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Let’s have a serious talk about drugs

A scientific rationale for the cannabis debate in Lebanon

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 opiate-dependent young men who had fallen by society’s wayside. Some organizations, 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, 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 techno-fueled 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 involves 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 economics 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 happiness. 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.

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Joseph el-Khoury

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

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1 comment

Tommy August 5, 2018 - 12:15 PM

The fact that you’re putting cannabis on par with alcohol just proves you’re a moron. Cannabis has never killed anyone in history while alcohol kills people everyday. The world is actually laughing at Lebanon, good job. Just legalize it already.

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