Joseph El-Khoury

The cannabis question

Walid Jumblatt’s call for the legalization of cannabis cultivation fits into a global trend, from the USA to Uruguay

These days, one is invited to pass a joint around at a trendy house party in Achrafieh and at beach raves in Batroun. (NOW)

As a psychiatrist, I spend a disproportionate amount of time talking about cannabis. Across a clinic desk or a dinner table, few things generate more interest these days than the pros and cons of legalizing cannabis in Lebanon. This proposition is not the fantasy of libertarian intellectuals newly arrived from Amsterdam, but an idea that periodically gets media attention with every economical downturn that hits the country. Earlier this year MP Walid Jumblatt, followed closely by colleagues from his political bloc, threw his hat in the ring and called for the legalization of its cultivation, pushing forward the economic argument but also the ‘harmless’ nature of cannabis use.


There is a well-established link between substance abuse and mental disorders. Addiction is itself a recognized mental disorder with serious consequences on individuals and society at large. Cannabis, similarly to alcohol, does carry the potential for addiction amongst a minority of those who use it. Based on current scientific knowledge, consumption of cannabis should remain occasional and limited to adults of sound mind. Anyone suffering from a psychological condition should avoid it due to its known association with severe mental illnesses, such as psychosis. The growing evidence of detrimental effects on developing brains makes it imperative that efforts are made to keep teenagers from using it, and preferably even beyond this age. Again, the parallel with alcohol in this regard is striking.


Given the dynamics of politics in this country, Jumblatt’s call in and of itself is unlikely to provide the gravitas for an effective change in the legislation. What is new in 2015 is that this call from a prominent public figure fits into a global trend of legalization of cannabis cultivation and consumption, from the USA to Uruguay. The legal frameworks adopted vary, but the premise relies on a number of key arguments:


First, despite billions of dollars spent, the heavy-handed “War on Drugs” spearheaded by the US for decades has failed to dismantle the criminal networks involved in trafficking. The supply and demand for illicit drugs has remained steady.


The second argument is that cannabis is no more dangerous on a personal or social level than alcohol; the most used and abused substance worldwide. Yet since Prohibition was repealed in the US in 1933, banning alcohol hasn’t been on anyone’s agenda, except maybe for religious reasons. If alcohol is legal, why shouldn’t cannabis be?


Third, since people are smoking cannabis anyway, taxing it would generate revenue for the state. In an ideal world, some of this income could potentially be used in social and health development programs aimed at dealing with the consequences of addiction. With no early evidence of a cannabis consumption epidemic in Colorado or Washington, we are likely to witness a domino effect of legalization in other US states as well as internationally.


As for us, in Lebanon, it can’t be said that smoking cannabis is something we learned from the ‘corrupt’ West. The consumption of psychoactive substances is a long-established tradition in the Near East, including Lebanon. Cannabis cultivation in the Bekaa Valley can be traced back to Roman times, according to some sources. Nonetheless, we are not a nation of trendsetters. What is happening in the US—the culture and habits of which permeate most aspects of our lives—will lead us to question and challenge long-established beliefs. It wasn’t that long ago that a woman smoking cigarettes would have been as shocking to passersby as a group of hipsters lighting up a joint outside a pub in Mar Mikhail is perhaps today. 


In less than a decade, attitudes towards drug consumption— cannabis in particular—have eased. This is noticeable among the cosmopolitan elite but also in more traditional settings. Cannabis seems to cross over many social and demographic lines, except maybe for religious conservatives. Smoking hash is no longer restricted to the backstreets of Bourj Hammoud or the dorm rooms of Hamra. These days, one is invited to pass a joint around at a trendy house party in Achrafieh and at beach raves in Batroun. One simply no longer needs to be associated with specific social circles to be exposed to it, and the traditional image of the ‘Hashash’ seldom applies.  


Unfortunately, the legislation and attitude of law enforcement agencies have not kept pace with the evolving reality. Aside from a timid initiative of court diversion in the form of the National Committee for Combating Addiction, little thinking has gone into how best to approach this growing social phenomenon.


According to the Civil Observatory for an Independent and Transparent Judiciary, in the past two years, only 110 individuals received the option of compulsory treatment as an alternative to indictment. In parallel, nearly 3,000 arrests were made for drug use in 2014 alone. Across Lebanon, young men and women caught using cannabis continue to face arrest, incarceration and humiliation. The trauma of this experience alone often has the paradoxical effect of reinforcing drug use behavior as an act of self-affirmation against a despised traditional society and of rebellion in the face of a distrusted state apparatus.


In the absence of consistent national surveys, we rely on compiling information from various sources to establish the prevalence of substance abuse in Lebanon. The scarce research done over the years estimates the percentage of high school students who had ever used cannabis in 1999 at 7%. This pales in comparison to 37% of American teens in 2014, according to a US national survey. Nonetheless, most experts would agree that all forms of substance abuse is on the rise in Lebanon compared to a decade ago. This includes regular cannabis use and excessive alcohol consumption among youth.


Alcohol consumption, unrestricted and unbridled, seems to be a pillar of ‘brand Lebanon.’ Drinking in the Paris of the East is a form of cultural resistance that few would dare challenge for fear of feeding into inter-sectarian rhetoric. It may come as a surprise that European governments spend time and money to encourage their youths to drink less and drink better. In Lebanon, by contrast, enthusiastic bartenders nightly serve strong alcoholic beverages to teenagers who then drive home without concern for their safety or that of others. 


I emphasize the parallel between these matters because I strongly believe the legalization of cannabis can only succeed and have the proposed relative benefits in a society where underage drinking and cannabis smoking can be controlled and related legislation implemented. The experience so far on these fronts and others is not encouraging.


Legalization would also involve taxation and a quality control system. If one wants to purchase cannabis legally, certainly one wants assurances that it is actually cannabis and that it is grown organically and with the appropriate content of THC—the active component that produces the desired euphoric effect.  As we often hear from users, the cannabis currently available on the Lebanese street is sometimes laced with other, more harmful ingredients, such as Ketamine, opiates and Salvia. I can hardly see our busy Ministry of Public Health laboratories focused on this matter when they are still struggling to establish what is in our labneh.


If we do legalize the cultivation of cannabis, we will need to accept that a significant proportion of the crops will be consumed locally by young Lebanese and for a purely recreational purpose. We should also stop promoting the myth of a production sold to diabetics and cancer sufferers in the developed world, as it is not in the healthcare field that cannabis will make its mark. When we are ready to accept these facts and contemplate their implications, we will be mature enough for a serious legalization debate. Until then, a more nuanced and less bureaucratic alternative is available: decriminalization.


Tried and tested in places such as the Netherlands (gradually since the 1970s) and Portugal (since 2001), decriminalization means that an individual caught with cannabis does not face arrest or criminal charges as long as the quantity carried is for personal consumption. It is a system that does not require direct intervention from state institutions in the complex regulation of the cannabis market. One downside is that it maintains a number of grey zones subject to subjective interpretation by lawmakers and police forces—for example; what constitutes personal consumption? would users be fined?, etc.


In Portugal, where all drugs—not just cannabis—have been decriminalized for the past 14 years, no explosion in drug use has resulted. Portugal remains one of the countries with the lowest rates of consumption in Europe. Benefits have included less crime, fewer drug-related overdoses, and better access to treatment. This half-measure would be more in tune with our Lebanese reality. By treating personal consumption of cannabis as a minor offense, it would allow a better allocation of law enforcement resources towards more serious crime and the prosecution of the more dangerous drugs traffickers.


Politicians and lawmakers will have to tackle the cannabis question sooner or later. Regardless of how they choose to answer it, clinicians will continue to raise awareness on the benefits of a substance-free lifestyle and to treat those who fall into the trap of addiction of any kind.


Joseph El-Khoury is a consultant adult & addiction psychiatrist at St George's Hospital University Medical Center in Beirut. 

These days, one is invited to pass a joint around at a trendy house party in Achrafieh and at beach raves in Batroun. (NOW)

It wasn’t that long ago that a woman smoking cigarettes would have been as shocking to passersby as a group of hipsters lighting up a joint outside a pub in Mar Mikhail is perhaps today."

  • يسترجي

    The conclusion is very good. If only the politicians help you in your noble duties instead of seeking public acclaim and fame for very selfish and shallow goals...

    March 25, 2015