New FHS Study Warns: Lebanese Students Misusing Prescription Drugs, Potentially Exposing Themselves to Harm

The AUB Faculty of Health Sciences (FHS) held December 5-6 an international scientific conference on “Public Health in Contexts of Uncertainty” in the region, to culminate its 60th anniversary celebrations.

The conference highlighted FHS’s research and outreach networks, which have allowed it to make a positive and tangible impact on public health in Lebanon and the region.

Over the years, the faculty has conducted dozens of studies on public health, including the breakthrough discovery of solar water disinfection, which was discovered by FHS Professor Aftim Akra in the 1980s.

Currently FHS is conducting several studies on health and behavior, including topics such as depression among seniors, gambling and addiction, sexual behavior, maternal and reproductive health, nurses’ health and safety, tobacco control and waterpipe smoking behavior, and many others.

One of the most recent studies published by FHS showed a dangerous trend among high school and college students of misusing prescription drugs.

Study on prescription drugs and students

Most college-age students find it easy to obtain prescription medication in Lebanon, potentially misusing or abusing the drugs, two new AUB studies have found.

The studies, both published in Drug and Alcohol Dependence journal, are the first to come out of the Arab world on the non-medical use of prescription drugs among youth.

The first paper, published in 2012, investigated how AUB students, a diverse group of Lebanese and non-Lebanese students, obtain and use prescription drugs. The second, published in October 2014, targeted private and public high school students in Beirut and explored whether nonmedical prescription drug users were more likely to smoke waterpipe, a widely practiced habit among young people in the Eastern Mediterranean.

Up to 63 percent of AUB students reported that it is rather easy to obtain prescription drugs without a doctor’s prescription, and waterpipe tobacco smokers were three to five times more likely to use sedatives, sleeping pills, or pain relievers without a doctor’s prescription.

Elsewhere, scientists have established a strong link between cigarette smokers and increased non-medical use of prescription drugs. Given that about one in two Lebanese high school students have tried waterpipe smoking, compared to one in four who have tried cigarette smoking, studying the link between waterpipe smoking and non-medical use of prescription drugs becomes imperative in order to devise the most useful public health intervention programs. Waterpipe tobacco smoking is misperceived as less harmful and addictive than cigarette smoking, when emerging research clearly indicates that it is comparable or worse to cigarette smoking.

“The results show a dangerous trend,” said Lilian Ghandour, assistant professor of epidemiology and population health at the AUB Faculty of Health Sciences. “The situation warrants close monitoring, and calls for immediate mobilization and increased awareness among stakeholders, including parents, the government, and youth themselves.”

Ghandour noted that students access potent prescription drugs such as Tramal, Vicodin, Xanax, Lexotanil, Valium and others either by buying them from a pharmacy without a prescription; or by having a physician prescribe one; or by using their friends’ or family’s leftover prescriptions. “Highest on the list are parents, who were the leading reported source for all medications except stimulants,” noted Ghandour. “Whether the supply is direct, on indirect by leaving such medication unattended at home, remains to be investigated”.

“Another concern is that since the country’s healthcare system is not centralized, patients may be able to obtain several prescriptions simultaneously since one physician may also be unaware of another’s prescription note,” Ghandour noted.

“Although the majority of students are using these prescription medications for their intended use, that is, they are self-medicating, since they may be unaware of the drug’s side effects and potency when combined with alcohol or other drugs, they are exposing themselves to some serious risks when ingesting these drugs without medical supervision,” warned Ghandour. “In some cases, these risks could be lethal.”

International scientific conference on Public Health in Contexts of Uncertainty

The Faculty of Health Sciences launched its international conference on December 5 with an opening ceremony led by WHO-EMRO Regional Director Alaa Alwan, Canada’s International Development Research Center Vice President Stephen McGurck and AUB President Peter Dorman. FHS Dean Iman Nuwayhid was the keynote speaker of the event.

The conference aims to answer several questions including: How are we, as public health programs and professionals, facing or responding to these uncertainties? How does public health-- traditionally nested primarily in governmental institutions-- operate when states are weak? How have we adapted our programs of research, education, and practice to respond to such challenges? How do we set priorities?

Among the topics discussed at the conference were public health and the state, teaching health during uncertain times, NGOs that serve health during crises, and public health systems dysfunctions. Also, former FHS deans shared anecdotes from their tenure at the helm of the faculty.

President Dorman, addressing FHS deans, faculty and staff told a packed West Hall auditorium: “You have grown this faculty from a small school into one of the most visible and influential academic institutions of public health in the region—one of the shining stars in AUB’s canopy. I would like to think that AUB and FHS are points of certainty in an uncertain world.”

Alwan highlighted the unprecedented levels of uncertainty plaguing the region, noting that over the past two years 16 of 22 countries in the region have been facing an emergency crisis, and about 80 million people are affected. “This is unprecedented in the history of the WHO in any region, since WWII,” he said. “Currently, more than half of the world’s refugees are present in this region.”

Zeroing in on Syria, Alwan noted that poverty has increased from 10 percent in 2010 to hit 43 percent of the population in 2013. Similarly, while almost 90 percent of Syrians used to have access to clean water in 2010, now only about 30 percent do.

Alwan emphasized the need for preparedness and multi-sectoral cooperation as well as strengthening community support in order to face the public health challenges ahead.

IDRC Stephen McGurck lauded FHS’s leadership role in public health saying: “Managing risks and instabilities in this uncertain and increasingly multipolar world requires flexibility, systematic learning, a commitment to excellence and innovation, and a steadfast spirit of collaboration in finding ways to incentivize goodwill and fresh thinking for the long-term. These are traits and aspirations that we have witnessed and value in our longstanding relationships with the University and its Faculty of Health Sciences.”

In a thought-provoking keynote speech, Dean Nuwayhid urged academics to challenge conventional ways of defining research parameters by introducing context into demographics and their research. As an example, he asked how should a researcher characterize a Palestinian refugee born in Syria to be made a refugee a second time round and be forced to move to Lebanon? Would that person be considered from Palestine, Syria, or Lebanon?

“We cannot practice and teach public health in a void,” he said. “We need to take into account the social and political contexts, while keeping in mind the history.”

Nuwayhid added that health is no longer the domain of health professionals but extends to areas outside of the sector.

The Faculty of Health Sciences was the first independent, self-governed school of public health to open in the Arab region. Since its founding in 1954, it has been informing and impacting the state of public health in Lebanon and the region, by producing top-quality research on various topics as well as educating dozens of students who went on to assume leadership roles in the public and private sectors. More recently, the faculty produced a book, Public Health in the Arab World (Cambridge University Press, 2012), as well as the Lancet series of research studies on public health. It also had a leading role in passing the Tobacco Law 174, proposing a Food Safety Law, informing policies on diesel use and leaded gasoline in cars, as well as policies on mental health and water quality. Its graduate program was accredited in 2006 by the Council on Education for Public Health (CEPH), and it is the first to receive this prestigious accreditation seal outside the Americas and the only one in the Arab region.