Policy analysisImplementing opioid substitution in Lebanon: Inception and challenges
Section snippets
Opioid substitution in the MENA region
In 2014, 80 countries and territories across the globe with an overrepresentation of high-income countries were implementing some form of OST. Methadone and buprenorphine were the most commonly used medications (Harm Reduction International, 2014). In around 50 other countries, the primary mode of treatment was still the traditional sequence of detoxification and residential rehabilitation (MacArthur et al., 2012).
The concept of harm reduction has slowly been gaining ground in the Middle East
Opioid use in Lebanon
Lebanon is a country of 4 million inhabitants on the shores of the eastern Mediterranean. It is a parliamentary democracy and a member of the Arab league. Its population is diverse both religiously and to a lesser extent ethnically, with wide socioeconomic variation. This combination of factors contributed to political instability since its independence from French mandate in 1943; a full-blown civil war between 1975 and 1990; and a state of near-hibernation for government apparatus. The impact
The implementation of opioid substitution in Lebanon
It was the concerted effort by international donors and organizers to stem the spread of HIV/AIDS and related blood-borne viruses in the MENA region that brought forward opioid substitution on the national agenda in Lebanon. Previously, individual patients that had been initiated on substitution abroad were treated by a small number of local doctors on their return to Lebanon. Despite anecdotal success stories, the absence of a reliable supply chain and a monitoring framework would have
Communication between healthcare providers
From the onset, one major limitation to implementation was the shortage in human resources experienced in delivering opioid substitution. Four pharmacists at two governmental sites were assigned and trained at the dispensing of buprenorphine. Dispensing units, like treatment centers are often environments where patients interact outside the control of healthcare providers. This informal interaction can have negative implications if not monitored or at least discussed with the patient, who is at
Discussion
The introduction of opioid substitution to Lebanon has had a significant impact on clinical practice in a relatively short period of time. Few recent healthcare initiatives have had an impact of such magnitude. Yet, it has proven to be difficult in finding evidence to the success of the program in the absence of reliable figures on the wider picture of the opioid problem in Lebanon. Some epidemiological studies suggest that Lebanon's substance use problem is not negligible (Karam, Ghandour,
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Medication for opioid use disorder in the Arab World: A systematic review
2022, International Journal of Drug PolicyCitation Excerpt :This review also highlights structural barriers to MOUD that are of particular relevance to the Arab World and can be targeted to improve MOUD implementation through each of the five metrics characterized by the RE-AIM framework. Ghaddar et al. (2018) describes financial, geographical, and social barriers to access MOUD, and El-Khoury et al. (2016) highlights communication and coordination challenges between prescribers and dispensers, an absence of local prescribing guidelines, a lack of supervised dispensing of medications, a lack of education regarding consumption and cessation of medications, drug diversion and trafficking, and constrained cooperation with security forces as barriers to treatment of patients in Lebanon. Many of these barriers may stem from the criminalization of narcotics in many Arab World countries, as well as the regional stigma associated with OUD patients (Harm Reduction International, 2020).
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2016, International Journal of Drug PolicyEvolution of policy for the treatment of substance use disorders in Qatar
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