Chapter 33 Drug safety in Lebanon Hala Sacre 1,2 , Aline Hajj 3,4 , Randa Aoun 2,5 , Souheil Hallit 2,6 , Abeer Zeitoun 2 and Pascale Salameh 2,7,8 1 Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon, 2 INSPECT-LB: Institut National de Sante´Publique, d’Epide´miologie Clinique et de Toxicologie, Beirut, Lebanon, 3 Faculty of Pharmacy, Saint-Joseph University (USJ), Beirut, Lebanon, 4 Laboratoire de Pharmacologie, Pharmacie Clinique et Controˆle de Qualite´des Me´dicaments, Saint-Joseph University (USJ), Beirut, Lebanon, 5 Faculty of Sciences, Saint-Joseph University (USJ), Beirut, Lebanon, 6 Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon, 7 Faculty of Pharmacy, Lebanese University, Beirut, Lebanon, 8 Faculty of Medicine, Lebanese University, Beirut, Lebanon 33.1 Introduction Therapeutic advances and the multiplicity of medications available to prevent or treat diseases have resulted in an increased risk of medication errors (MEs) and adverse effects related to drug use (World Health Organization, 2011c). Therefore the challenge is to put in place an integrative system, in addition to practices that would improve patient safety at all levels, especially medication safety (World Health Organization, 2016). 33.1.1 Country profile Lebanon is a developing country classified as a middle-income country by the World Health Organization (WHO) (World Health Organization, 2015), and as an upper-middle-income country by the World Bank (El-Khoury et al., 2012). In 2007 the Lebanese population was estimated at 3,759,136 inhabitants (World Health Organization, 2015) then at 4,822,000 in 2013, of which 21% were under 15 years of age and 12% were over 60 years old (El-Khoury et al., 2012). This number dramatically increased in 2017 to reach 6.1 million inhabitants (Arezki et al., 2018), due to the influx of Syrian refugees upon the declaration of war in Syria in 2012. The Lebanese health system is mostly private with conflicting characteristics at several levels (El-Khoury et al., 2012; World Health Organization, 2015): (1) despite collective solidarity and private insurance, 51.7% of the population has no social coverage; (2) health care is funded by various means (public, semipublic, and private) but households are the main mode of financing (Saleh et al., 2015); and (3) the state, represented by the Ministry of Public Health (MOPH), acts as a third-party payer rather than simply regulating the health care system, particularly for chronic dis- ease medications. Despite these discrepancies, patients have access to public and private care regardless of their social status (Ammar et al., 2016). 33.1.2 Dispensing practice In Lebanon, the dispensing of medications is subject to law 367 of August 1, 1994 governing the practice of the phar- macy profession (Khalifeh et al., 2017). Medications are mainly available through private community pharmacies, but patients in need can get theirs through governmental primary health care centers or nongovernmental organizations (NGOs); expensive medications are distributed free of charge by the MOPH to all patients who have no social coverage regardless of their economic status (Ammar et al., 2007; Harris et al., 2014). In community pharmacies, dispensing patterns are similar to those in developing and transitional countries where prescription-only medications are dispensed over the counter, without counseling, oftentimes by unqualified personnel, resulting in poor patients’ adherence to treatment. Most medications can be obtained without a prescription, including but not limited to antibiotics, antidepressants, and chronic diseases medications (Miller and Goodman, 2016; Basak and Sathyanarayana, 2010; Farah et al., 2015; Jamhour et al., 2017). In fact, only two classes of medications are strictly reg- ulated in Lebanon: psychotropic drugs and narcotics (Ministry of Public Health, 2001). Although the law is rigorously 449 Drug Safety in Developing Countries. DOI: https://doi.org/10.1016/B978-0-12-819837-7.00033-9 © 2020 Elsevier Inc. All rights reserved.