The 2020 MENAHRA situation assessment has presented a comprehensive review on the situation and development of the harm reduction response of drug use and its harms in the Middle East and North African region during the timeframe 2010-2020. Key situational factors hamper the harm reduction prioritization and response in the region. The current situation of drug production, trafficking and consumption (including harmful use) is exacerbated by political and economic instability, protracted conflict in some countries, security issues, weak cross border cooperation, the relationship between weapons, human and drug trafficking, the absence of alternative livelihoods for drug producers, and migration and displacement of almost 11 million in the region. We present here an overview of the regional situation generated by the MENAHRA 2020 situation assessment followed by regional prioritisation and country specific data and advocacy briefs.
Surveillance and academic activity on drug use trends, size estimates of key populations and treatment characteristics, and BBV prevalence in community and prison settings differ per MENA country and in some countries remains scant or dated, making it difficult to assess extent and trends in the MENA region. This hampers advocacy for harm reduction and the development of effective evidence-based drug and public health policies at country and regional level.
Law Enforcement and Penal Settings
Over 600,000 people are deprived of their liberty in the MENA region, the vast majority of who are male and detained on drug related charges (Al-Shazly and Tinasti, 2016). Repressive and punitive approaches to drugs including corporal punishment and death penalty, criminalization, coercive drug treatment mandated by the courts and aggressive policing continue to discourage health care seeking by PWUD. Some countries have reported the rise in private drug treatment and rehabilitation centers using methods which are not evidence based. This reinforces marginalization and stigmatization of PWUD/PWID and perpetuates unsafe/high risk use of drugs in the region.
Drug Use Trends
Although the MENA region is primarily a drug trafficking and transit region, there are notable production and consumption trends in Captagon (commonly fenethylline), opium, heroin, cannabis, ATS and Khat. Cannabis remains the most commonly used substance. Increased use of synthetic cannabinoids, ATS, and pharmaceutical drugs in a number of countries in the region has been observed through shifting trends of drug use. A concerning rise in synthetic cannabinoid use has been noted in Jordan, Kuwait, Egypt, and Palestine. ATS use has increased in Afghanistan, Kuwait, Iran, Iraq, Lebanon and Palestine. The rise in pharmaceutical drug use however, is the most widespread and noted among 15 of the 20 MENA countries (Afghanistan, Algeria, Egypt, Iran, Iraq, Jordan, Kuwait, Pakistan, Palestine, Qatar, Saudi Arabia, Syria, Tunisia, UAE, and Yemen). The World Drug Report 2020 has identified the trafficking and non-medical use of Tramadol and Captagon as one of the key challenges faced within the region.