The epidemiology of substance use in the West Bank: Who is at risk?

Illicit drug use is bound by a religious, social, and cultural stigma in Palestine. The extent of illicit drug use in Palestine is difficult to estimate due to the limited availability of research and challenged by poor measurement and inconsistent reporting. Concern about the hidden nature of drug use continues to be reported. We investigated the prevalence and risk factors associated with illicit drug use in the north of the West Bank. We compared the results between refugee camps and rural and urban areas. The recruited males (N = 1045) were invited to fill out a self-administrated questionnaire and to give urine samples in 2022. Multi-line drug screen test in urine was used as a screening tool to evaluate the presence of 12-drugs in urine samples. The respondents (N = 656) were aged 15-58 years. At least one drug was detected positive in 19.1% of the participants' urine samples, with the highest percentages among refugees (25.9%), followed by rural (13.6%) and urban participants (10.9%) (P-value < 0.001). Moreover, around half of the drug users were multidrug users. Refugees were 3.8 times (P-value = 0.002), and urban were 2.3 times (P-value = 0.033) more likely to be drug users than rural participants. Besides the geographical factors, socio-demographic factors like age (<30 years), marital status (single), drinking alcohol, and vape-smoking played significant roles in the increasing risk of illicit drug use in the West Bank. The findings from this study draw attention to our limited understanding of the epidemiology of substance use among Palestinians.