only the pharmaceutical industry, pharmaceutical wholesalers, pharmacies, and

pharmaceutical electronic system providers (PSEF) are allowed to sell drugs online, both to

pharmaceutical services, large pharmaceutical traders (PBF) and the public.

The drug industry is a complex industry because it requires science, research, technology,

human resources, regu- lation, imported raw materials, specific facilities and infrastructure,

high costs, and a long distribution chain. The drug industry has high commercial and

economic value while having high social value in preventing, treating, and curing diseases.

Business actors in the drug industry need to place consumers and the public as subjects who

need to be protected for their safety and security in the use of drugs and food.

In today's business competition, the use of the internet in the form of social media makes it

easier for businesses to promote their products and provide education to the public. The use of

the internet through websites and marketplaces is also needed by business actors in selling

products. In addition to fulfilling the requirements as well as the provisions and licenses in

conventional sales, there are several things that need to be considered in online sales,

including: including information on medicinal products include a clear production date, batch

number, and expiration date; include an United States-language label; include a telephone

contact number for post-purchase communication; include a pharmacy/drugstore business

license, a license of the responsible pharmacy practice, a small trade business license and

others; include a trusted site mark; clear hyperlinks; a secure transaction method; be listed on

a secure online pharmacy site; not sell hard drugs without a doctor's prescription; and not sell

through social media.

Before sellers open an account, marketplaces are required to provide information on the

prohibition of selling drug and food products that are not in accordance with regulatory

provisions, such as the prohibition of selling hard drugs, narcotics, psychotropic drugs, and

other drugs that are not registered with BPOM or the health department. In addition,

individuals or individuals are prohibited from selling drugs online but must be registered

through a pharmacy/PSEF license. Lokapasar must verify every account opened by drug and

food sellers. Marketplaces should set up automatic detection to recognize any uploaded illegal

medicine products, whether posted on official marketplaces or individuals, without a license

to sell medicine. Lokapasar needs to remove products, temporarily suspend, and even close

accounts if they do not comply with the SOP.

In addition to the products, lokapasar also monitors every testimonial on the products sold,

and provides a report button that is connected to lokapasar's complaint service and

BPOM/cyber team. Lokapasar continues to monitor accounts that sell hard drugs on its

platform. Lokapasar collaborates with BPOM and the health department in monitoring

product promotion and sales. Regarding each BPOM finding, Lokapasar is obliged to follow

up on the recommendations of BPOM. The role of e-commerce associations as well as

marketplaces is important to continuously remind their members to comply with the

provisions and requirements and be cooperative in monitoring the circulation of illegal drugs.

Public Participation in Accessing Food and Drug Distribution

One of the characteristics of health services that distinguishes them from other services is the

asymme- try of information, namely that consumers of health services are in a weak position,

while health providers such as medical personnel and health workers know more about the

benefits and quality of services offered. Consumers of health services in their position as legal

subjects are also in a weak position. However, on the contrary, business actors in the health

sector occupy a strong position that makes consumers have no bargaining options (Sugiantari,

2016: 195). Sociologically, the patient's position is lower than that of health workers

(Maisusri, 2016: 2). This makes people trust health workers in getting the health services they

need. On the other hand, technological advances have enabled the public to access drug and

food information online, either through social media or e-commerce platforms.

People in making medical decisions are often influenced by medical personnel and health

workers. However, with the ease of the inter-net, people can freely make decisions by first

accessing the drugs and drug information needed through the internet media. Often, people do

not understand that the drugs they need are categorized as hard drugs whose use requires a

prescription and doctor's supervision, or other drugs that are often prescribed by a doctor

abused. People think that these drugs are commonly sold in the market, especially online.

Likewise, with the efficacy of these hard drugs, the public has taken it for granted to consume

them without a prescription and supervision from a doctor. Therefore, it is important to

increase public awareness and knowledge about hard drugs and drugs that are often misused.

Although there is no avoiding the ease of obtaining medicines online, the public should

always uphold the aspect of caution. The public needs to increase awareness of drug and food

products by always checking the production date, expiration date, drug logo, BPOM

distribution permit or home industry food permit from the health department, ingredients,

contra-indications, and others.

Of course, increasing public awareness and knowledge is not something that is easy, but

requires time, continuous efforts, and other resources. Health promotion media can be used to

increase public awareness and knowledge, for example through public service advertisements

on national television, radio, print mass media, social media, websites at strategic and routine

times, using media span- duk posted in each RT/RW, health service facilities, schools,

markets, and other public facilities.

In addition to increasing vigilance, the public also plays a role in monitoring the circulation of

drugs and food online. The public needs to report to the marketplace and BPOM about drug

and food products that do not meet the requirements, the use of inappropriate images, and the

inclusion of excessive testi moni. Unfortunately, the public often does not play an active role

in providing information online accurate to the police on matters relating to the illegal

circulation of drugs in online media, which is caused by fear and tends to be indifferent

(Ariestiana, 2020: 73).

Supervision of the online circulation of drugs and food also involves all elements of society

including public figures, influencers, bloggers and others who become role models on social

media. Providing communication, information and education to the community can increase

understanding and awareness of drug abuse (Qona'ah & Afianto, 2019: 46).

As part of the community, pharmacist professional organizations also play a role in online

drug and food distribution, namely by bridging public policy to pharmacists and fostering

pharmacists so that their competence is in line with the development of drug and food

distribution which is also carried out online. The competence of pharmacists in online drug

and food distribution is not yet supported by pharmaceutical service standards that regulate

the mechanism and system of online drug distribution. The need for detailed service standards

will serve as a guideline in practice and can eliminate pharmacists' doubts to support the

circulation of drugs and food online in accordance with regulatory requirements.

Conclusion

Advances in information and communication technology have led to an increase in the

circulation of drugs and food online through marketplaces, websites, and social media. The

Covid-19 pandemic that has hit United States since early March 2020 has had an impact on

the increase in medical consultations through telemedicine services that enable people to get

electronic prescriptions and the drugs they need. Similar to selling activities In addition to

conventional purchase, online drug and food distribution must also fulfill the provisions of the

laws and regulations.

Unfortunately, the convenience of the inter-net is often misused by selling illegal drugs that

threaten public health. The practice of buying and selling drugs and food online has been

going on for a long time, but there is no law that specifically regulates the circulation of drugs

and food online. BPOM only issued its regulations in 2020, namely through BPOM

Regulation Number 8 of 2020 concerning the Supervision of Drugs and Food Circulated

Online.

The policy requires the role of actors in its implementation, namely: the bureaucracy

(government), the private sector, and community groups. The government has very limited

resources to monitor millions of sales accounts and a wide variety of drugs and food.

Cyberspace monitoring tools are no match for the high public interest in online drug and food

distribution. Moreover, online circulation knows no geographical boundaries and can cover

the entire world.

In policy implementation, the private sector has a role in creating integrated programs that

support public policies. The public can play a role in increasing vigilance and reporting to

market locations and BPOM on drug and food products that do not meet the requirements, the

use of inappropriate images, and the inclusion of excessive testi- moni.

Some suggestions for the government include: the need for massive socialization of online

drug and food circulation regulations; the creation of more technical and detailed regulations

and service standards related to the role of pharmacies in drug and food circulation online in

the form of pharmaceutical service standards; increased communication, information, and

education to the public not to sell medicinal products online; increased BPOM resources both

at the center and in each district/city; and increased role of market locations in filtering every

product sold.

In addition, the POM Bill, which has been included in the 2021 Priority Prolegnas, requires

accelerated discussion with the government. The POM Bill is expected to become a legal

umbrella in the supervision of drugs and food, including the circulation of drugs and food

online.