In Lebanon, the “war on drugs” is well and alive, with punitive drug laws, a security-first approach and the demonization of people who use them firmly in place.
This isn’t unusual: across the world, there is a shared dream of achieving a “drug-free world”, an idea that endorses massive spending on law enforcement, weapons and chemicals to eradicate drugs from society – no matter the cost.
This goal is not only unrealistic, it’s had devastating consequences: unprecedented rates of addiction, expansion of organised criminal activities, prison overcrowding, environmental degradation, and more.
As a result, drugs exist in a “discursive no man’s land” – it is a topic that we all know exists, but cannot publicly or critically discuss.
It’s well past the time to reassess the way society controls drug harms. Across the world, more and more countries are experimenting with decriminalization and drug regulation, addressing decades of racist and classist laws and investing in better health and social policies.
It’s within this context that we’re launching a monthly series produced in collaboration between TalkingDrugs and Megaphone, to highlight current debates and global developments on drug policy, linking them to Lebanon’s national realities. Its aim is to imagine and propose alternatives to drug prohibition, exploring innovative ways to critically engage with one of the best kept secrets of our society.
On International Overdose Awareness Day, we remember those who left us and ask what could have been done to keep them alive.
Imagine you are sitting with a friend when they start to become confused. They’re sweating, shaking, struggling to speak. You’re not sure how to help, and their breathing is becoming more forced, more difficult – until it suddenly stops. They’ve lost consciousness.
You know they have diabetes, so you suspect their blood sugar has dropped dangerously low, but you’re not totally sure. You think a professional should get involved, so you call an ambulance.
There is no question about whether it’s safe to call an ambulance. Your friend is having a medical emergency; the priority is to keep them alive. Emergency services will come to give with potentially lifesaving support – no questions asked.
Now imagine that the substance used – sugar – was illegal.
Imagine that, before calling the ambulance, you had to wonder whether telling the emergency services what happened could bring the police. Imagine that the person experiencing the emergency could be treated not only as a patient, but as someone who had committed a crime.
The scenario sounds absurd. Yet for people who use drugs, especially opioids like heroin or tramadol, this is not a hypothetical; these calculations are very real. In Lebanon, where just the possession of drugs could lead to three years in prison, if people ever need medical attention when using drugs, they must first weigh whether their symptoms are worth disclosing their criminal activity – which could mean intense questioning, arrest, or worse. This means that, more often than not, people won’t seek help until it’s too late or serious.
In Lebanon, treating an overdose is not only a medical question – the continued criminalisation of drugs in our society means that it’s mostly an issue of criminalisation, policing, and stigma.
A drug overdose is a medical emergency, one that can be quickly addressed with the right medicine. But whether someone survives an overdose can depend on something that has nothing to do with medicine: it mostly depends on whether they and the people around them feel safe enough to call for help.
Overdose deaths are a policy failure, not a moral failing
We know how to respond to an overdose medically; there are medications globally available that can safely reverse overdoses. What we have been less willing to confront is the barriers we’ve created that prevent us from keeping people who overdose safe and alive.
Every 31 August, the world observes International Overdose Awareness Day (IOAD), a global campaign that commemorates all the lives lost to drug overdoses, calling for humane measures that prevent overdoses, reduce the harms of drug use, and keep people safe and alive.
This day serves as a reminder that, regardless of the reason why people use drugs in the first place, they face additional risks that could potentially kill them and that stem from the continued criminalisation of drugs.
While drug consumption itself can pose some (undeniable) risks to people’s health, there are other harms that are exponentially increased from drug criminalisation: drugs bought in illegal markets are usually of unknown potency and/or contents – meaning someone can never be sure of what’s inside them. While for some drugs like cannabis these risks are less severe, for other substances like heroin, tramadol, cocaine and others, not knowing the potency of what you’re using can be fatal.
Drug criminalisation not only means that drug markets are unregulated, with uncontrolled products used by unknowing consumers, there are no safety mechanisms in place to keep people safe and alive in case something goes wrong. This is especially the case with Lebanon’s public health system, which should, in principle, cater to everyone – not just those deemed deserving of care.
Criminalisation and public health
Drug criminalisation creates an environment in which drug use is understood first as a crime and only after as a health issue. That distinction matters enormously during an overdose, when a person doesn’t have the time to negotiate whether they deserve medical care or not.
In Lebanon, circular 55/1 from 2006 has meant that hospitals receiving medical “incidents caused by a third party” (like gunshots, stabbings and car accidents) should call Internal Security Forces. This has wrongly been extended to include drug overdoses. And while the state has made an effort to correct this interpretation through the publication of several circulars,high staff turnover, the lack of implementational monitoring and underlying stigma by healthcare professionals against people who use drugs mean the risk of law enforcement involvement remains very real.
From the moment someone is using drugs and they or their friends overdose, they know that if something goes wrong and they need medical attention, they risk arrest, death, or both. In countries that criminalize drug use, calling an ambulance for a drug overdose can often mean that the police will come along too. This happens beyond Lebanon: there’s global evidence that police presence for drug-related medical interventions can be a serious barrier for people seeking help.
A person who uses drugs does not become less entitled to treatment if they need it; they should not have to die in an emergency if they have knowingly consumed an illegal substance.
We don’t ask whether someone “deserved” their heart attack before treating them. Neither do we question their life choices before saving their lives. In Lebanon and beyond, we endorse laws and drug control systems that separate forms of suffering as valid and deserving rescue, while others deserve instead blame and punishment. Health systems should not distinguish between people; they have the duty and responsibility to care for people, regardless of their choices. Yet, in the case of drug use, criminalization transforms stigma into a public health risk, rather than merely an unpleasant social attitude.
In fact, the lack of legal protections for those accessing services when dealing with drug emergencies means they’re less likely to seek help. You wouldn’t seek help too if you thought an ambulance or hospital staff may lead to a visit from the police.
The progress is real, but fragile
There’s been efforts by civil society organizations in Lebanon to ensure people feel safe enough to seek help: some hospitals are considered “safe” for people who use drugs. These are public and private hospitals that do not report overdoses to Internal Security Forces, in compliance with the Ministry of Public Health’s directives. The number of hospitals following this directive, however, fluctuates every year with changing staff and policy awareness.
Policy change can also help keep people alive, but they require a move away from judgement, stigma and paternalistic attitudes towards people who use drugs. Among available choices, Lebanon could implement Good Samaritan-type laws to protect people seeking medical assistance from criminal prosecution. Additionally, wider access to naloxone – a life-saving medication that reverses opioid overdose that is currently only distributed by drug treatment centres to their service users – would be a serious improvement; its distribution to drug-using communities alongside their friends and family could better prepare people to respond to overdoses without getting health systems involved. Access to this antidote should be universal, not dependent on enrollment in treatment.
But these changes only tinker with the edges of what is ultimately a broken system of drug control, one that prioritises punishment over care for those dealing with drug-related health and social issues.
