Tramadol and Lebanon's prescription drug problem through the eyes of users and recovering addicts
Published by The Daily Star
Original Article here.
BEIRUT: “The first time I took tramadol I thought, ‘Wow, this shit is good.’ The second time I took it was the next day, and that was it,” Salma, a former long-term drug user, told The Daily Star. Prescription drug abuse has been in the spotlight recently as the rate of consumption rises in Lebanon and around the world.
In May, The Daily Star reported that Lebanese patients’ use of prescription drugs was twice the rate recommended by World Health Organization, according to the Lebanese National Health Authority head Ismael Sukkarieh.
Although overprescription of certain medications contributes heavily to drug abuse worldwide, experts and former users said that highly addictive drugs can often be obtained without a prescription in Lebanon, either at pharmacies that do not abide by laws, or via dealers who smuggle them in from abroad.
Salma’s sister and former prescription drug user Yasmeen began using the substances at the age of 16 while living in Jordan. She also started with the opiate tramadol – a medication used to treat moderate to moderately severe pain. Both women asked that their identities be concealed.
“You feel more productive when you take these drugs,” Yasmeen said. “But through prolonged use it starts to get to you. It triggered a chronic back problem for me ... because I was just sitting at home all the time every day, writing paid essays [for university students], and it allowed me to make thousands of dollars at the cost of my body.”
Much of the money Yasmeen earned writing essays while under the influence of prescription drugs was spent on her sister Salma’s legal fees in a court case involving alleged drug use.
“I’ve ... been to court for [drugs] in this country, and it’s a money scam,” Salma said. “The amount of times that [the] court will be adjourned ... means you have to continue paying your lawyer and continue paying fines ... I paid up to $16,000 over the span of three years for drug use, and they weren’t even sure [I was guilty] because I hadn’t been tested – [the evidence] was word of mouth,” Salma said.
As someone who had used prescription drugs, including Lexotanil, Xanax, Ritalin, tramadol and Lyrica, as well as illegal drugs such as heroin, cocaine and MDMA, Salma said that the prescription pills could often have much more sinister effects.
“There’s a really big difference between taking heroin and taking a tramadol pill. Even if you use heroin on a regular basis, it’s not something that you do parallel to your life. It’s a separate thing. You go into a room, you close the door, you create a safe space and you take heroin. It’s not something you take and then go out, or function, regardless how little you take. On the other hand, pills are made by people for people, for patients who want to continue their normal life but are in pain, so they can take it and go to work, and that makes it more acceptable and much more dangerous,” she said.
She added that taking pills, as opposed to MDMA crystals or cocaine powder, felt like “something more civilized.”
“I can do it in the street; I can do it sitting with my mom,” Salma said.
Salma highlighted how prescription drugs allow many users to continue a normal life, even enhancing their concentration and reducing stress. One drug user, who asked to be identified as Bill, said that this was a little-understood fact of prescription drug abuse.
“As a functional addict who maintains [acceptable grades at university] ... it is hard to spot me as an addict; I am left with myself to [deal with] this internal conflict. ... To have a society that supports rehabilitation and not punishment will free many students and people alike [from this] struggle,” Bill said.
“The functional addict does not exist in the public eye, which leaves the person [user] in the dark. [Skoun, Lebanese Addictions Center] or other rehabilitation centers are the solution and need to be expanded and brought to the mainstream,” he added.
Both Salma and Bill are currently undergoing rehabilitation at the Skoun center, founded 14 years ago as the first outpatient center with a specialized addiction unit in Lebanon. The center’s director, Nadya Mikdashi, said the organization supports the decriminalization of drugs, a process which she said would ease the various hurdles drug users in Lebanon have to overcome before they can receive treatment.
“[The government] simply relies on arresting people for drug use rather than investing in what prevents it. Instead of creating opportunities for the youth through treatment, employment or education, they criminalize them. We need prevention, not criminalization,” she said, adding that less than 10 percent of Skoun’s funding comes from the government, through the Social Affairs Ministry.
Metn MP Ghassan Moukheiber has thrown his support behind a draft law that Skoun recently submitted to Parliament calling for the decriminalization of drugs.
In a video posted on Skoun’s social media accounts, Moukheiber called for the decriminalization of drugs and the treatment of drug abuse as a public health issue.
Dr. Rabih Chammay, head of the National Mental Health Program at the Health Ministry, also called for an end to the penalization of drug users in a video, saying the change would help foster a climate in which users are “more inclined to seek the help that they need.”
“If the idea is to decrease drug use, [current policy] simply is not working,” Skoun’s Mikdashi said.
Former prescription drug user Yasmeen said that the government’s lack of support for rehabilitation centers was one of the reasons she didn’t seek professional help, saying that these centers seemed to exist in a “gray area.” Yasmeen also said she feared that she would have to unequivocally quit all drug use if she sought treatment, a commitment many users said they were not prepared to make due to the finality of the decision.
Mikdashi said she was well-aware of these concerns, which is why Skoun has pioneered individualized care and harm reduction as their main strategy, rather than pursuing aggressive abstinence programs.
“We don’t require people to be drug-free before our treatment; we’re here to help them to become drug-free, that’s the whole point. ... If someone wants to stop taking tramadol, it doesn’t mean that they can’t also enjoy a glass of wine,” she said.
Salma and Bill see this as one of the main reasons for the success of Skoun’s treatment, namely that they can both continue to use other drugs, such as hashish and alcohol, recreationally, while also reducing the overall harm they inflict upon themselves from other substances they abuse.
“[Quitting prescription drugs] is the most difficult thing I’ve had to do,” Yasmeen said, “because when it’s prolonged use, it’s no longer self-medication or a pick-me-up, it becomes your state of consciousness. The physical withdrawals are only a quarter of the problem; after they cease you have months of getting accustomed to life when you’re sober, not expecting to be constantly high, because tramadol is a very long trip, six to eight hours of an exponential high. It’s magnificent.”