Tesis

Efikasi Asetilsistein Dalam Mengurangi Gejala Putus Zat Pada Pasien Ketergantungan Metamfetamin = The efficacy of acetylcysteine on withdrawal symtoms in metamfetamin dependent patients.

Ketergantungan metamfetamin merupakan permasalahan kesehatan di Indonesia dan global dengan angka yang meningkat setiap tahunnya. Terbatasnya bukti klinik farmakoterapi sehingga sampai saat ini belum terdapat terapi standar bagi penyalahgunaan metamfetamin. Penelitian ini bertujuan melihat efektivitas dan keamanan asetilsistein yang merupakan prekursor glutation, sebagai salah satu pengobatan baru yang memiliki potensi dalam bidang adiksi yang dapat mengurangi gejala putus zat dan keinginan untuk menggunakan metamfetamin melalui kuisioner ‘Putus Zat Metamfetamin’ dan SCL-90, serta pemeriksaan kadar glutation (GSH) dan glutation disulfide (GSSG). Penelitain Randomised control trial (RCT) ini dilakukan bulan september sampai november 2019 pada 66 pria dengan ketergantungan metamfetamin di Balai besar Rehabilitasi Lido Badan Narkotika Nasional (BNN) Indonesia. Dilakukan randomisasi blok pada peserta penelitian untuk menerima obat dan plasebo (2x600mg asetilsistein oral, n=33 atau plasebo, n=33). Gejala putus zat metamfetamin dinilai melalui skor kuisioner ‘Putus Zat Metamfetamin’ dan perbaikan gejala psikiatri pada saat putus zat metamfetamin dinilai melalui skor kuisioner SCL-90. Kadar antioksidan GSH dan GSSG diukur sebelum dan sesudah pemberian obat dan plasebo. Asetilsistein tidak berbeda bermakna dalam mengurangi skor gejala putus zat (withdrawal) metamfetamin , perubahan gejala psikiatri dan perubahan kadar antioksidan jika dibandingkan dengan plasebo. Asetilsistein juga tidak memiliki perbedaan bermakna dalam hal keamanan jika dibandingkan dengan plasebo. Diperlukan penelitian lebih lanjut melalui uji klinik dengan randomisasi stratifikasi untuk menkonfirmasi hasil penelitian ini.
Kata Kunci: Metamfetamin, Asetilsistein, withdrawal, Glutation (GSH), Badan Narkotika Nasional (BNN)


Methamphetamine dependece is one of the most prevalent health problems in Indonesia and globally, with increasing number every year. Current pharmacotherapies have limited clinical evidence and there has been no standard therapy for methamphetamine dependece. This study was designed to evaluate the efficacy and safety of acetylcysteine which is a precursor of glutathione, as one of the new treatments that has potential effect in addiction that can reduce withdrawal symptoms through the 'Methamphetamine withdrawal symptoms' and SCL-90 questionaire, and through measuring the levels of glutathione (GSH) and glutathione disulfide (GSSG) This double-blind randomized clinical trial was conducted from September to November 2019 on 66 men with methamphetamine dependence at Lido Rehabilitation Center National Narcotics Control (NNB) of Indonesia. Block randomization of study participants was carried out to receive the drug and placebo (2x1200 mg of oral acetylcysteine, n = 33 or placebo, n = 33). Symptoms of methamphetamine withdrawal are assessed through the questionnaire score 'Methamphetamine withdrawal symtoms' and SCL-90. GSH and GSSG antioxidant levels were measured before and after administration of drugs or placebo. Acetylcysteine was not significantly different in reducing the scores of methamphetamine withdrawal symptoms, changes in psychiatric symptoms and changes in antioxidant levels when compared to placebo. Acetylcysteine also did not have a significant difference in safety when compared with placebo. Further research is needed through clinical trials with stratified randomization to confirm the results of this study.
Keywords: Methamphetamine, Acetylcystein ,Withdrawal, Glutathione (GSH), National Narcotics Control Board ( NNB) of Indonesia.