Addicted to the pharmacy

Lema Chehimi

‘Said’ used to be addicted to over-the-counter drugs. “I used to take Tramal and Legaflex,” he explains. “I am not taking them now though. I used to go on and off them every three months.”

Said says that he took them to feel better; one drug energized him while the other made him depressed. “But now I completely stopped taking any of them because they are very addictive drugs that I don’t want to get used to,” he insists.

Said only agreed to a phone interview on the condition that his lawyer listened to the conversation on loud speaker. The lawyer, who also asked me to be discreet about her identity when the article was published, warned me not to offend her client or to record his voice. Otherwise, Said would press charges. 

According to Oum El Nour Rehabilitation Center statistics, Lebanese youth are taking drugs from an ever younger age. In 2008, 69% of 12-19 years olds had taken drugs compared to 59% in 2002.

Samar Kataya runs her own private pharmacy, Al Hawraa, in Bir Al Abed in the southern suburbs. “They’re mostly young men and teenagers. A lot of them have tattoos all over their bodies. They all have dark patches under their eyes, they’re very thin physically and most of all they’re all smokers,” she says.

When Kataya encounters medicine addicts, she prefers to stay “on the safe side,” telling them that she does not “purchase nor sell the kind of dangerous medication they ask for."

Normally, when a person gets sick, he or she visits their preferred physician who, after carrying out a check-up, issues a prescription, which then allows the pharmacist to sell the prescribed medicine to the patient.

However, whenever drugs like Alprox, Stilnox, Valium, Rivotril, Dormicum, Lexotanil, Xanax and others are prescribed, a pharmacist has to be aware that this isn’t just another prescription for an antibiotic or ointment.

These drugs are medicines that can be sold at any pharmacy around Lebanon. But how and to whom they are sold must be monitored.

May Badran is a pharmacist in the regulatory affairs section of a multi-divisional trading company in Lebanon which distributes pharmaceuticals to pharmacies in Lebanon. She is in charge of registering the drugs at the Lebanese Ministry of Public Health.

In Lebanon, most of the drugs that are abused are sedative hypnotics, which require a prescription from a physician and, by law, must be kept locked in a hidden, steel safe. “Come and take a look,” says Kataya, bending to reach a small hidden closet containing a steel safe box. Every pharmacy also keeps a record of the quantity and type of sedative hypnotic drugs that are purchased. This information must be shared with the Ministry of Public Health, which also carries out sporadic checks on pharmacies’ records.

Any patient requiring a sedative hypnotic drug must have an appropriate prescription carrying a recent, unedited date. If the doctor makes a mistake writing the date he must correct it adding a stamp to show it is legally corrected. The name of the sedative has to be written clearly by the doctor with clarification on the appropriate amount of capsules or boxes for each particular patient.

Any doctor or physician has the authority to prescribe sedatives including dentists and pediatricians. However, only psychiatrists have the authority to prescribe sedatives for six months. A pharmacist cannot give a patient more than the appropriate amount for him/her for that one month.

Drugs that are not sedative hypnotics do not require prescriptions and pharmacists will not be penalized by the Ministry of Public Health if they sell them to patients, Badran explains. For example, Badran explains that “anti-psychotic drugs can be sold without prescriptions because they are not very strong and dangerous.”

Alex, 20, student, admits that he’s been taking Normacalm, which is composed of safe herbs, and Dormicum, a sedative hypnotic which he says helped him with his anxiety and his nervous breakdowns. “I took it out of my own volition; no one prescribed it for me. But it made me feel better when I was in pain. But I really cannot tell you where I got Dormicum from or how,” he insists.

Kataya says that a lot of young men and women like Said and Alex come to her pharmacy asking for drugs. “Legaflex gives a sleepy feeling and relaxes the body. As for Tramal, it is actually a painkiller that can be addictive when high dosages of it are taken. Tramal doesn’t need a prescription from a doctor. Addicts know what they ask for. But, fortunately, our syndicate has acted out of its own volition and agreed that all pharmacists do not sell this particular drug without a doctor’s prescription. These young people know nothing about the drugs they’re taking. They ask for them because the names are popular through word of mouth. Some even mix sedative hypnotic drugs with muscle relaxants,” she says.

Some addicts even ask for a cough syrup called Dulcana, which contains Codeine, a narcotic painkiller, Kataya adds. “They drink the whole bottle in one single shot to get the full effect of loss and relaxation,” says Kataya.

“There are always sneaky ways for addicts to get what they want,” adds Kataya. “I, for example, am very aware that there are a couple of physicians around the area who are known for selling sedative hypnotics drug prescriptions for very low prices. What I usually do is send the addicts away telling them that I don’t sell this drug as soon as I see that one of these doctors has issued the treatment. Other pharmacists arrange agreements with certain physicians they know. What they do is buy stamped prescription sheets in the name of the doctor they are familiar with from the doctor himself and as soon as an addict steps in the store and asks for the sedative drug, the pharmacist proceeds with everything legally. Those who do that usually do so just for the sake of selling and making profit with disregard to ethics,” she adds.

 “My profession is not a light one. It all comes down to the pharmacists and doctors being conscientious,” concludes Kataya. 

 
A previous version of this article was published in Issue IV of the Lebanese American University's 'The Tribune'

Revised box: 

There are four categories of psychotropic drugs:

Sedative hypnotics: Minor tranquilizers, used for sleep disorders. There are four categories: benzodiazepines, buspirone, barbiturates and ethyl alcohol. Depending on the drug, side effects can include addiction, sedation, memory disturbance, dull attention, dysarthria (meaning talking very slowly and stumbling over one's speech), and paradoxical excitement. Sedative hypnotics are the most commonly abused type of drug in Lebanon. A prescription is required.

Anti-psychotic drugs: Major tranquilizers, also known as neuroleptics. They are used to treat paranoia, schizophrenia, mania and drug-induced vomiting, among other illnesses. They can affect the central nervous system and the cardiovascular system, including one’s heart rate. Side effects can include drowsiness, Parkinsonism, abnormal involuntary movements of the jaw and the tongue, dryness of the mouth, blurred vision, constipation and urine retention. They can be sold without prescription in Lebanon.

Anti-depressants: There are five categories of anti-depressants, used for different types of depression and causing different side effects. Depending on the drug used, side effects can include hepatotoxicity (liver poisoning), tremors, confusion, hallucination, nausea, insomnia, blurred vision, dryness of mouth, anorexia, diarrhea and thyroid enlargement.  

Psychotomimetic drugs: Hallucinogenic, not used clinically.