National population size estimation of illicit drug users through the
network scale-up method in 2013 in Iran
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Abstract
Background: For a better understanding of the current situation of drug use in Iran, we utilized the
network scale-up approach to estimate the prevalence of illicit drug use in the entire country.
Methods: We implemented a self-administered, street-based questionnaire to 7535 passersby from the
general public over 18 years of age by street based random walk quota sampling (based on gender, age
and socio-economic status) from 31 provinces in Iran. The sample size in each province was
approximately 400, ranging from 200 to 1000. In each province 75% of sample was recruited from the
capital and the remaining 25% was recruited from one of the large cities of that province through
stratified sampling. The questionnaire comprised questions on demographic information as well as
questions to measure the total network size of participants as well as the network size in each of seven
drug use groups including Opium, Shire (combination of Opium residue and pure opium), Crystal
Methamphetamine, heroin/crack (which in Iranian context is a cocaine-free drug that mostly contains
heroin, codeine, morphine and caffeine with or without other drugs), Hashish, Methamphetamine/LSD/
ecstasy, and injecting drugs. The estimated size for each group was adjusted for transmission and barrier
ratios.
Results: The most common type of illicit drug used was opium with the prevalence of 1500 per 100,000
population followed by shire (660), crystal methamphetamine (590), hashish (470), heroin/crack (350),
methamphetamine, LSD and ecstasy (300) and injecting drugs (280). All types of substances were more
common among men than women. The use of opium, shire and injecting drugs was more common in
individuals over 30 whereas the use of stimulants and hashish was largest among individuals between
18 and 30 years of age.
Conclusion: It seems that younger individuals and women are more desired to use new synthetic drugs
such as crystal methamphetamine. Extending the preventive programs especially in youth as like as
scaling up harm reduction services would be the main priorities in prevention and control of substance
use in Iran. Because of poor service coverage and high stigma in women, more targeted programs in this
affected population are needed