Despite tough laws and cultural taboos, drug use is a reality across the Middle East. From captagon ravers in the Gulf, to hashish smokers across North Africa, the region has a history of use, cultivation and distribution. Yet, one key factor that has exacerbated drug use – particularly chaotic and problematic use – in the region has been war and conflict.
This has been particularly prominent in the Levant, a region which has witnessed civil wars, foreign invasions, and wars over the past two decades. Most recently, Israeli attacks across the region have displaced thousands into more precarious lives and environments in Gaza, the West Bank, Lebanon and Syria.
A new report by MedGlobal, an organisation providing humanitarian support and developing health programmes in vulnerable areas, retrospectively examined Syrian drug use, its civil war and its impact on health systems, bringing to light research from 2022 conducted across people living within the nation and abroad.
The struggle for power between the ruling Assad regime and armed opposition forces which began in 2011 (and still rages on) caused massive destruction and harm: thousands of homes were destroyed across major cities, the economy collapsed, and over 500,000 were killed, of which roughly 300,000 were civilians. Non-state forces control different parts of the country, complicating access to healthcare as well as facilitating the trafficking of drugs across many border points.
This latest report examines how drug use developed in the nation as a response to the civil war, teasing out lessons not only for Syria, but surrounding nations struggling with similar contexts of conflict, healthcare infrastructure destruction and human displacement.
Drugs across Syria
While cannabis cultivation was prevalent in Syria before the civil war, drug use has risen considerably since 2011. This is particularly due to the trade of captagon- an amphetamine drug produced by state-affiliated groups that brings much needed funds to the government. Estimates suggest that 80% of the world’s captagon supply is produced in Syria, and the drug has generated billions in revenue for the Assad regime. But as the report reveals, it also impacted drug use in Syria.
Through a wide online survey of respondents, MedGlobal’s report revealed that drug use among 18-29-year-olds has increased threefold since the conflict began. Respondents stated that the main reason for an uptick in problematic drug use was “escaping suffering and reality.” Alongside captagon, local demand for medical opioids like tramadol also grew with over the counter purchases of the substance as well as through the illicit market.
The report also found that Syrians in government-controlled areas are more than twice as likely to use drugs compared to their counterparts in opposition areas. The highest rate of drug use however, was found among Syrians seeking asylum outside of the country. One in five, or 20%, of asylum seekers reported using drugs, compared to just 10% before the war.
According to MedGlobal, Syrian drug use is primarily focused on cannabis and opioids. 66% of survey respondents said that cannabis was the drug most spread across the nation, followed by 56% believing it was captagon. The report also discusses the role of pharmaceutical opioids in fuelling addiction in the Middle East, especially as when the conflict began the legal pharmaceutical market collapsed and users turned to the stronger pills on the black market.
The report also revealed a difference in social acceptance of drug use between those living in government-controlled regions and those in opposition controlled areas. 63% found it unacceptable in government-controlled areas, compared to 79% in opposition-controlled areas. In conjunction with the high level of drug use in government-controlled regions – 11% compared to 5% – this perhaps reflects a societal and empathetic understanding of drug use as escapism in opposition controlled areas, which may be in less stable conditions than those held by the state.
Drugs for mental health
The effect of conflict on drug use is not only short-term, as revealed in the report: when speaking to Syrian refugees, 20% of those who were in asylum reported some degree of drug use; this is 2.5 times more than the total population average (8%), and almost twice as much declared drug use than those that had remained in government controlled areas (11%). While there is strong evidence that the majority of asylum seekers (particularly those seeking refuge in the European Union) are young and healthy, there seems to be a connection between starting to use drugs after displacement, perhaps as a coping mechanism or to self-medicate for trauma.
Caroline Rose, Director of the Strategic Blind Spots Portfolio at the New Lines Institute and contributor to the report, told TalkingDrugs:
“Wars’ heavy effect upon communities can impose years-long traumas and mental health disorders, often unaddressed by under-resourced public services that have been gutted by the conflict.”
Ultimately, the report confirmed that drug use increases as a form of escapism during intense conflict, used to find distractions or solace amidst mental and physical anguish. Using drugs to deal with losing your home, family, or way of life is a common behaviour.
“Many of the dynamics related to conflict, trauma, and substance abuse have been seen in other conflict zones,” Diana Rayes, another contributor to the report, told TalkingDrugs.
“Conflicts in Afghanistan, Iraq, and Colombia have also led to an increase in drug use as a coping mechanism,” Rayes added.
Regional lessons
The use of tramadol, a dependence-forming opioid medication, was also noted across the report, as it was often dispensed by pharmacies without a prescription. Tramadol use is frequent in Middle Eastern warzones: the drug was frequently used in Palestine as a response to Israeli occupation. As early as 2010, there is evidence that tramadol was traded in the illegal market or through fake prescriptions. This has led to historically high rates of use: news reports in 2008 stated up to 30% of males between 14 and 30 used opioids regularly. More recent reports noted a “tramadol crisis” recurring in 2019.
Given the analysed drug use in Syria, it isn’t extreme to assume that Israel’s year long assault on Gaza, which has killed more than 45,000 Palestinians and displaced almost 2 million people will lead to a spike in drug use. This is exacerbated by Israel’s targeted destruction of Palestinian health infrastructure, which was condemned by the UN as a crime against humanity. Such destruction of health infrastructures, as noted in Syria, only reduces people’s access to drug-related services, from prevention to treatment.
Israel’s recent ground invasion on Lebanon has already crippled drug treatment infrastructure. Further conflict in the region is only likely to deteriorate the conditions for people using drugs, pushing them towards more problematic forms of drug use due to a lack of support and, crucially, hope for the future.
Not only is the presence of conflict similar in Gaza, Lebanon and Syria – but the nature of the conflict itself draws deep parallels. As we saw in Syria’s conflict, Rose says, “We are witnessing mass targeting of civilian infrastructure and communities. Not only has Israel’s offensive into Gaza and Lebanon generated over 43,000 deaths and displaced millions of Gazans and Lebanese, but it is sowing the seeds of prolonged struggle and trauma for survivors.” As a result, “this shared trauma could very well incentivise survivors to seek out illicit drug consumption as a coping mechanism.”
Captagon use is already prevalent across Lebanon: it is a key transit state for the drug to leave Syria and reach more lucrative markets like the Gulf states – particularly Saudi Arabia.
Since the country’s economic crisis in 2019, more people have turned to drug use to seek solace from deteriorating living conditions, and to keep going.
“There is particularly a strong relationship between war-ravaged economies and the consumption of stimulants that can prevent hunger, increase feelings of invincibility, and stave sleep for productivity,” Rose told TalkingDrugs.
Amidst the horrors of conflict in Gaza and Lebanon – civilian and combatant deaths, destruction of infrastructure and historic sites – one group will undoubtedly not be the priority. People using drugs, a group which will persist and grow throughout and long after the bombardment, are lacking the attention and support needed to improve their conditions.
