Let’s have a se­ri­ous talk about drugs

A sci­en­tific ra­tio­nale for the cannabis de­bate in Le­banon

Executive Magazine - - FRONT PAGE - By Joseph el-Khoury

The cannabis de­bate never com­pletely goes away in Le­banon.

This is not sur­pris­ing, given that the coun­try is a ma­jor pro­ducer and con­sumer of the psy­choac­tive plant. Ev­ery­one who is any­one has an opin­ion on the drug, usu­ally ex­pressed through im­pact­less sound bites. The dis­cus­sion was reignited on June 18 by an In­ter­nal Se­cu­rity Forces (ISF) Face­book post re­port­ing a “drug bust” that led to the ar­rest of three teenagers, ac­com­pa­nied by a pic­ture show­ing rollups, a plas­tic bag with a small amount of hash, and one joint. The post drew wide­spread mock­ery on­line, with com­ments from Face­book users thank­ing the po­lice for “sav­ing” them and mak­ing them feel much “safer.” Be­neath the sar­casm, the in­ad­e­qua­cies of our drugs laws were duly ex­posed.

RET­RI­BU­TION OR RE­HAB?

This vi­ral ISF mis­fire was fol­lowed by an of­fi­cial, the­o­ret­i­cally bind­ing, cir­cu­lar is­sued by At­tor­ney Gen­eral Judge Samir Ham­moud on June 26—World Drugs Day—urg­ing his col­leagues to im­me­di­ately re­fer drug users to the Drug Ad­dic­tion Com­mit­tee, in ac­cor­dance with ar­ti­cle 199 of Law 376 (1998). Since the law was passed 20 years ago, judges have had the op­tion of re­fer­ring in­di­vid­u­als ar­rested for drug pos­ses­sion to a re­ha­bil­i­ta­tion com­mit­tee based in the Min­istry of Jus­tice. How­ever, a sur­vey re­leased ear­lier this year by SKOUN, a lo­cal non-profit out­pa­tient ther­a­peu­tic cen­ter, found that a very low num­ber of ar­rested drug users had been re­ferred. There are a num­ber of ex­pla­na­tions for this, stigma and ig­no­rance be­ing ob­vi­ous ones. But for years the com­mit­tee has also re­ceived no po­lit­i­cal back­ing, re­main­ing chron­i­cally un­der­funded and un­der­staffed.

The value of the re­ha­bil­i­ta­tion of­fered via this com­mit­tee is ques­tion­able, even to those ar­rested and re­ferred to it as “ad­dicts.” The term ad­dic­tion has it­self lost pop­u­lar­ity in clin­i­cal cir­cles as it does not ac­count for the wide va­ri­ety in pat­terns of use and the im­pact on the phys­i­cal and men­tal health of the user. Ev­i­dence from a mul­ti­tude of stud­ies world­wide sug­gests it is likely that the ma­jor­ity of those ar­rested for pos­ses­sion of cannabis, or even harder drugs, are not ad­dicted to them and do not re­quire in­ten­sive treat­ments like detox­i­fi­ca­tion and res­i­den­tial re­ha­bil­i­ta­tion. Most drug use is recre­ational, though some re­mains prob­lem­atic and can lead to loss of func­tion­al­ity, mood disor­ders, and psy­chotic ill­nesses in the ab­sence of phys­i­cal depen­dence.

The tra­di­tional struc­ture of re­ha­bil­i­ta­tion in Le­banon fo­cused on the tail end of heavy drug use: mostly opi­at­ede­pen­dent young men who had fallen by so­ci­ety’s way­side. Some or­ga­niza- tions, such as Oum el-Nour, did evolve, and now of­fer a more di­verse ap­proach, such as com­mu­nity pro­grams and spe­cial­ist cen­ters for women. In 2012, the Min­istry of Pub­lic Health launched its opi­ate sub­sti­tu­tion pro­gram, which widened Le­banon’s treat­ment hori­zons,

Most drug use is recre­ational, though some re­mains prob­lem­atic and can lead to loss of func­tion­al­ity.

but also widened the rift be­tween the pro­po­nents of to­tal ab­sti­nence and the ad­vo­cates of harm re­duc­tion.

De­spite an ab­sence of re­li­able sta­tis­tics, pat­terns of il­le­gal sub­stance abuse in Le­banon con­tinue to evolve. New drugs have come onto the mar­ket—such as spice, salvia, and ke­tamine—and are of­ten sold mixed to­gether and laced with toxic con­tam­i­nants. The use of cannabis is also on the rise, with stud­ies re­veal­ing a wider pub­lic tol­er­ance and in­creased use amongst the younger gen­er­a­tions. The elec­tronic dance scene has also ex­ploded, with Beirut be­com­ing an in­ter­na­tional des­ti­na­tion for tech­no­fu­eled nights out. With this rep­u­ta­tion came MDMA and a va­ri­ety of stim­u­lants, ex­pand­ing the in­ven­tory of party drugs, which was long-dom­i­nated by co­caine.

Each coun­try has an idio­syn­cratic drug ecosys­tem re­spon­sive to so­cial, po­lit­i­cal, and eco­nom­i­cal fac­tors that reg­u­late sup­ply and de­mand. In Le­banon, the es­tab­lish­ment has re­al­ized that ac­tion needs to be taken, yet they and the pub­lic seem in­ca­pable of hav­ing a ma­ture de­bate on which drug poli­cies to adopt.

SHIFT­ING POLI­CIES

Whether you think drugs are harm­less en­ter­tain­ment or the af­flic­tion of our gen­er­a­tion, it is hard to find a con­vinc­ing ar­gu­ment for putting ado­les­cents in jails that fail to re­ha­bil­i­tate. Out­side of Le­banon, the drug prob­lem has been ap­proached in a more in­no­va­tive man­ner, with an emerg­ing trend to­ward de­crim­i­nal­iz­ing or le­gal­iz­ing some or all drugs. All pol­icy op­tions carry risks and have caveats. But gen­er­ally, a body of ev­i­dence is build­ing to sup­port this lib­eral per­spec­tive. Por­tu­gal, the Nether­lands, Uruguay, the US, and—most re­cently—Canada have all been more than will­ing to ex­per­i­ment with this ap­proach.

De­crim­i­nal­iz­ing is usu­ally the least prob­lem­atic first step, as it in- volves the state fore­go­ing the use of in­car­cer­a­tion for drug use. It does not re­quire a sig­nif­i­cant shift in phi­los­o­phy, as prison sen­tences could be re­placed by fines and in­vest­ment in preven­tion and treat­ment ef­forts.

Le­gal­iza­tion, how­ever, car­ries with it a lo­gis­ti­cal night­mare. It re­quires a strong state ap­pa­ra­tus able to guar­an­tee the sources of pro­duc­tion and dis­tri­bu­tion of drugs. I do not be­lieve the Lebanese govern­ment would be able to reg­u­late a le­gal drug pro­duc­tion and re­tail in­dus­try. For ex­am­ple, calls to le­gal­ize cannabis for med­i­cal pur­poses— re­cently backed by the MPs of Baal­bek-Her­mel—ig­nore the fact that the over­whelm­ing ma­jor­ity of cannabis is used for recre­ational pur­poses in Le­banon. Ex­port­ing Lebanese cannabis for med­i­cal use would mean de­priv­ing recre­ational users of a cheap lo­cal sup­ply. This might be wel­come to some, but the counter ef­fect would be an even greater re­liance on crim­i­nal net­works to source and sell cannabis to recre­ational users.

Politi­cians, blog­gers, and ad­vo­cates have too of­ten used pop­ulist dis­course to gain the sup­port of a large sec­tion of the pop­u­la­tion, while dis­miss­ing the ba­sics of drug eco- nomics and global ex­pe­ri­ence. It is worth men­tion­ing that the US is only now in­vest­ing mil­lions in re­search­ing the im­pact of cannabis on men­tal health, in par­tic­u­lar psy­chosis.

As its stands, the take­away mes­sage has to be that the drug con­ver­sa­tion should con­tinue, in a trans­par­ent and hon­est way. Sup­port­ing lib­eral laws for deal­ing with drug pro­duc­tion, deal­ing, and use should not au­to­mat­i­cally mean sup­port for recre­ational drug con­sump­tion. Cannabis is not a harm­less path to achieve happi- ness. In the event that it is le­gal­ized, it should be put at least on an equal foot­ing with al­co­hol. Lim­i­ta­tions on who can use it and un­der which cir­cum­stances should be en­forced. Le­gal or not, sub­stance abuse in all its forms should be dis­cour­aged, es­pe­cially for those still in the devel­op­men­tal stage be­fore adult­hood. JOSEPH EL-KHOURY is an as­sis­tant pro­fes­sor of psy­chi­a­try and an ad­dic­tion spe­cial­ist at the Amer­i­can Uni­ver­sity of Beirut. He has been in­volved in com­mit­tees and ini­tia­tives re­lat­ing to drug treat­ments and poli­cies in Le­banon. He is also a co-founder of the drugs aware­ness web­site mukhad­der.com

De­spite an ab­sence of re­li­able sta­tis­tics, pat­terns of il­le­gal sub­stance abuse in Le­banon con­tinue to evolve.

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