Policy analysis
Implementing opioid substitution in Lebanon: Inception and challenges

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Abstract

Opioid Substitution Treatment (OST) is a firmly established method of treating and managing dependence to opioids in Europe, the US and rest of the developed world. It has a solid evidence base and a positive safety track record. Dissemination of its practice, in parallel to the acceptance of harm reduction as an effective approach, is still timid in low and middle Income countries. After years of advocacy on the parts of clinicians and the voluntary sector, the government of Lebanon launched a national opioid substitution program in 2011 using buprenorphine as the substance of substitution. Lebanon is one of the first countries in the MENA region to establish such a program despite a difficult socio-political context. This paper provides the background of harm reduction efforts in the region and presents the outline of the program from inception to present date. Challenges and recommendations for the future are also discussed. The Lebanese experience with opioid substitution is encouraging so far and can be used as a template for others in the region who might be contemplating broadening the range of services available to tackle addiction to heroin and related substances.

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,

References (23)

  • E.G. Karam et al.

    Substance use and misuse in Lebanon: The Lebanon rapid situation assessment and response Study. UNODC Report

    (2003)
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