The medications available in Lebanon no longer only include those with well-known brand names, as a drug shortage in the country has created a real problem for patients, leading to the entry of medications that are not internationally recognized into the Lebanese market.
Mohammad Hashim (60 years old) futilely tried to find hypertension medication at numerous pharmacies but failed. He was forced to substitute it with an alternative drug, which did not suit him and caused several complications, resulting in a hospital admission. The alternative medication was not recognized by the Ministry of Health, as revealed by Hashim's doctor. This means that people's health is now at the mercy of traders.
The issue of alternative medications in Lebanon is not new. Lebanese law has permitted their entry on the condition that they undergo laboratory testing. However, the chaos dominating the drug market, the lack of funds necessary to import them from abroad, and the cessation of major companies supplying the market have driven many traders to introduce drugs from different countries, including Iran and Syria.
In the past, Lebanese patients would buy drugs from Arab countries as a substitute for Lebanese medications due to their lower prices. However, today, in the absence of licensed drugs, the introduction of alternative medications has become a necessity for a large segment of the Lebanese population, despite their higher risks.
Dr. Selim Abi Saleh, the head of doctors in the north, does not deny the presence of alternative medications in Lebanon, attributing the situation in a statement to "Al-Modon" to two factors: the government's decision to open the door for imports and a severe shortage of medications due to the economic crisis. According to Abi Saleh's estimates, the size of the Lebanese drug market exceeds 1.6 billion dollars annually, and due to the lack of foreign currency, the introduction of alternative drugs from Arab countries or elsewhere has become a reality.
Since the 1990s, not all drugs in Lebanon are subjected to review and monitoring by the national laboratory for political reasons. Instead, the Ministry of Health relies on some laboratories outside Lebanon or local university laboratories to test the quality of medications. Nevertheless, many medications have recently entered Lebanon and are being sold indiscriminately, without any review or supervision, according to a source specialized in medical affairs. With the collapse of the political and economic situation in the country, the entry of unlicensed medications, according to the same source, has turned into a lucrative trade, not only for drug dealers but also for a significant number of traders who have found in drugs an additional profit.
Markets have been flooded primarily with Syrian and Iranian medications, while some importers are attempting to bring in some Indian drugs, although they have not yet been confirmed in the market.
### Smuggling and Trade
Legally, drugs can usually only be introduced to Lebanon with legal approval issued by the technical committee in the Ministry of Health. According to the procedures for drug registration in the ministry, a request is submitted to a committee composed of two doctors, two pharmacists, and four other members, who grant their approval after fulfilling specific conditions, and the drug becomes legal. However, since 2019, this mechanism has not been in effect, according to the source. The work of the technical committee has become almost nonexistent. As a result, some companies have sought to introduce drugs through smuggling before legislation was passed allowing their import.
The most dangerous issue, according to the source, does not only relate to medications for hypertension or diabetes but also includes cancer drugs that have entered the country and are being distributed to patients.
Some doctors refuse to prescribe alternative medications for treating patients. According to General Practitioner Dr. Hussein Ayyash, prescribing any drug that is not approved by the World Health Organization puts both doctors and patients at various risks. What is happening in Lebanon regarding the sale of alternative drugs is merely a form of internationally unprohibited commerce. Ayyash states to "Al-Modon": "I was shocked to find that one of my patients developed liver inflammation due to taking an alternative drug to treat cholesterol after the price of the original medication soared more than tenfold, forcing me to switch him to a cheaper drug that had negative results."
Mrs. Maryam Darwish (pseudonym, 65 years old) recounts that a charitable clinic prescribed her an alternative cholesterol medication. After using it for about a month, she began to experience symptoms of delirium and lethargy and was no longer able to complete her usual household tasks. After conducting tests, she was surprised to find liver enlargement. A follow-up with the doctor revealed that the medication contained chemical substances including amoxicillin/clavulanate, which contributed to liver poisoning and subsequently caused partial enlargement.
Although the issue of alternative medications in Lebanon is not new, its effects are starting to impact the health security of Lebanese citizens amidst the absence of any regulatory authority over the medications entering the markets, especially the smuggled medications distributed in some health centers.
