Lexotanil, Valium, Xanax, Tranxene... These are very familiar names that have integrated into the everyday life of Lebanese society. With an import bill totalling $76 million in nerve medications and tranquilizers alone, these drugs raise a haunting specter of long-term use as a replacement to handling the normal stress of everyday life.

Such drugs help control symptoms such as anxiety, agitation, profound sadness, depression, sleep, confused thinking, poor concentration and discomfort from physical pain. However, risk of drug dependence greatly increases when tranquilizers are taken regularly for more than a few months, although problems have been reported within shorter periods.

Imports of tranquilizers, nerve medications and mental health drugs - making up 19% of pharmaceutical imports - come second only to antibiotics, which account for 20% of imports. Vitamins comprise 14%, heart & artery medications, 9%, while gastric, respiratory, skin disease and hormone medications each make up 7%, followed by cancer drugs at 4% and other pharmaceutical imports equal 6% of the total (figures are according to the Joint Project between Parliament and the UNDP, and the Health Sector in Lebanon Report).

Based on Information International’s opinion poll and estimation by pharmacists and pharmaceutical distributors, Lexotanil, Xanax, Librax and Tranxene make up 68% of tranquilizer, nerve and mental health pharmaceutical imports, followed by Valium, Prozac and others which amount to 32%.

These figures add up to the consumption of approximately 500 million pills per year (this figure may be over- or underestimated due to smuggling activity). This will lead us to several different results and it is possible to deduct that the number of people taking these medications totals 685,000 (if we consider each takes 2 pills daily) or 273,000 (if 5 pills/day are taken by each).

These figures mean that between 11.8% and 29% of Lebanese aged 15-64 are using tranquilizers. This is in comparison to use by countries in Table 11.

Comparative Tranquilizer Use

In Information International’s poll of university student habits, 7.7% of those polled admitted to taking tranquilizers, bringing the number to 7,700 students, as shown in the diagram below.

Broken down by gender, the 7.7% who admitted to taking tranquilizers were made up of 9.1% females and 6.4% males.
The kind of institution being attended was also a measure, with those attending private universities having a higher user rate (8.6%) than Lebanese University students (7%). The most common reasons for use are illustrated in Graph 10.

When asked about their knowledge of friends also using tranquilizers, 23% said they knew of other students who used them while 77% said they did not. Of those who responded positively, the tranquilizer most used by friends was, by far, Lexotanil and the most frequent justification provided was sickness.

Also, a correlation was found between higher tranquilizer use and increased student expenditure. So, as in smoking, alcohol consumption and drug addiction, available income plays a big role in the purchase of tranquilizers.

5.7% of students whose expenditures did not reach more than $200/month took tranquilizers, while this percentage increased to 6.7% among those who had an allowance of $200-$500, 18.1% of those who spent $500-$1000, and finally, 18.8% of those with expenditures of over $1000 took tranquilizers.

An important question to be asked concerned the individuals who initially introduced students to the drugs.

Although 59.5% of the students replied that their doctors advised them to take tranquilizers, a 1997 study commissioned by UNICEF described the relationship Lebanese have with their pharmacists as follows:

“The pharmacy often figures as a substitute for medical treatment. A visit to the pharmacy is less time-consuming, less costly and after all, it is conceived to provide more immediate results. Visiting the pharmacy is a routine activity and approval by the pharmacist was conceived as certifying the correctness of the prescribed treatment. Advice from the pharmacist was observed to be taken more seriously than the one of the physician.”

The study also found that “since individuals can purchase virtually any medicine they desire from pharmacies, they can prescribe and treat themselves with a variety of agents. This makes lay people in Lebanon considerably more autonomous in controlling their health than in Europe and the United States, where there is a stricter enforcement of the laws that regulate medical practice and drug sale.”

This variable is a significant determinant in the popularization of tranquilizer use since they are all too often sold over the counter without a prescription. A great deal could be achieved in the battle against tranquilizer abuse if some regulations were applied to their dispensal. Table 12 is a comparison of Lebanese and American dispensal policies.

Dispensal Policies

The lack of a framework for control of Lebanon’s pharmaceutical market is highlighted in the table by unrestricted quantity dispensal and disregard for laws requiring a doctor’s prescription, considerably increasing the risk of abuse.

Also, the 1999 study published by the Zavarian Review noted that tranquilizers were being sold like hot cakes in the Lebanese pharmaceutical market, and the author describes a trend of carrying around a box of 1.5 mg of Lexotanil, taken to handle nearly everything, from minor stress to headaches, indigestion and even the flu.

With regards to the sorts of tranquilizers being taken by students, Graph 12 illustrates the most widely used as according to Information International’s poll.

In an American study conducted by the Scientific American publication in 1996, an attempt was made to measure depression rates throughout the world. It was found that the lifetime risk of depression (defined as the probability that a subject will suffer at least one episode lasting a year or more) ranged from 1.5% in Taiwan to 19% in Lebanon. In between were Korea at 2.9%, Puerto Rico at 4.3%, U.S. 5.2%, Germany 9.2%, Canada 9.6%, New Zealand 11.6% and finally France with 16.4%.

It is important to note that France is the largest consumer of tranquilizers in Europe, while its depression rate still remains below that of Lebanon. According to the United Nations International Narcotics Control Board, Europe occupies first place when it comes to the medical use of tranquilizers and doctors in France prescribe about four times more tranquilizers than other European nations. Therefore, it is important to gather more accurate statistical data pertaining to the use of tranquilizers in Lebanon as this country’s consumption rates may actually rival those of France.

This growing problem of widespread addiction can be largely addressed with greater regulation, and the importance of conducting more accurate studies is paramount to bringing the reality to the minds of the Lebanese public at large.