Retribution over rehabilitation
Published by Executive Magazine
Original Article here.
Drug use in Lebanon is said to be prevalent but remains difficult to define. An estimate from a 2012 report by the Institute of Health Management and Social Protection at Saint Joseph University in Beirut suggested that the “number of drug users in Lebanon ranges from 10000 to 15000 and that this figure is continuously increasing.” The leading drugs of choice are heroin, cannabis and cocaine, the report concluded, and statistics corroborate a high incidence of those drugs among arrested users. Looking at the statistics on user-related arrests gives a tip-of-the-iceberg snapshot of the problem but gaps in the data obscure its real size and challenges efforts to push progressive alternatives, like rehabilitating drug users instead of jailing them, forward.
When arrested, anecdotes by drug users describe maltreatment during detainment at the hands of the Lebanese police. One such story was recounted by Sadecc Choucair who admits, in his self-published book, he was under the influence of alcohol at the time of his detainment – a fact that may have altered his recollection of the incident. In telling his story Choucair alleges entrapment and wrongful detention by the Internal Security Forces, Lebanon’s national police, although Executive could not corroborate this.
On Christmas Eve 2013 Choucair was having drinks at his neighborhood watering hole when he received a telephone call from a close friend in search of a quick fix. In ten minutes I’ll be there, the friend said, though Choucair had told him he wasn’t carrying any weed. Not a dealer, Choucair was a university student that smoked recreationally with no prior run ins with the law. What transpired next, according to his recount, was less a friendly catch up and more an ambush planned by the authorities. The police arrested Choucair and hauled him down the street to the drug unit’s holding cells at Makhfar Hobeish (Ras Beirut police station). There, detectives questioned Choucair, coercing an admission of drug use and forcing him to spill the names of his dealer and others he knew who smoked.
[pullquote]Studies from other countries show strong correlation that rehabilitating users is cheaper than incarcerating them[/pullquote]
Local advocates say Lebanon’s drug control regime is repressive, the judicial process opaque, with little emphasis on harm reduction and quality of life for drug addicts. There are significant gaps in the data for several important indicators: the number of drug use-related prosecutions, the number of individuals incarcerated for drug offenses, the number of rehabilitated users, and the efficacy of treatment programs in terms of cost and success rates, and the effect of rehabilitation, instead of incarceration, on crime rates. While data for Lebanon is limited, studies from other countries show strong correlation that rehabilitating users is cheaper than incarcerating them, that crime rates drop when drug offenders are treated for addiction instead of sent to jail and that personal lives improve significantly when the government focuses on harm reduction over criminal punishment. Advocates in Lebanon point to small victories that have advanced the issue but say significant obstacles remain.
Choucair’s account falls in line with the findings of torture and abuse in Lebanon’s police stations and detention centers by the Human Rights Watch (HRW), a global watchdog. In a 2013 report HRW interviewed 52 individuals arrested for drug offenses, prostitution or homosexuality. The report highlighted personal accounts of aggressive interrogation tactics and mistreatment in the prisons – 19 of the interviewees, detained for drug use or prostitution, gave testimony to HRW while in pretrial detention. “Seventeen former detainees reported being denied food, water or medication when they needed it, or of having their medication confiscated. Nine individuals reported being handcuffed in bathrooms or in extremely uncomfortable positions for hours at a time. Eleven said ISF personnel forced them to listen to the screams of other detainees in an effort to scare them into cooperating or confessing. Twenty-one women we spoke with reported that police had subjected them to some form of sexual violence or coercion,” HRW found.
In response to allegations of abuse, the ISF in 2014 launched a pilot project to boost public trust in the police, revamping the image of the Ras Beirut police station, where the drug enforcement unit is headquartered, and introducing new training methods to the police force. The ISF also launched a complaint system for citizens to record ill treatment by the police.
But Karim Nammour, a lawyer and member of the Legal Agenda, a judiciary watchdog advocating for reform of Lebanon’s drug control regime, say the police’s reforms have not eased the heavy-handed tactics that drug users face. Users, Nammour says, are the weakest link because they often do not have the financial resources or political clout that others in the drug trade might leverage to avoid trouble.
[pullquote]Counting its victories where it can, the ISF and judiciary hit hardest at those who are weakest, throwing users down a deep hole they must climb out of[/pullquote]
To the police they are the low hanging fruit in a drug version of the Garden of Eden, a quick score to pad the numbers for results. Nammour’s criticism lies in what he says is an imbalance in who is targeted and arrested and statistics from the drug enforcement unit of the ISF back up the notion that the police aggressively pursue drug users. In the last four years, 2012 through February 2016, the police arrested 11,038 drug users – 6,057 of those were for hashish use – compared to 2,169 street level dealers and 992 individuals closer to the source (growers, manufacturers and distributors).
Then again the arrest numbers also suggest, as Nammour points out, a pervasive culture within law enforcement and the court system viewing drug use as a criminal offense instead of an issue of public health, in contrast to a global outlook that favors harm reduction and civil infractions over incarceration.
Counting its victories where it can, the ISF and judiciary hit hardest at those who are weakest, throwing users down a deep hole they must climb out of. From arrest through protracted legal battles in the courts the deck is stacked against users, particularly the more vulnerable of those who have crossed the invisible line into the dark world of addiction. They say they want to go to rehab but the system says no, no, no.
Think of the money
“In Lebanon it is not allowed to use or buy drugs,” says Colonel Ghassan Chamseddine, chief of the drug enforcement arm of the ISF. True, the use and possession of all narcotics is against the law, not to mention the sale, distribution and production. But for users the law offers a path to avoid a criminal record and get the help they need to break addiction: rehab.
According to Nammour’s calculations less than 3 percent of the some 8,700 arrested drug users since 2013 were actually sent to rehab. The math is not exactly accurate, he acknowledges, because it is based on arrests rather than cases that are prosecuted. It is incredibly difficult to obtain statistics from the judiciary because access is limited (Executive’s multiple requests to judiciary officials and to the Ministry of Justice were declined or remain unanswered). Most cases are sealed because they are ongoing investigations, are classified secret because of the nature of the investigation, or involve a minor. The judiciary also has no centralized information system so lawyers, like Nammour, must go to each court and build connections with clerks to obtain case information – it will never be accurate, he says.
There are findings of financial and societal benefits of rehabilitating drug users instead of sending them to jail. In Western countries studies have found the cost of incarcerating drug users greatly outweighs the cost of rehabilitating them. Data also show a correlation in a fall of crime rates when drug offenders are rehabilitated rather than imprisoned. But there are no figures available on the cost of incarceration in Lebanon’s prisons and there is also a dearth of data on the cost of drug rehabilitation provision to the country’s users and addicts.
A 2013 tally by the Central Administration of Statistics found Lebanon’s incarcerated population totaled nearly 73,000, up only slightly following the parliament’s ratification of law 216 in 2012, shortening the annual prison calendar to 9 months to ease overcrowding in the country’s 21 prisons, suggesting incarceration bills may be high [ed. note: the 2012 budget ceiling – Lebanon has not passed a national budget since 2005 – for the Ministry of Interior and Municipalities did not separate the expenses of the police force and prison system, it totaled almost $535 million].
A 2008 Ministry of Public Health case study of drug rehabilitation treatment estimated some 1000 drug users were incarcerated (though not necessarily for drug offenses) at Roumieh prison, Lebanon’s largest jail. But the study only noted the high financial costs of offering such treatment within the prison; it did not break down what those cost amounts were nor did it give a figure of the total amount needed. Executive could not find the number of prisoners in jail for drug offenses, and the outdated studies do not allow a comparison of the cost of incarceration to that of drug rehabilitation.
In Western countries the financial cost of imprisonment is high. A 2012 study by the Vera Institute of Justice in the United States found, in a survey of prisons in 40 US states, the annual average cost to taxpayers was $31,286 per inmate. A European Council survey of 47 of the union’s prison administrations found that the average per day cost for each inmate in 2011 was 103 euros ($116).
[pullquote]Despite the found benefits, little has been accomplished to help users receive the treatment they need to break addictions and avoid prison time[/pullquote]
The National Institute on Drug Abuse (NIDA) in the United States estimated the average cost to rehabilitate heroin addicts with methadone treatment for a full year was nearly $4,700 per patient. NIDA also found that in several estimates “every dollar invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs and theft. When savings related to healthcare are included, total savings can exceed costs by a ratio of 12 to 1.” Deloitte, a for-profit consulting firm, found a dramatic reduction in Australia of AUD 111,458 ($84,604) in total financial savings when diverting drug offenders from prison to inpatient rehabilitation.
Correlations between rehabilitation and a fall in crime rates are also positive. For example, The Economist reported that Texas spent $241 million in 2007 on alternatives to prison for nonviolent drug offenders, including rehabilitation treatment, and that in the period between 2003 and 2011 violent crimes dropped by 14.2 percent.
Despite the found benefits, little has been accomplished to help users receive the treatment they need to break addictions and avoid prison time. Some users (there are few indicators other than anecdotal) who do go to rehab in Lebanon do so voluntarily, before the police pick them up, at non-profit treatment centers like Skoun or Oum el Nour or with specialized practitioners in hospitals. Joseph Khoury, an addiction psychiatrist at the American University of Beirut Medical Center (AUBMC), says most of the users he treats come to him on a voluntary basis, instead of for court ordered rehab.
The alternative of rehabilitation instead of jail time is but a theory. Since its ratification in 1998 this aspect of the law remains largely ink on paper. Nammour argues that prosecutors wrongly interpret the law when going after drug users. “The law states that a person using drugs, an addict – that’s the term used – is to be penalized unless this person states that he or she wants to undergo treatment. So you have two components of the crime – being an addict or refusing to undergo treatment. If one of these components doesn’t exist you don’t have a crime,” Nammour tells Executive. He says their justification for arresting users is to generate leads gleaned from interrogating them, that prosecutors pit users and street dealers against each other to widen the cast of their net. Lumping users into investigations pervades the notion amongst law enforcement and prosecuting officials that users are also criminals, Nammour argues.
Judges point out that users can receive rehabilitation treatment once their case reaches the court but Nammour says no, this is a wrong reading of the law that disincentives users from seeking treatment because it punishes them upfront. Rehabilitation is meant to be an alternative for drug users to avoid jail time, but because they are used as bait they are not afforded this option until it is too late. “This person will feel that [they’ve already been penalized] and at the end of the case – this is a pattern I’ve seen in almost every case – they don’t want to go to rehab anymore. What’s the point? When we tell them the point is so that you keep a clean criminal record (because if you finish treatment the judge should close the case with no marks on their record), they’ll tell me that ‘I don’t care about my criminal record, I just want this over with. I don’t want to go through anymore’,” Nammour says. Faisal Abdullah, a defense lawyer, says he’s had clients that have been incarcerated multiple times only to later die of an overdose because they did not receive the treatment they needed to break addiction.
But referrals for rehabilitation are also hindered because the government lacks the ability to treat the large number of arrested users. Lebanon’s 1998 drug law established a Counter Addiction Committee (CAC) meant to identify user cases that qualify for rehab. Though the CAC is up and running it does not have the necessary means to be effective in providing the alternative to incarceration. “There are very real obstacles prohibiting the CAC from referring [users for rehabilitation] – to refer 3000 users per year, it’s a huge number,” Nammour says. For one the sheer number of drug users arrested per year overwhelms the committee. Centralized in Beirut, Nammour argues the caseload should be diffused across several committees spread throughout the country. But an appointment to the CAC is an unpaid commitment that piles an additional full time caseload on already overworked judges (the same is true for others appointed to the committee, government officials plus doctors and civil society representatives). That the committee hardly functions is “a major gap” in the provision of rehabilitation, says Khoury, the addictions psychiatrist at AUBMC, a gap that “actually undermines its purpose because the government, the police or the legal profession don’t take this committee seriously enough.”
Then there’s the issue of too few treatment centers in the country. “Because the government did not accredit rehab centers – you have a committee created by the law that is completely disabled because it doesn’t have accredited rehab centers to send users to,” Nammour says.
Long road to recovery
Advocacy by civil society, led by the Legal Agenda and Skoun, has produced small but tangible victories. Last year the Ministry of Public Health published a five year plan to improve mental health care in the country, including substance abuse. The Ministry of Justice, the responsible authority, has accredited three rehabilitation centers to treat drug addiction but the spaces available are yet inadequate given the numbers arrested.
[pullquote]Last year the Ministry of Public Health published a five year plan to improve mental health care in the country, including substance abuse[/pullquote]
More recently, the Ministry of Public Health issued a memo (the ministry provided the memo but declined to comment) barring the medical community from calling the police when overdosing users show up at hospitals. Allegedly, hospital administrators or their staff acted as a network of informants for the police, but Nammour could not provide evidence supporting this allegation citing fear of defamation lawsuits and Executive was not able to independently corroborate the claim. On whether the ISF has informants in hospitals Chamseddine tells Executive that, “No police [officers] from the drug enforcement agency are working in hospitals. I don’t care about arresting people overdosing, I care about their safety and their rights – we prefer they are treated to become well to avoid loss of life.” When the police are called about overdoses, he says, they are contacting nearby police stations and not his unit. Chamseddine also adds that hospitals are obligated, as per a 2006 memo by the general prosecutor, to call the police when a patient is a victim of crime, such as a gunshot wound. Nadya Mikdashi, Skoun’s executive director, points to the misinterpretation of this 2006 memo as enabling the reporting of overdosing patients. For whatever reason, calling the cops on patients, Nammour says, at least compromised doctor-patient confidentiality, a violation of Article 7 of their medical code of conduct (Lebanon’s Hippocratic Oath). In any case, the new memo from the Ministry of Public Health is a welcome step forward but one that Skoun says it will closely follow to observe its application.
Nammour says the way ahead is straightforward yet challenging – apply the law, focus on enabling the CAC and accrediting treatment centers so that users who need rehabilitation have a place to go. But the key area that would resolve a number of issues is the period when a drug user is arrested and investigated, where users become disillusioned with the system and first encounter the obstacles they must hurdle to avoid prosecution and receive rehabilitation treatment. “There is a lot of work to be done because we’re speaking about the most rigid part of the judiciary looking at drug users [as criminals],” he says. Short of decriminalization or full on legalization of narcotics, Nammour says Lebanon can best serve its drug using population by rehabilitating them and expanding harm reduction programs, an outcome that Executive has previously advocated.