“Do you think I want to be microdosing Ketamine every day?”, asks Nadim Haroush*, a local living in Beirut, Lebanon’s capital city.
“I’ve been self-medicating with it for over a year because I’m so anxious. Disintegrating. Almost everyone I know is using [drugs] or drinking because we’re losing money as we speak,” adds Haroush, whose events business went into administration last year. “You think that the government that let Beirut explode will help me – or fight Covid?”
Data supports the picture that Haroush describes. Preliminary findings from an ongoing study of some 500 subjects, points towards a substantial increase in substance use in Lebanon, says Lilian Ghandour, an associate professor of epidemiology at the American University of Beirut (AUB), who is leading the investigation.
Haroush is one of millions stricken by Lebanon’s manifold crises, which collectively are now deemed to be the biggest threat to national stability since the 1975-1990 civil war. Battered by fiscal, financial and banking collapse, Lebanon’s economy has spiralled out of control since mid-2019, leading to mass protests and ongoing political paralysis in what was an already fragile country. This situation deteriorated further still last year, under the weight of Covid-19 and the chemical explosion in August 2020 that left hundreds dead, thousands injured and 300,000 homeless across Beirut.
In short, Lebanon is on the brink. Two weeks ago, the nation’s freefalling currency lost one-third of its value, plunging more Lebanese people into poverty and igniting new waves of protest. The country could even run out of the publicly provided electricity at the end of the month.
“Political crisis, unemployment, bank savings lost, lockdown, Covid, PTSD from the explosion, lack of justice. Can you imagine the pressure on people?”, says Lina Khoury from Oum El Nour, an NGO working in addiction recovery.
Last year Embrace, a Lebanese charity that runs a mental health and suicide prevention helpline, experienced a significant increase in people engaging with their services.
“Starting in 2020, especially after Covid and then the explosion, there’s been a significant rise in demand for mental health and substance use treatment services,” says Tatyana Sleiman, executive director at Skoun, which is one the biggest NGOs in Lebanon that provides support for addiction.
More people are smoking, drinking or taking illegal and legal drugs, adds Sleiman. “Substances have become a coping mechanism, a way to forget or have fun.”
More specifically, Skoun has witnessed that alcohol, pharmaceuticals and cannabis are increasingly being used to sleep, self-medicate or control anxiety. Preliminary findings from AUB’s study confirms this, its authors told the New Statesman, with a large portion of respondents saying they had increased or begun drinking over the last year. The survey also reportedly found that the use of tobacco, cannabis, Benzodiazepine and sleeping pills has risen substantially (albeit to varying degrees), regardless of socioeconomic status.
Skoun also reports a notable rise in crystal meth consumption, which the NGO says was not previously an issue in Lebanon. “Meth is being seen as a cheaper alternative to other drugs, and its effects last much longer,” explains Sleiman. While within the country’s refugee camps, the use of salvia (a herbal hallucinogenic) is reportedly growing, she adds.
Haroush has found that many drugs have become more expensive and poorer in quality. “People are getting desperate and buying novocaine used by dentists. Haroush says that he and many others have turned to Syrian-made Ketamine sold by operatives linked to Hezbollah, a Lebanese political party (which is listed as a terrorist organisation by the US) that has fought in Syria for almost a decade. Hezbollah’s involvement in drug trafficking is widely known.
Beyond Ketamine, there have been reports that cocaine, MDMA and other amphetamines are becoming more popular among those who can afford it, says Khoury. People are seeking “upper” drugs that act as temporary antidepressants, she adds. Since many of these have to be imported from outside the Middle East, however, they have risen in price due to Lebanon’s severe shortage of US dollars.
Consequently, there is a growing demand for locally produced substances that are less expensive, says Khoury. “In some cases, buying drugs is cheaper than food.” Like hashish, locally-made alcohol has also remained relatively cheap, making it arguably the most accessible substance in Lebanon. Nonetheless, more and more of the country’s poorest residents are making home-made alcohol, which can have dangerous consequences, says Haroush.
Even before the current crisis, there was a big problem with drinking in Lebanon, explains Ghandour. “We have drive-through stores where you can order Vodka shots on the go. So, it’s very likely that alcohol misuse disorders are on the rise.”
Prescription pills are also easy to access in Lebanon. “Almost everyone I know is on some kind of tranquilliser, such as Xanax, Lexotanil, and other psychoactive pharmacy drugs,” adds Ghandour. In recent months, however, there have been widespread reports of pharmacy shortages, as many prescription drugs in Lebanon are imported.
“We’re really worried for those recovering from heroin addiction, who require an opiate substitution. This medication was already expensive, and now it’s getting really bad with the economic crisis,” says Skoun’s Sleiman.
Furthermore, there are fears that the rising price of drugs in Lebanon may be pushing some of the country’s poorest drug-users into crime, Khoury adds. Over the last year, car thefts and robberies have risen across the country.
Ghandour worries that demand for mental health treatment in Lebanon has only grown during the crisis. Many do not realise they need help with their mental health, feel stigmatised to seek treatment or simply can’t access the limited available care.
In ways like these, Lebanon’s woes may also shed a foreboding light on a much wider issue. For while much more research is needed on the relationship between Covid-19 and substance misuse across the globe, extant studies already suggest that the pandemic has increased intake and made those with substance use disorders more vulnerable to coronavirus.
History seems to be repeating itself, says Khoury. “During the Lebanese Civil War substance addiction became so common in dealing with trauma. But it wasn’t until after the conflict that the scale of the problem became clear. We need to start preparing for the fallout now.”
[See also: Why Lebanon is too important to fail]
*Names have been changed to protect identities.