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This April, the U. For years, some European countries have quietly diverged from policies based on aggressive suppression of drug production and the criminalization of users. More recently, some key Latin American states have openly challenged the global counternarcotics regime and called for reforms. On March 7 in Doha, we met with police and military officials, NGO representatives, and academics from across the Middle East to discuss the rising drug challenges in the region and the increasingly contested global regime. We found the Middle East and North Africa are grappling with intensifying drug problem—increased use, spread of drug-related communicable diseases, and widening linkages between drug production and smuggling and violent conflict and terrorism. And there is a growing sense that the repressive policies against illicit drugs long-applied in the region have not been effective in counteracting these negative trends. MENA countries have by and large not taken an active or vocal role in global drug discussions. Many governments do not collect or disclose data on levels of drug production, trafficking, and use. Drugs are a social taboo, with little public or government attention to the problem. This policy is increasingly rejected by the international community, even by the stringent International Narcotics Control Board. Even very small possessions of medications such as codeine can be deemed illegal in the region, such as in Dubai , and result in imprisonment or worse. Despite poor data, there is nonetheless a sense that drug use is on the rise in MENA. Drug use could well be on the rise elsewhere in Iraq and Syria, although records are kept poorly or not at all. Bored, unemployed, frustrated young people and war-traumatized dislocated populations are understandably vulnerable to the temporary escape offered by drugs. Refugees pose a new challenge for states designing policies to address drug use. Badly-integrated and highly marginalized diaspora communities often have small segments that become crucial vectors of international smuggling. Prevention policies have been largely ineffective in containing rising drug use. Drug treatment is underprovided throughout the region. In the Gulf, even relatively progressive Qatar established its first drug treatment center only in the past few years. Conservative societies in the region tend to stigmatize users, so few seek out help. In the Middle East, drug production and trafficking has long funded violent conflict. In Lebanon, for example, Hezbollah and various sectarian militias taxed the cultivation of marijuana and opium poppy in the Bekaa Valley beginning in the s. ISIS now appears to be smuggling local weed too. Alternative development policies have often been cast too narrowly and have relied on questionable substitute crops such as tobacco. Synthetic drugs are also a problem for the region, particularly where poorly governed or ungoverned areas provide cover for laboratories. The production of Captagon is increasing in Lebanon and it is even more widely produced in Syria, where it is smuggled and taxed by ISIS for revenue. ISIS fighters are also alleged to consume Captagon to increase their fighting prowess and brutality echoing amphetamine-fueled violence by West African fighters in the s. This group has taxed a broad range of smuggled goods, but its narcotics that captures the headlines. The region also experiences problems with legal drugs, such as qat in Yemen. While qat is culturally acceptable, it decreases productivity of users, increases family indebtedness, and causes severe overexploitation of scarce water resources to support its cultivation. For many women in Somalia during the Shabab era and today in places such as Djibouti , peddling qat was the only source of livelihood even as it made their husbands unproductive and drove households into high debt. But suppressing production and trade may not be politically or economically sustainable, as even the terrorist group al-Shabab learned in Somalia when it tried to disrupt qat trading. Like with its s predecessor al-Itihaad, prohibition of qat use and trade caused al-Shabab to lose crucial support from influential business leaders and clan chiefs, undermining the political entrenchment of the group. There are some positive counter-examples in the region. Recognizing that its highly punitive policies have failed, Iran has adopted some important harm-reduction measures even while clinging to executions and even though many treatment centers, especially for women, have to operate hidden from view. Along with Morocco , it has been experimenting with methadone maintenance, needle exchange, and other harm reduction measures as well as ways to improve the effectiveness of treatment. Some , Iranian addicts are reported to receive methadone maintenance and 76, buprenorphine treatment. Turkey has been a model since the s of how to produce medicinal opiates and prevent their diversion into the legal drug trade. With the help of U. In North Africa, Morocco has witnessed a reduction in marijuana cultivation. So there are some cases where well-designed policy responses can have an impact on drug production. MENA governments might look to Thailand for lessons. In the Middle East and North Africa, social taboos, traumatized dislocated populations, state fragility, weakness and corruption of law enforcement, rivalrous geopolitics, and intense conflict all inhibit effective drug policies. If governments and civil society in the region do not start thinking deeply about drug trends and policies, the threats and harms will grow much more intense. Governments and NGOs need to start gathering and disclosing data on drug use and better map drug smuggling. Drug use should be depenalized: Throwing users into jail will not stop use and may facilitate radicalization. Use should be destigmatized and better treatment provided, while public health approaches should also be adopted. If governments force eradication before effective alternative livelihoods are in place, it is likely that farmers will only be further pushed into the arms of militants and such policies should not be intensified in the Bekaa Valley, for example. There is no easy way to disrupt terrorist drug funding, the eternal dream of governments around the world. But interdiction can more effectively target the drugs-terrorism nexus. The first step, before all else, is to acknowledge drug challenges are on the rise in the Middle East and that repression is not stopping them. Foreign Policy. Africa Security Initiative. Sections Sections. Sign Up. Vanda Felbab-Brown and. Ugly trends, ugly policies MENA countries have by and large not taken an active or vocal role in global drug discussions. Cash for militants, cash for the poor In the Middle East, drug production and trafficking has long funded violent conflict. Bright spots? Breaking the cycle In the Middle East and North Africa, social taboos, traumatized dislocated populations, state fragility, weakness and corruption of law enforcement, rivalrous geopolitics, and intense conflict all inhibit effective drug policies. More On. The death of Sinwar and a moment of opportunity. Toxic tampons and gender bias in health research. Gilbert, Carly Bennett October 17,

Breaking bad in the Middle East and North Africa: Drugs, militants, and human rights

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Official websites use. Share sensitive information only on official, secure websites. On the basis of a review of published papers between and we briefly review substance use in the EMR with special focus on the emerging drugs pertinent to this region, namely tramadol, captagon and khat. The prevailing situation of war, insurgencies, political conflict and civil unrest in many countries of the region has dramatically influenced substance use problems in every aspect, from production and trafficking to availability and pattern of use. This is compounded by the long-standing position of this region as one of the largest opium production sites globally. Additionally, increased production and availability of different types of stimulant, especially captagon, has also become a major drug problem in the region 3 Fig. From the information available the general situation of substance use in the EMR region indicates that in about 4. The regional estimated crude death rate due to substance use disorders in was reported as 1. The EMR has been the scene of prominent production and seizure of opioids, cocaine, amphetamine-type stimulants and khat. Opioids remain the main cause of mortality related to use of illicit substances in the region. The second- and third-highest global death rates per from opioid overdoses occur in Libya and the United Arab Emirates UAE respectively. Tramadol is an opioid that is widely used to treat moderate to severe pain and has also been used off-label in the treatment of sexual dysfunction such as premature ejaculation. There is growing evidence of non-medical use of tramadol in the EMR, reflected in the number of people in treatment for tramadol-related problems and the number of tramadol overdose deaths reported in some countries, particularly among young people. Among Egyptian adolescents, tramadol use is more prevalent than heroin. Such tight control is concerning because it may restrict the medical use of tramadol, particularly in countries of the region where regulatory mechanisms make other opioids opioid agonist treatments for opiate addiction less available for medical use. The increasing trend of clandestine manufacture and use of amphetamine-type stimulants has become a major concern in countries such as Iran, Morocco and Pakistan. There is also a high demand for fenethylline captagon tablets in some countries of the region, especially in Syria, Lebanon and countries in the Arabian Peninsula. In addition to the established patterns, there have been emerging regional trends of substance use not only related to cultural and geographical expectations in the region but also as a result of the large number of displaced populations. Captagon is an illustration of this trend. Catha edulis , commonly known as khat, is a flowering plant growing in the khat belt countries in the Horn of Africa and the Arabian Peninsula. Khat misuse and dependency is still the major illicit substance use-related problem in countries such as Djibouti, Yemen, Somalia and southern provinces of Saudi Arabia. In Saudi Arabia, khat use is mostly prevalent in the Jazan region in the south of the country on the Yemeni border. Khat chewing was about four times higher among males than females in both current and lifetime users. People who use khat frequently report increased levels of energy, alertness and self-esteem, better ability for communication, sensations of elation, enhanced imaginative ability and a greater capacity for associating ideas. Khat chewing might reduce productivity considering the large amount of time individuals spend on khat chewing. Additionally, another group of studies suggested a possible association between heavy khat consumption and psychosis. Multiple substance use is a common practice in the EMR and adulterated substances available on the drug market have added to the vulnerability of people with substance use to various health hazards, making the clinical picture of drug intoxication complicated. For example, in some countries of the EMR people have added amphetamine-type stimulant use to opium use — drugs with completely different profiles of intoxication and withdrawal symptoms. The EMR has a unique nature due to the presence of conflict and emergency in a number of countries. One may hypothesise that a combination of a social instability with additional increase in forcibly displaced populations, b increased demand in these substances for personal consumption by the affected heterogenous populations in the region and involved combatants, as well as c the enhanced production and distribution of these emerging drug markets has synergistically created the 'perfect storm' across the Eastern Mediterranean countries. This heterogeneity is reflected in the hybrid pattern of substance use and the emergence of new trends. The presence of a significant number of populations on the move due to internal displacement or migration affects the capacity of national health systems to effectively manage the evergrowing substance use problem and to meet the needs of the population. Accurate epidemiological data are needed to allow a better understanding of the impact of this problem on both general and marginalised populations. Regional political instabilities have fuelled the use, production and trafficking of these substances, potentially creating problems within healthcare systems. Being known as the traditional production and trafficking hub for various drugs demands the importance and need for more attention to control the substance use situation in the EMR. This can only be achieved with reliable and accurate data collection. All the authors contributed to the conception of the paper. This research received no specific grant from any funding agency, commercial or not-for-profit sectors. Data availability is not applicable to this article as no new data were created or analysed in this study. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. BJPsych Int. Find articles by Hossein Mohaddes Ardabili. Find articles by Abolfazl Akbari. Parnian Rafei 3 MSc. Find articles by Parnian Rafei. Find articles by JL Butner. Find articles by Riaz Khan. Find articles by Yasser Khazaal. Find articles by Abdulmalik Zuhair Arab. Mohammed Rafiq Qazizada 8 Dr. Find articles by Mohammed Rafiq Qazizada. Find articles by Basma Al-Ansari. Email amb30 st-andrews. Find articles by Alexander Mario Baldacchino. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. 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Djibouti buying Heroin