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Drug and Alcohol Use in Iraq: Findings of the Inaugural Iraqi Community Epidemiological Workgroup

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Official websites use. Share sensitive information only on official, secure websites. Reports suggest increased use of alcohol, prescription drugs, and illicit drugs in Iraq in the past decade, which may portend an increase in substance use disorders SUDs and, thus, an increased need for treatments. To develop better information on the nature and extent of drug and alcohol use in Iraq, the Iraqi Ministry of Health, with support from the U. Drug seizure data was the primary data source, provided by Iraqi law enforcement and customs officials. Ministry of Health officials presented data from hospitals medical and psychiatric , outpatient clinics, and health centers, as well as from surveys of medical patients, pharmacy patients, and prisoners. The data suggest that the most commonly used substances are alcohol, hashish, and prescription drugs. Seizures of Captagon, methamphetamine, Afghan opium, teriac a crude form of opium , and heroin at border crossings may indicate that these substances are becoming more popular. A plan for an ongoing program of CEWG meetings was developed. Drug and alcohol use in Iraq is increasing and new drugs are appearing in the country. An ongoing program for monitoring drug use trends and informing Iraqi policy makers is important for public health planning, including the development of strategies to identify citizens with SUDs and provide them treatment. The Republic of Iraq, with an estimated population of 34 million people, is a country bordered by the Islamic Republic of Iran to the east, Turkey to the north, Syria to the northwest, Jordan to the southwest, and Kuwait and Saudi Arabia to the south. As of , there was no official Iraqi agency or organization conducting country-wide or even regional data collection on substance use World Health Organization \[WHO\], Thus, estimates of the patterns and consequences of drug use must be derived from various official and unofficial sources, none of which fully and accurately depicts the substance use situation in Iraq. A survey conducted in found that lifetime prevalence of alcohol use in Baghdad was Besides the growing levels of alcohol use, which is occurring along with increasing alcohol availability, especially in Baghdad, commonly used drugs across the country are sedative hypnotics and benzhexol. Responses indicated that diverted medications, which were mostly obtained through the black market and privately owned pharmacies without a prescription , were the leading drug problem, particularly benzehexol and anxiolytic medications, including benzodiazepines. These increases in the use of alcohol, prescription drugs, and illicit drugs may indicate an increase in substance use disorders in the country and, therefore, an increased need for treatment interventions. In order to develop a coordinated response to the problems related to the use and abuse of substances in Iraq, the Iraqi Ministry of Health, with funding from the U. The CEWG is a surveillance system that provides information on changes in illicit drug use, drug supplies, and drug-using populations, as well as the consequences of drug use on users. Data gathered and shared during the CEWG meetings can highlight an emerging problem or show how an existing problem is changing. Comprising a network of researchers from major metropolitan areas, the U. CEWG has been used to provide ongoing community-level surveillance on the nature of emerging trends in substance use in the United States, and this information has been used to directly inform policy makers. Data is gathered from multiple sources, including law enforcement records, hospital emergency department admissions, drug treatment centers, medical examiners' and coroners' offices, public health centers, surveys, and ethnographic research. The objectives of the CEWG are to identify local drug use patterns, monitor drug use trends, and detect emerging substances of abuse. Once this information has been obtained, representatives of the Iraq CEWG will communicate and disseminate the information to appropriate agencies to assist in the development and assessment of policy decisions, prevention strategies, and treatment intervention strategies National Institute on Drug Abuse \[NIDA\], The 2-day meeting reviewed the importance of and methods for developing a capacity in Iraq for better understanding the nature and extent of drug and alcohol use in the country and reviewed some of the existing data on this topic. During the morning of the first day of the meeting, Iraqi and international speakers provided background and a rationale for using the CEWG methodology as an epidemiological data approach. During the afternoon of the first day and the morning of the second day, a series of 14 reports were given that presented data and information on the current use of drugs and alcohol in Iraq. The primary data source was drug seizure data provided by law enforcement and customs officials from locations around Iraq. In addition, Ministry of Health officials presented data from hospitals medical and psychiatric , outpatient clinics, and community health centers, as well as from several surveys of medical patients, a survey of pharmacy patients, and three prison surveys. On the afternoon of the second day, a workshop was conducted to discuss ways of improving future CEWG meetings by expanding the types and sources of data that would help meet the CEWG goals. In addition, even though a representative from the Iraq Forensic Department did not attend the meeting, data regarding drug enforcement, including drug arrests and drug seizures, were provided. The primary source of these drugs was pharmacies in Iraq, many of which provided these medications without the necessary prescriptions. Reports in the Iraq-CEWG suggested that seizures of prescription medications occur throughout Iraq, suggesting that availability is still widespread. In contrast, seizures of illegal drugs are made predominantly in the southern governorates and in Kurdistan, in the north. It appears that Basra Iraq's major port city is one of the main entry points for much of the illicit drug supply in the south, and the border of Iran is an entry point in the north. The seizure reports estimate an expansion of the amphetamine market in Iraq. The first seizure of Captagon tablets and powder was made in Since that time, Captagon seizures have increased substantially. With a long and increasingly open border with Iran, it is likely that methamphetamine manufactured in Iran is being transported into Iraq. Until , hashish dominated non-pharmaceutical drug seizures, with only small quantities of heroin and opium being confiscated. In and , there were multiple reports of seizures of teriac close to the border with Iran Rawson, At the present time, there is evidence of heroin use in Iraq, which is primarily smoked or snorted. Injection does not appear to be the preferred route of administration by the majority of users. Significantly increased use of tramadol a relatively weak mu-opiate agonist was reported in a number of the regions in Iraq. In Mosul, a city in the north of Iraq, a study was conducted on individuals who were using tramadol. Of those interviewed, Regarding people's reasons for using Tramadol, Tramadol use was reported as the primary substance use disorder of patients admitted for treatment at the Baghdad Medical City Detoxification Unit. Following the data presentations and discussions, the group recognized the following considerations for future meetings:. At the present time, there is one inpatient treatment center in Baghdad and psychiatric units in Mosul and Basra. The only data available at present concern the type of substance used on admission. For subsequent CEWG meetings in Iraq, attempts will be made to obtain and present the following data:. Police records arrests and accidents, automobile accidents, falls, sexual harassment related to drug and alcohol use, etc. Surveys street surveys, youth risk behavior surveys, school surveys, high-risk population surveys. Surveys are among the primary sources of data on drug use. Surveys conducted regularly on populations at risk can provide information on attitudes, as well as trends and emerging problems. One specific suggestion was that a national survey on alcohol and drug use be conducted in Iraq to inform future CEWG meetings. A suggested parameter for the survey is to sample approximately 3,— participants nationally. The survey will be done by local staff who will receive a one-week training course in survey data collection, including training on survey research ethics and confidentiality. Sampling will collect information from a representative segment in each governorate; in addition, the following populations at high risk will be oversampled: sex workers, street vendors, and young adults. Saliva samples will be collected on a subset of participants and tested to assess validity of the self-reports. The initial meeting of the Iraq Community Epidemiological Work Group brought together leaders from a broad swath of Iraqi institutions. The 2-day meeting reviewed the importance of and methods for developing a capacity in Iraq to better understand the nature and extent of drug and alcohol use in the country and reviewed some of the existing data on this topic. The findings from this meeting suggest that since the time of the reports by Aqrawi and Humphreys and Al-Diwan on drug use in Iraq, as summarized in Rawson , some aspects of the drug-use situation in Iraq have remained relatively stable, while there have been significant changes in other areas. The psychoactive substances most widely used in Iraq continue to be alcohol and the following prescription drugs: benzodiazepines, benzhexol, codeine, and a variety of psychiatric medications. However, there was near universal agreement that the use of hashish, tramadol an opioid-type analgesic , and amphetamine-type substances ATS is increasing rapidly in some areas and that drug and alcohol use overall is increasing. Reports from Basrah health officials and police were noteworthy. The 01 Pills appear to be of the same type of ATS that are being used in epidemic amounts in Saudi Arabia, and they appear to be coming into the country via ships traveling to the Gulf and Saudi Arabia. The crystal is likely coming from Iran, since drug seizures have been near the Iranian border and crystal use in Iran is very extensive. In addition, reports from Mosul and from federal drug seizure data suggest that the use of tramadol is also increasing substantially in many parts of Iraq. This drug is available to users from pharmacies and from street drug dealers. At the present time, there is little evidence of increased use of heroin in Iraq, and rates of injection drug use appear to continue to be relatively low. The practical advantage of CEWG methodology is its use of existing data, prepared in a standard format. The data from existing sources is augmented by research and population surveys, when available. A national survey is currently being planned to provide new information, which will inform future meetings of the Iraqi CEWG and, it is hoped, lead to improved treatment for Iraqis with substance use disorders. As a library, NLM provides access to scientific literature. Subst Use Misuse. Published in final edited form as: Subst Use Misuse. Find articles by Nesif Al-Hemiary. Find articles by Jawad Al-Diwan. Find articles by Albert Hasson. Find articles by Richard A Rawson. Issue date Nov. PMC Copyright notice. The publisher's version of this article is available at Subst Use Misuse. Financial interests: None. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

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