Michelle Wazan, Tatyana Sleiman, Dima El Hajj, Ramzi Haddad
5 min
In many countries, the criminalization of drug use creates a dangerous barrier to emergency medical care. When hospitals report overdose cases to the police, patients fear arrest and often avoid seeking help, significantly increasing the risk of preventable death. This paper examines the situation in Lebanon, where drug use is criminalized and hospitals have historically reported overdose cases to law enforcement, despite the existence of ministerial directives meant to protect patient confidentiality and access to care.
Between 2016 and 2024, the authors conducted repeated nationwide mappings of hospital practices across Lebanon. Using structured phone surveys with senior emergency department staff, the researchers documented whether hospitals reported overdose cases to the police and assessed their awareness of Ministry of Public Health circulars. The study also involved sustained advocacy efforts, including the dissemination of information to hospitals and collaboration with government entities to clarify that overdose cases do not constitute reportable crimes.
While advocacy led to a notable increase in the number of "safe hospitals"—those that do not report overdose cases to the police—the progress remains fragile. The authors found that even when hospitals were aware of protective circulars, many continued to report patients due to fear of legal liability, pressure from local security forces, and personal stigmatizing attitudes toward people who use drugs. The study highlights that in a climate of crisis and weak institutional accountability, incremental policy changes are insufficient. Without embedding these protections into formal hospital protocols and staff training, the threat of police involvement continues to undermine the right to health.
This research demonstrates that protective policies are often ineffective when they exist in a vacuum of punitive drug laws. For policymakers and health advocates, the Lebanese case serves as a warning: legal directives alone cannot overcome the deep-rooted culture of criminalization that permeates health care settings. True access to emergency care requires not just policy reform, but a fundamental shift in how medical institutions view their duty of care toward marginalized populations.
In Lebanon, the criminalization of drug use and the misapplication of ministerial directives have led hospitals to report overdose cases to law enforcement, deterring people who use drugs from seeking urgent medical care and increasing the risk of preventable death. This paper examines overdose response as a right to health issue, using civil society advocacy in Lebanon to illustrate how law enforcement involvement in health care settings undermines access to emergency care. Drawing on repeated nationwide mappings of hospital practices when receiving overdose cases conducted between 2016 and 2024, the paper documents patterns of compliance and noncompliance with Ministry of Public Health directives prohibiting the reporting of overdoses to the police. While sustained advocacy has contributed to multiple policy milestones, including ministerial and syndicate circulars reaffirming hospitals’ duty of care without police involvement, implementation has remained uneven. Although more hospitals have stopped reporting overdose cases to the police, continued reporting remains tied to limited staff awareness, fear of liability, and stigmatizing attitudes toward people who use drugs. The Lebanese case highlights both the critical role and the structural limits of civil society monitoring in safeguarding access to emergency medical care under conditions of criminalization, crisis, and weak accountability. We argue that incremental protective policies are insufficient where emergency care remains entangled with punitive drug policy.
Alex: So the policy isn't just fighting the law—it's fighting turnover and stigma simultaneously. What are staff actually saying when they admit to reporting these cases?
Sam: The justifications are telling. Many cite fear of legal liability, even though the circulars explicitly protect them. Others mention what the paper describes as the "tongue of people"—fear of social or media backlash if an overdose patient dies and the police weren't notified. In some areas, the physical presence of military or police checkpoints at hospital entrances creates a coercive environment where reporting feels like the default, regardless of what the Ministry says.
Alex: And the stigma itself—does that actually override their clinical training?
Sam: It does, and this is where the paper pushes beyond the policy layer. The authors document instances where staff explicitly argued that drug users are "harming others" or that treatment is a waste of resources. Which means that even when a hospital is technically safe—because they're not calling the police—the quality of care can still be compromised by staff attitudes. Policy is only as strong as the culture it's embedded in.
Alex: It sounds like the NGO is acting as a surrogate for a state that isn't doing its job. What's the ceiling on that approach?
Sam: That's the critical limitation, and the authors are candid about it. The study lacks granular mortality data to correlate "safe" status with actual lives saved—primarily because overdose deaths are so heavily underreported to begin with. And the NGO-led monitoring has no coercive power. If a hospital decides to ignore them, there's no legal sanction. Only social pressure.
Alex: So the takeaway is that you can't legislate your way out of a punitive culture.
Sam: That's the core argument. The authors suggest that until these protections are integrated into a standardized, state-run digital registry—where compliance is automatically audited rather than manually chased—the system remains fragile. Without that structural shift, you're relying entirely on the persistence of civil society to keep the doors open for the most vulnerable patients. And that's not a sustainable equilibrium.
Alex: A sobering conclusion. Thanks for walking through it.
Sam: Thanks for listening to ResearchPod.