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Opioid Addiction Looks Much Different In Arab America


Arab American communities face the tribulations of war at home compounded with the problem of addiction.

By Anonymous

In the early morning hours of August 17, 2017, Michigan State police busted into a quaint, corner walk-in pharmacy on the corner of Warren and Yinger in Dearborn, Michigan, a suburb south-west of Detroit, interrupting the daily deluge of transactions regularly accruing round-the-clock lines out the door at the infamous local “pill mill.”

Dr. Mohammad Derani was arraigned and had his medical licence suspended from the Department of Regulatory Affairs. Derani, who had written over 500,000 prescriptions since January 2017, averaging 43 every work day between 2015 and 2017, ranked among the most prolific distributors of controlled substances in 2015 and 2016, according to sources.

The national epidemic abuse of opioids, which include heroin or prescription pills, is often considered a white rural or suburban issue. Though Arabs and Muslims have not be spared from the epidemic, their ability to surmount the challenges of diaspora and tackle a nationwide drug epidemic shows a success, rather than deficiency, at the intersections of culture and community.

Like millions of Americans, Dearborn’s residents battle a nationwide drug epidemic that claims the lives of an estimated 100 Americans a day. In the city, drug-related arrests have jumped from 500 in 2011 to 1,000 in 2016. Opioid deaths more than doubled across the country as drugs of choice among users transitioned from prescription opioids to hard street drugs like fentanyl and heroin — a transition that coincided with the skyrocketing price of drugs following a period of overprescription.

Dr. Derani was one high profile case, but many doctors have been involved in fraud, overprescription, or other opioid scams. In June 2017, six southeast Michigan doctors were found guilty of pocketing illegal kickbacks amounting to $132 million in a nationwide insurance fraud scheme.

“Easily 8 out of 10 of our calls and cases were due to overdoses,” Ed, a 22 year-old emergency medical technician and second generation Arab-American, estimates. “Heroin, opioid, drug overdoses are an overwhelming problem, regardless of age, background, or nationality.”

Arab American communities face the tribulations of war at home compounded with the complications of adjusting to what is regarded within the community as a uniquely American problem of addiction. Both professionals and community members note the relative silence their issues are met with in mainstream America, and how that silence is internalized by Arab Americans, discouraging them further from seeking help.

Numerous community professionals and leaders, for years, noted the stigma surrounding mental health and substance abuse in the Arab American community. Silence and denial hamper any discussion around addiction. At funerals for the victims of a disease that claimed no one demographic, at times, deaths became reported by family and community members as heart attacks or as other natural causes. No one wanted to admit the actual cause.

At funerals for the victims of a disease that claimed no one demographic, at times, deaths became reported by family and community members as heart attacks or as other natural causes. Click To Tweet

“People wanted to say these youth had heart attacks, at 18, 19 years old,” said Mona Hijazi, public health lead at ACCESS. “Back in 2016 [when we started these programs] we couldn’t find anyone to talk to regarding these experiences.” Now, the program ACCESS pioneered, the ACCESS Substance Abuse Program (ASAP), boasts frequent community conversations, addiction counseling coaches, and informational resources that have been translated into Arabic.

Hijazi, also ASAP coordinator, is no stranger to the effects of addiction. Having grown up alongside a family member who spent two decades battling prescription drug abuse and addiction, she understands the challenges that many of her clients face. But she also draws upon her experiences in her role as part of the community coalition. “I never talked about [addiction] until I started my work because I felt that I was holding back from people that I was talking to. I actually had to go and talk to my mom and asked her if she would be okay if I said something — and not say who or even go into details — and she said, if you save one mom a heartache, why not.”

Since 2016, Hijazi recognizes that there had been tremendous change. ACCESS and the ICA began to partner up on ASAP, holding frequent talks and informational sessions and seeking community based help. The community outreach has been effective in raising awareness and breaking stigma. “The good thing about this partnership [with the mosque] is the Imam talks about how he can’t save somebody’s child with religion; that this is a medical issue and addiction should be treated as a disease.”

Dr. Hoda Amine is a Dearborn-based psychotherapist and social worker treating those suffering from addiction in the city’s east neighborhood. She pinpoints self-esteem issues as the factors predisposing her patients towards addiction. These factors, she identifies, are the result of the liminal status second generation Arab Americans find themselves in as “not quite” one or the other. “They don’t know how to be Arab and don’t know how to be American,” she says. “There’s a lot of pressure from the family and the society. They want to fit in — but they also want to disassociate.”

The opioid epidemic saw its transition from its prescription drug phase in the 1990s to a heroin and street drug crisis as the influence from the legacy of over-prescription manifested itself in the production and proliferation of street drugs. As drugs became more expensive, many that had become addicted to pain medication, finding their supply running out, turned to street drugs or more potent — and more dangerous — opiates.

While the grassroots efforts in the Arab American community have helped discussion and dialogue proliferate, institutions such as mosques and even law enforcement are also highly involved in community education and emergency treatment around addiction.

Local police nationwide are known for their participation in some of the most invasive, anti-black and Islamophobic policies and practices, including military and intelligence trainings with Israel, widespread surveillance of Muslim and Arab communities, and impunity for police murders of black people. Dearborn PD is the only police department in the state accepting Countering Violent Extremism (CVE) funds, supported by a highly controversial DHS grant issued to sponsor surveillance of mainly Muslim American communities, resulting in more names on the watch list than any city in the U.S. behind New York. However, they are also lauded for their perceived contribution in local addiction recovery efforts. Police partner with groups like the Dearborn-based SAFE substance abuse coalition group, mosques, and local schools to promote substance abuse awareness, and to provide resources such as naloxone, an anti-opioid agent.

This also highlights a complicated relationship between local law enforcement and minority communities, especially considering the deeply embedded role law enforcement has in opioid recovery. Yet despite the police’s public image as the front line in the war on opioids, it is women and progressive youth that have, as those most acutely impacted, made true efforts in changing the culture and breaking the stigma.

Safaa is one example of many who suffered in silence due to the stigma of coming out with an addiction. Like many others, her use started with doctor’s prescriptions, worsening once her tolerance level matched her prescribed supply. In recovery, Safaa realized that there was a need for a confidential support group for women in her community facing addiction. “It’s embarrassing for women to talk about these issues [around men] because there’s a stigma, there’s shame,” she says.

Thankfully, according to studies, women are more likely to seek treatment — however, counselors who work with Arab and Muslim American clients note that these women will seek care only outside of the community gaze.

It’s embarrassing for women to talk about these issues (around men) because there’s a stigma, there’s shame. Click To Tweet

Assembling the first Arab women’s addiction recovery support group, Safaa opened up a space where local women not only have access to confidentiality and support, but where, two years in, informational resources translated into Arabic have been made accessible, and honest dialogue on the issue in private spaces is facilitated. “[We are] the first Arab women’s (addiction’s anonymous) coalition,” she adds. “We do outreach, get together, talk about [drug] abuse.”

Zeinab, a freelancer who wrote for a local paper during the summer of 2016, recalls the response local outlets faced to publishing news on the sudden deaths of young community members, mostly young men, that had overdosed. These platforms received backlash that at times amounted to threats.

However, Zeinab says things are changing. “Yes, there was a backlash after the reported deaths in 2016, but I think our generation kind of shushed the angry voices,” she says. “They paved a way for discussion through organizations like SAFE and even youth programs at religious and academic institutions.” She credits new mediums and voices, as well as existing grassroots spaces, for helping move the conversation forward.

As these initiatives show, Arabs and Muslims have leveraged social and cultural dynamics to help combat a nationwide epidemic. It is because of — rather than in spite of — cultural tenants in religion, community, and service that they have been so effective at finding and creating solutions for recovery.

And for many of them, the very women, who, while less likely to die of painkiller abuse, are still more at risk, their bearance of the greater share of emotional and social burden in the home and in the community also render them the leaders in this effort.

“As women, we take on so much and we don’t say anything…we approach that especially when it came to substance abuse,” adds Hijazi. “Yet it’s possible to get through this [together], that you’re not alone as a mom, as a sister, as a friend.”