Pharmacists on the frontline: Medication misuse and abuse during violent conflict in four MENA countries.

Purpose: An important, yet under-researched, impact of violent conflict on public health is the susceptibility of populations in conflicts to drug abuse and misuse as increased stress, the easy availability of drugs, and the relaxation of taboos against drug use exacerbate the problem. This study explores the experiences of pharmacists regarding drug misuse and abuse in four conflict-affected MENA countries.

Methods: The study is part of a larger two-year (2021-2023) project investigating the impact of violent conflict in the MENA region on medicine abuse and misuse and the experiences of pharmacists in managing this challenge. This part used a quantitative approach using survey methodology with a sample of pharmacists in Syria, Libya, Yemen and Iraq.

Results: A total of 181 questionnaires were filled (65.7 % male, mean age = 29.9 years old. The majority of the pharmacists (n = 170, 93.9 %) reported that on average, 27.88 % of the pharmacy customers were suspected of misusing/abusing medications in the past 3 months. The most misused medicines were pregabalin and sedatives/hypnotics followed by opioids like tramadol, in addition to cough and cold and anti-allergy preparations. Almost one-third of respondents (31.49 %) refused to dispense drugs which they thought were intended to be used inappropriately. Sixty-five (35.9 %) said that they had been subjected to violence for the sake of obtaining medications, and 17 (9.8 %) reported being threatened five times or more in the past year.

Conclusion: Based on the results above, future interventions in conflict settings must address both supply-side governance and the broader psychosocial drivers of medication misuse/abuse to ensure that pharmacists are supported rather than exposed in their essential work.