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HEALTH CRISIS

Compounding crises push growing number of Lebanese to self-medicate

Compounding crises push growing number of Lebanese to self-medicate

Ghandour says self-medication 'as a coping mechanism is a very important yet highly overlooked issue in Lebanon.' (Credit: Big Stock)

BEIRUT — The rapid succession of tragedies plaguing the country combined with an overloaded, underfunded mental health care system have led to a worrying increase in people self-medicating with alcohol, tobacco, cannabis and psychoactive prescription drugs, a new study finds.

The findings of the soon to be published study, in which some 600 residents of Lebanon from various socio-economic backgrounds were asked about their self-medicating behaviors, shows a “substantial increase” in substance use, says Lilian Ghandour, an associate professor of epidemiology at the American University of Beirut, who leads the project. “Self-medication as a coping mechanism is a very important yet highly overlooked issue in Lebanon,“ Ghandour says. “Especially considering the mental health pandemic we’re facing, these findings help us create sorely needed mechanisms to develop a better response system.”

Participants in the AUB study were asked, through interviews conducted in 2021, to compare their substance use in 2020 to their previous typical consumption. The study focuses on the use of various tobacco products, alcohol, cannabis and psychoactive prescription drugs, such as tranquilizers, barbiturates and opioid pain relievers.

While several findings were cause for concern, one outcome is particularly striking: when it comes to prescription drugs, 70 percent of those who used them in 2020 reported either an initiation or an increase in usage. In comparison, 30 percent of alcohol users stated that they had either started drinking or were drinking more in that time period, which, Ghandour warns, is still a considerable percentage.

Ayman, a 27-year-old writer from Beirut, who manages to infuse his animated anecdotes with a barely hidden tinge of stunned melancholy, spent the first half of 2021 in a parallel world, asleep during the day only to lie awake when everyone else was asleep. The trifecta of tragic events – the collective disenchantment after the euphoric 2019 uprising, the country’s economic collapse and the 2020 port explosion — had unfolded in Lebanon during the two years before, combined with the ever-present shadow of COVID, had left him (like so many others, he is quick to add) unable to “feel grounded in any sort of reality of safety.”

“After everything we went through, the post-thawra disillusionment, the financial meltdown, COVID and to top it all off, the [Beirut port] blast, it’s the Israeli jets that finally broke me,” Ayman says. “Can you believe it?”

While Ayman had been using cannabis for years to combat his anxiety, watching Israeli warplanes from his window in the early hours of Christmas day of 2020 sent him reeling to the extent that he sought out other ways to soothe himself during the seemingly endless sleepless nights that followed.

“I was absolutely terrified. Xanax helped a bit but it gave me horrific nightmares, in which I saw my friends die. Smoking nargile, which I rarely did before, became a comforting ritual. There was something about the sound of the bubbling water, the changing of the coals, the lightheadedness, it grounded me somehow,” he says. “And I started drinking more and more just to fall asleep, or rather pass out.”

While plenty of research has been done on illegal drug use in Lebanon, such as the comprehensive National Report on Drug Situation in Lebanon released by the Ministry of Public Health in 2017, which focused on drug prevalence, market, policy, treatment and prevention, little attention has been paid to self-medicating behaviors of the average citizen. Ghandour’s research aims to fill that gap.

It’s important to note the difference between substance use disorders and self-medication. Someone who self-medicates may screen ‘no’ or ‘mild’ on SUD symptoms but still takes prescription medication without a doctor’s prescription, or independently increases the dosage or length of usage. The main distinction lies in the motivation: one self-medicates for medicinal purposes, to treat physical pain, anxiety or to help you fall asleep rather than getting high for non-medicinal reasons.

For 34-year-old Nour, who had to move back in with her family in Tripoli last summer due to what she describes as “the impossibility of living in Beirut, both financially and emotionally,” growing up in an environment where anti-anxiety medication was passed around “like candy” felt like the norm.

“My mom, my aunties, my friends’ parents. We just didn’t know any better.”

This nonchalant attitude towards self-medication as a coping strategy is not unique to Nour’s upbringing. Many Lebanese, from different generations, share similar stories about tranquilizers and opioids painkillers casually being consumed at home during the 1975-90 Civil War and other particularly precarious times the country went through.

Although Nour had cultivated a preference for rolling a joint to take the edge off while living in Beirut, being surrounded by family has made her go back to what she refers to as “Xanax, my old trusted friend.” Although she hasn’t needed her own prescription yet, as it’s still accessible through friends and family, the increase in price and decrease in availability has already made her reach out to friends abroad, just in case.

“I know it’s bad that everyone in this country has become so blasé about popping pills,” she says. “But what do you expect? We’re merely the latest generation in Lebanon to collectively suffer from PTSD. But definitely not the last.”

Prescription drug abuse has been plaguing Lebanon for a long time, in fact Ghandour conducted a previous study on the behaviors and patterns surrounding this phenomenon in 2012.

“The four main issues are easy access, lack of education about associated harms, the diversion of medication and the lack of a centralized system to monitor med usage, ” says Ghandour.

She stresses that the fault does not lie with pharmacists, doctors or patients.

Rather, it’s the easily abusable system that allows for what Ghandour calls “doctor-shopping,” as many can get different prescriptions from different doctors which they can then use at different pharmacies, none of which have a centralized system with which they can flag possible abuse.

Furthermore, Ghandour says, the majority of the population is not aware of the associated harms of self-medicating.

“Most people who self-medicate aren’t illegal drug users but rather have a harmless substance-using profile. Instead they use them to self-medicate or to help them fall asleep. However, while their profile might be harmless, taking such medications without medical supervision could actually lower your heart rate to the extent that could potentially prove fatal.”

“Awareness plays a crucial role,” Ghandour says. In 2019, Ghandour and her team had gathered all relevant stakeholders, including members of all relevant ministries, to share recommendations based on their collected data, to combat underage alcohol drinking through the development and implementation of regulation measures. But then Lebanon started crumbling, and the mental health care system crumbled — “or, let’s pray, paused” — along with it.

“That’s the sad irony,” Ghandour says. “Now that we need it more than ever, it’s even less available.”

But even some of those who are perfectly aware of the dangers of self-medication would rather take the risk than be left to their own devices while a perpetual sense of doom hangs over them.

“I know what self-medicating does to you, especially without therapy, but when you feel like you’re dying, nihilism takes a hold of you. Many of us in Lebanon have this sense of a foreshortened future,” Ayman says. “When I saw those Israeli planes from my balcony, my trauma-addled mind convinced me they were nukes, because why not? Even the port, which I didn’t think about at all, beyond it simply being there, turned out to be dangerous. In Lebanon, every day we’re just waiting for something else to explode.”

BEIRUT — The rapid succession of tragedies plaguing the country combined with an overloaded, underfunded mental health care system have led to a worrying increase in people self-medicating with alcohol, tobacco, cannabis and psychoactive prescription drugs, a new study finds.The findings of the soon to be published study, in which some 600 residents of Lebanon from various socio-economic...