Skoun, founded in 2003, is Lebanon’s first and only out-patient facility offering prevention and treatment for drug users. Located in Achrafieh, the center offers voluntary counseling for addicts, group therapy and drug replacement therapy. The overwhelming majority of patients who seek Skoun’s help are addicted to heroin and between the ages of 22 and 30 years old, although patients range from age 16 to 50. With a budget of $600,000 to $800,000 per year, Skoun treated 172 drug users in 2008 through funds it received from grants and private donations.
The idea for Skoun came about because of a “lack of services in Lebanon,” says Skoun’s director, Nadya Mikdashi. Other drug rehabilitation facilities in Lebanon include the in-patient rehabilitation center called Oum al Nour, while several hospitals have detox programs.
Skoun’s approach is different, as they seek to treat people on an ongoing basis while they are living their daily lives, so that they can tackle “other life issues, not just addiction issues,” Mikdashi says. This approach isn’t new; in the West, 70 percent of addiction care is out-patient. Skoun views addiction as treatable and a specialty of mental health.
Amin has been a patient at Skoun for one year to treat his heroin addiction. He says he spent only a short period of time in another facility, which he claims “seemed to work under the presumption [that] you have messed up on your own. From now on, we tell you what to do, what to think, who to see and even what to say.”
“Skoun is different,” he says. “You take responsibility for your feelings and emotions, confront them, and accept what makes you happy as much as what brings you down.”
Amin has slipped up and used heroin a few times, as most addicts do according to Mikdashi. But Amin says that “it’s important to know why it happens, and how to prevent it in the future. So to say if you lapse again, you are kicked out, like some facilities do, is dooming people to failure.”
Every week, Skoun administers Amin a controlled dose of buprenorphine, an opiate replacement, and also samples his urine to ensure his overall health. Over the past year, Amin has been gainfully employed as a journalist and writer.
Mikdashi says that she has seen a steady rise in substance abuse and addiction in the last several years, including party drugs, such as ecstasy or amphetamines.
There are no reliable figures on how many people abuse substances in Lebanon, although estimates range between 10,000 and 15,000 users. Mikdashi says that some users come to the center for addiction to hashish.
“The nature of the drug is different [from opiates or harder narcotics],” Mikdashi says. “But the psychology of addiction is the same,” even if hashish is not as debilitating. In addition, patients also come to Skoun for alcoholism — what Mikdashi calls the “unspoken drug. There’s not enough of an understanding of what alcoholism is.”
Education
Mikdashi thinks that attitudes towards drugs are changing, that people are better informed, and that there is less stigma surrounding addiction. She says the main problem is drug education in schools has not been specific, and teenagers only get told that “drugs are bad, drugs will kill you.”
Another issue is that this approach doesn’t take into account the prevalence of drug experimentation and that no distinction is made between heroin and hashish use, for example. So if a young person tries hashish or sees other people using it, and sees that it is not killing them or ruining their lives, they dismiss what they learned about drugs in general. “We try to explain to young people, because experimentation is a reality, that there are differences between substances,” says Mikdashi, so that they understand the danger of addiction.
Lebanon’s Internal Security Forces (ISF) General Crime division arrests drug users as well as dealers. While a law passed in 1998 states that drug addiction should be treated as an illness rather than a criminal offense, the law has not yet been implemented.
“According to the law, if I arrest an addict here, I should send him to the committee for drugs. In this committee there will be a judge and a doctor, and they will decide if this person will go to the hospital, to treatment or to jail,” says General Michel Shakkour, the director of the ISF’s General Crime division. “They should send him to a certain rehabilitation center and a detox center that is free and belongs to the government. But we don’t have this yet. It hasn’t been established. So you can’t use this system.”
Instead, drug users often end up in prison, even more often than drug dealers. Every year, about 1,000 to 1,300 drug users are imprisoned, compared with 400 to 500 dealers.
“When I arrest people, I send them to the judge. And the judge sends them to prison,” Shakkour explains.
Because of the absence of a free, government-run facility, usually only families who can afford rehab succeed in getting their loved ones released.
“The family or the parents come to the judge, and ask to take their kids to the treatment center,” says Shakkour. “They sign a paper in front of the judge, and he releases them.”
Laws less implemented
Mikdashi says that the problem with the 1998 law is not only that it can’t be implemented, but that it only decriminalized addiction and not usage. She points out that there also needs to be a clear division between addicts who will deal to support their habits and drug traffickers.
But penalties for small-time dealers, or facilitators, are usually the same as major traffickers — up to 5 years in prison, and many of the large-scale dealers remain at large because they can bribe their way out of getting caught.
“If he’s a user, he’s a user. If he’s taking one cigarette or two cigarettes, heroin or hashish, it’s all the same [sentence],” says Shakkour.
But is it wise to have the same policies towards users of soft and hard drugs?
“From my point of view, yes,” Shakkour says. “From my experience, all the drug users of hashish… go for harder drugs.”
He believes the majority of the Lebanese population, especially teenagers, will try hashish. However, the World Health Organization has stated emphatically that “the theory that marijuana use by adolescents leads to heroin use is the least likely of all hypotheses.”
Skoun has recently completed a two-year series of workshops, sponsored by the European Union, to sensitize judges, investigators and policemen to addiction and how to deal respectfully with addicts. In cooperation with Shakkour, 1,200 new police recruits have received “sensitivity training.”
“Recovery is not just about dropping drugs or addiction, it’s about having a satisfying life and healthy relationships,” Mikdashi concludes.
Drug regulations in the Middle East and North Africa
The majority of countries in the region – Algeria, Bahrain, Egypt, Iran, Iraq, Jordan, Kuwait, Libya, Oman, Qatar, Saudi Arabia, Sudan, Syria, the UAE and Yemen—currently have statutory provisions for executing drug-related offenders. In addition to narcotics-related prosecutions, Iran, Libya, Saudi Arabia, Sudan, Kuwait and Yemen also punish consumption and possession of alcohol.
Syrian and Iranian laws treat addiction as a medical problem. Syria prescribes treatment at state-operated rehabilitation facilities for drug addicts who surrender to the police. Iran has instituted opium alternative programs for addicts since the 1960s, but has also executed tens of thousands on narcotics charges in the last decade. The death sentence can be handed down for possession of more than 30 grams of heroin or 5 kilograms of opium; lesser drug offenses are punished with imprisonment, fines or lashes.
While the UAE has reportedly not carried out the death penalty for drug offenses, its laws are considered some of the most draconian — and confusing. Possession of painkillers and certain over-the-counter cold and flu medication can result in a mandatory four year prison sentence. A Swiss national is currently serving a 4 year prison term after three poppy seeds from a bread roll were found on his clothes at Dubai airport. A Briton was arrested in Dubai for carrying Melatonin jet-lag tablets, which are sold over the counter in the US — as well as in Dubai.
Syrian drug policy authorizes capital punishment for narcotics manufacturing, trafficking, or sales. In 2008, at least four Syrian nationals, two Turks and one Lebanese citizen were sentenced to death for trafficking heroin and cocaine. In Algeria three men were sentenced to death in 2008 for trafficking some 600 kilograms of marijuana.
In 2007, Morocco reportedly arrested 18,734 Moroccans and 255 foreigners for drug-related offenses. Moroccan law provides a maximum prison sentence of 30 years for drug offenses, as well as fines ranging from $20,000 to $80,000. Ten to 15 year prison terms are the typical sentence for major drug traffickers convicted in Morocco.
