Predictors of time to relapse in amphetamine-type substance users in the matrix treatment program in Iran : a Cox proportional hazard model application

Background: The aim of this study was to determine which predictors influence the risk of relapse among a cohort of amphetamine-type substance (ATS) users in Iran. Methods: A Cox proportional hazards model was conducted to determine factors associated with the relapse time in the Matrix treatment program provided by the Iranian National Center of Addiction Studies (INCAS) between March 2010 and October 2011. Results: Participating in more treatment sessions was associated with a lower probability of relapse. On the other hand, patients with less family support, longer dependence on ATS, and those with an experience of casual sex and a history of criminal offenses were more likely to relapse. Conclusion: This study broadens our understanding of factors influencing the risk of relapse in ATS use among an Iranian sample. The findings can guide practitioners during the treatment program

The Hidden Aspects of A Century of Substance Use Policymaking in Iran

The use of substances, especially opiates, has been a longstanding and significant problem in Iran. In response, Iran has experimented with a wide range of policies including nonintervention, regulation, legalization, prohibition, and criminalization. Exploring Iran’s substance use policies suggests that the Iranian government has been more concerned with byproducts of policies such as financial revenue, promoting diplomacy, and maintaining power, rather than genuinely alleviating the substance trade and addiction. First, we explore how opium taxation was the core substance use policy before oil became the main source of government income. Second, we discuss how conflicts of power between the health sector and other stakeholders relegated the role of the health sector and medical professionals. Lastly, we analyze the post-1979 revolution policies when Iran experienced social desolations, such as during the Iraq-Iran war and the subsequent economic recessions. We reveal that stigmatization and scapegoating of people who use substances have been used as a cover-up to obscure deeper social problems. This historical analysis ultimately reveals that Iran’s substance use policies have largely neglected medical approaches in favor of more oppressive, but politically expedient options

HIV, hepatitis C virus, and hepatitis B virus co-infections among injecting drug users in Tehran, Iran

SummaryObjectivesTo assess the prevalence of HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and co-infections among injecting drug users (IDUs) in Tehran.MethodsA sample of 899 IDUs (861 male and 38 female) was recruited in Tehran from treatment and harm reduction facilities and from drug user hangouts in public areas in equal proportions. ELISA testing for HIV, HCV antibody (HCV-Ab), hepatitis B surface antigen (HBsAg), and hepatitis B core antibody (HBcAb) was carried out. Positive HIV tests were rechecked by Western blot.ResultsThe prevalence of HIV was 10.7%, HCV infection was 34.5%, and past or current HBV infection was 50.7%. Infection with all three viruses was seen in 6.5% (95% confidence interval 4.9–8.2) of participants. HIV/HCV, HIV/HBV, and HBV/HCV co-infections were seen in 8.7%, 7.8%, and 21.0% of participants, respectively. The rate of HCV infection among HIV-positive cases was significantly higher than in HIV-negative IDUs (80.6% vs. 28.7%, p<0.0001). There was no significant association between these infections and co-infections with gender and source of sampling.ConclusionIn general, co-infection with these three blood-borne viruses is common among IDUs. Since co-infection increases the morbidity and mortality of all infections, the observed level of co-infection in the high number of IDUs in Iran necessitates a serious comprehensive response

COVID-19 and Substance Use Disorders:Recommendations to a Comprehensive Healthcare Response. An International Society of Addiction Medicine (ISAM) Practice and Policy Interest Group Position Paper

Coronavirus disease 2019 (COVID-19) is escalating all over the world and has higher morbidities and mortalities in certain vulnerable populations. People Who Use Drugs (PWUD) are a marginalized and stigmatized group with weaker immunity responses, vulnerability to stress, poor health conditions, high-risk behaviors, and lower access to health care services. These conditions put them at a higher risk of COVID-19 infection and its complications. In this paper, an international group of experts on addiction medicine, infectious diseases, and disaster psychiatry explore the possible raised concerns in this issue and provide recommendations to manage the comorbidity of COVID-19 and Substance Use Disorder (SUD).Publisher PDFPeer reviewe

Ups and downs of addiction harm reduction in Iran: key insights and implications for harm reduction policy and policing

Abstract Drug use is a critical behavioral disorder or a delinquency behavior (in the judiciary system's words) that comes with a burden at multiple levels: individual, community, public, and global. These social structures apply different interventions to reduce this burden in their field. Given the society as a whole, these structures must be harmonious and synergistic to optimize these endeavors in terms of cost–benefit. In practice, however, reducing the burden of addiction is followed by conflicting approaches by different organizations, in terms such as “eradicating drugs,” “eliminating drug users,” “obliterating addiction,” and ultimately, drug use harm reduction. In the harm reduction philosophy, drug use is recognized as an inescapable fact in human societies, and tries to control its personal and public consequences in different dimensions (health, economic, and social). Therefore, this approach includes broad measures such as: changing the pattern of consumption (from high-risk substances to less dangerous substances) through modification of the laws and law enforcement measures, distributing disposable syringes to prevent HIV transmission, providing basic life needs such as shelter for street-based drug users to reduce the social consequences like homelessness, prescribing substitute agonists to reduce the committing crime to obtain the needed drugs, and even the drug court program, which prevents the exacerbation of complications in a person with a chronic and relapsing disorder, due to the imposition of inappropriate sentences (like incarceration in unacceptable conditions). It is contrary to the approaches that aim to reduce the drug supply rate and drug use incidence and prevalence to zero. As a result of the conflict of interests, goals discrepancies, and differences in organizational culture, these approaches may contrast with each other. We see this in the harm reduction between the health system and law enforcement. Different factors affect the harmony or conflict between these two structures. This article addresses the impact of ideology, social conditions, and bureaucratic administration on the relationship between the health system and the police in drug use harm reduction in Iran

Executive Function and Attention Deficits in Post-Traumatic Stress Disorder: A Study on Iranian War Veterans

Objectives: Patients with Post-Traumatic Stress Disorder (PTSD) show poor cognitive performance during neuropsychological tests. Literature is scarce regarding veterans suffering with chronic PTSD. Therefore, in this study, we aimed to compare the cognitive deficiencies of veterans with chronic PTSD with those of healthy participants. Methods: A total of 51 hospitalized veterans and 45 healthy individuals were selected using a purposeful sampling method. Both groups performed a simple Stroop Test and the Continuous Performance Test (CPT) and completed the PTSD Checklist for DSM-5 (PCL-5). Results: The results of independent samples t-test showed a significant difference in cognitive impairment between the veterans with PTSD and healthy subjects, and the veterans had lower performances on most aspects of the tests than that of the control group. Discussion: According to our results, veterans with chronic PTSD showed lower cognitive performance than that of healthy individuals. This suggests that examination of the cognitive functioning of patients with PTSD can be useful in the diagnosis, prognosis, and treatment of PTSD

Profile of People Who Inject Drugs in Tehran, Iran

The marked shift in the patterns of drug use in Iran, from opium smoking to injecting drug use, has led to serious health-related outcomes. This study was designed to explore characteristics of people who inject drugs (PWID) in Tehran, Iran. Nine hundred and four PWID were recruited from treatment and harm reduction facilities, as well as drug user hangouts in public areas in Tehran. Participants were interviewed using the Persian version of the World Health Organization Drug Injecting Study Phase II questionnaire. The median age at the time of the first illegal drug use, at the time of the first injection and current age was 20, 24 and 32, respectively. In more than 80% of the cases, the first drug used was opium. The transition from the first drug use to the first drug injection occurred after an average of 6.6 and 2.7 years for those who had started drug use with opium and heroin, respectively. Two-thirds of the participants shared injecting equipment within the last 6 months. Difficulty in obtaining sterile needles and thehigh cost of syringes were reported as the major reasons for needle/syringe sharing. Approximately 80% of community-recruited PWID reported difficulties in using treatment or harm reduction services. Self-detoxification and forced detoxification were the most common types of drug abuse treatment in alifetime. Despite a dramatic shift in drug policy in Iran during the past few years, wider coverage of harm reduction services, improvement of the quality of services, and education about such services are still necessary