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Iran J Psychiatry Behav Sci. The illegal use of amphetamine-type stimulants ATS is a global health concern with medical, psychiatric and social impacts. The use of ATS is a major health concern amongst the Persian population. The traditional pattern of illicit drug use in Iran is opium and the main route of drug use is smoking 1. However, in the recent years i. Although Iran has the only universal methadone treatment system in Western Asia 2 , ATS use is a health problem in Iran, which cannot be treated with methadone maintenance treatment 3 , 4. Amphetamine-Type Stimulants include a group of many drugs such as methamphetamine, ecstasy, and methylphenidate Ritalin tablets. Some ATS such as methylphenidate are prescribed for the treatment of medical and psychiatric problems such as attention deficit and hyperactivity disorder yet they can be misused with no medical prescription. This issue can result in dependence 2. Amphetamine-Type Stimulants dependence such as methamphetamine dependence is a relapsing condition with no approved pharmacotherapies 4 , 5. Furthermore, ATS-dependence is associated with high-risk behaviors such as violence, psychosis and suicide 1 - 5. Researches attempting to find an effective medication are ongoing and cognitive-behavioral treatments have remained as the main treatment options for ATS dependents 4. Amphetamine-Type Stimulants dependence has numerous reasons. For example, a recent study of males and females injecting methamphetamine users in Tehran indicated that methamphetamine dependence was associated with living with sexual partners, long duration of dependence, and lack of participation in step meetings and psychological sessions 6. Literature is not well documented on the prevalence of ATS dependence and the reasons associated with this problem in Iran. Furthermore, ATS treatment barriers have not been documented in Iran. To address this gap in the literature, this study aimed to investigate the prevalence of ATS dependence, the reasons associated with this problem and the treatment barriers in a group of general adult population in 22 districts of Tehran. Rapid situation assessment RSA was selected as the main study design in This was because of efficiency, cost-effectiveness and using a mixed quantitative-qualitative methodology 7. Furthermore, conducting a comprehensive survey in Tehran was time-consuming and expensive because the city is vast and populous. This guideline has been developed by the United Nations office for drug control and crime prevention as a standard method for conducting RSA 7. The study sites included 22 districts in Tehran; via the following official information resources, 22 districts with considerable rates of illegal use of ATS in the past two years were identified. After determining the study population, Open-Epi software was used to determine the sample size in each district. After determining the total required sample size using this software, convenience sampling was used as the main method of sample taking in each district of Tehran. Eligibility criteria included age of 18 - 65 years old, male or female gender, living in the same districs where the participants were recruited for at least three months prior to recruitment and taking any stimulant with no medical prescription. Dependence on ATS was defined as the daily use of any ATS within the past twelve months for a purpose not consistent with legal or medical purposes in Iran. This definition was based on the recent American diagnostic and statistical manual of mental disorders 8. Based on the study guideline 7 , to increase the chance of finding ATS dependents in each district, 10 to 12 former ATS users with good communication abilities were recruited and trained. This group facilitated finding eligible participants in each district. Overall, 35 well-trained interviewers were recruited to collect quantitative and qualitative data. They were general practitioners, social workers or registered psychologists with high qualifications in interview techniques. A checklist was designed with the collaboration of three senior drug researchers at the Substance Abuse and Dependence Research Centre in Tehran. The checklist included details of demographics, illegal use of ATS and qualitative questions about the reasons of ATS use and treatment barriers. The checklist was piloted on 30 ATS dependents before conducting the study. The validity of the checklist was considered with reviewing the relevant literature in the field of ATS use 5 , 6. The study was conducted between September and January Participation was confidential and voluntary. Consent forms were signed by participants. The study had one quantitative section, which included participants and one qualitative section, which included 60 interviews. All interviews were conducted in pre-allocated interview rooms in the districts. The FGDs consisted of six to ten people. Key informant interviewing was also conducted. Audio-taping was implemented with prior permission. Overall, ten key informants KIs were interviewed. Key Informants included health professionals, who worked with ATS dependents at drug treatment centers or other professionals such as the police. Quantitative data were analyzed using Chi-square test, independent samples t-test and logistic regression in SPSS version Qualitative data were analyzed using Atlas-ti qualitative software. Of the 22 districts, districts one and three were of high socio-economic status. Overall, seven districts 2, 4, 5, 8, 9, 13 and 22 were middle class and the remaining districts had low socio-economic status. Overall, participants were recruited from 22 districts. District 11 had the lowest reported prevalence rate of ATS use 1. More than half of the participants were males The age range and the mean age SD of all participants were 18 to 60 years and 32 SD 11 years, respectively. Overall, participants 4. Overall, A considerable number of participants reported that they experienced low mood The qualitative analyses of the interviews showed multiple reasons associated with the illicit use of ATS and different treatment barriers as follows:. A theme that repeatedly emerged from the narratives was a desire to increase a performance. Participants repeatedly described the roles of physical energy, concentration, and job-related performances as their reasons associated with current ATS use. Some guys use ecstasy for energy and sex. Furthermore, participants repeatedly explained how their misconceptions of ATS as non-addictive drugs resulted in self-treatment for psychiatric problems. I have some clients, who misuse ATS for low mood or anxiety at this clinic. Participant accounts indicated how beauty-related issues resulted in current ATS use. In addition, further data analysis highlighted that some beauty salons had recommended ATS as a way to improve quality of skin. Some people think Shisheh is good for skin. Participant narratives underscored how some ATS users used opiates before initial ATS use and believed that only opiates such as opium, opium residues and heroin were addictive. Further qualitative analyses of narratives indicated that most participants did not have an adequate amount of information about the addictive effects of ATS. As a result, some of them used ATS to substitute them with opiate use. Among participants, who were dependent on illicit ATS use, narratives described how poor knowledge of illicit ATS treatment services in the community prevented them from treatment entry. Further qualitative analyses of the narratives demonstrated that although, ATS treatment was a necessity for some participants, poor information about ATS treatment centers hampered treatment entry. I know I need treatment but who can help me? Among participants, who were dependent on ATS use, their narratives described how poor knowledge of the side effects of ATS use prevented them from treatment entry. Further qualitative analyses of the narratives indicated that although ATS treatment was a necessity for some of them, poor information of the addictive nature of ATS use and ignoring treatment primarily hampered treatment entry. I can quit any time I want. Participant narratives suggested that stigma prevented treatment entry for ATS use. The study findings demonstrated that some participants perceived the necessity of treatment but social stigma prevented them from treatment entry. I want treatment but what will happen to me if I go for treatment. The study indicated that ATS dependence was present in the study regions in Tehran. This was a new trend of illicit drug use at the time of conducting the study 2. The study results indicated that ATS dependents were more likely to be younger, single, educated, unemployed and with more unstable living conditions compared with non-ATS users. Such characteristics were likely to predispose this group to misuse of ATS. A research study indicated that participants with ATS dependence were more likely to be single and jobless than recreational ATS users 3. These demographic characteristics should be considered in designing and implementing prevention and educational programs for this group in Iran. Studies have indicated that cognitive-behavioral interventions are effective in the treatment of ATS users 9 , Such treatment interventions should be provided for this group in Iran. In fact, it was likely that most of them had no actual knowledge of the side effects of ATS use. Their misconceptions were likely to originate from lack of knowledge or poor ATS education. Poor knowledge of the side effects of ATS can be a strong motivation to self-treatment with ATS use or its common use in the community 11 - Therefore, the provision of educational programs is suggested for this group. Key Informants repeatedly emphasized the roles of mass-media in ATS education and prevention. Health policy makers should consider ATS education as a health priority. Studies have shown that drug education is necessary to prevent the epidemic of any type of drug 17 - Furthermore, law enforcement and police efforts should target ceasing ATS production and distribution in the Persian community on a large scale. Poor knowledge of available ATS treatment services was frequently reported as an important barrier to treatment entry. A study on Puerto Rican injecting drug users found that perceived barriers to drug treatment played strong roles to treatment entry Opiate use treatment is available in Iran but ATS use was a new health concern at the time of conducting the study. Therefore, participants were likely to not know about the availability of ATS treatment in the community. On the basis of the study findings, we suggest policy recommendations for increasing access to treatment for ATS users in the community. It is important for people to have access to appropriate ATS treatment facilities in the Persian community. The role of mass-media, especially television in informing people about the treatment facilities for ATS use treatment in the community, is emphasized. Schools, universities, educational centers and hospitals should also contribute to informing people about the side effects of ATS use and available treatments in the community. Poor knowledge of the side effects of ATS use and considering ATS as non-addictive drugs were strong barriers to treatment entry. A study indicated that poor knowledge of the side effects of illicit drug use was associated with its easy use Participants were likely to traditionally consider opiate use as a health problem only while ATS use was a new concern in Iran at the time of conducting the study. To improve service delivery, treatment services should re-orient their services to better address the needs of ATS users in Iran. People should be informed that ATS use could be as addictive as opiate use. Finally, the study results indicated that stigma had a detrimental impact on ATS treatment entry. This issue was due to the new nature of ATS use at the time of conducting the study in Iran. A study in the USA indicated that stigma among people with substance use disorders hampered treatment entry These study results highlight the need for more work on stigma due to its important role in preventing treatment entry for the ATS use problem. The results of this RSA highlight the importance of understanding the reasons associated with ATS dependence and treatment barriers. As the first report from Western Asia, especially the Persian Gulf region, the findings of this study highlight the necessity of the provision of effective laws against ATS producers and vendors, as well as ATS education, prevention and treatment programs for the population of Tehran. The use of ATS without medical prescription was a hidden activity in Iran during years and As a result, it was difficult to conduct a household survey. Therefore, the study was limited to a RSA. Conducting household surveys is suggested. Drug use treatment and harm reduction programs in Iran: A unique model of health in the most populated Persian Gulf country. Asian J Psychiatr. Methamphetamine use and treatment in Iran: A systematic review from the most populated Persian Gulf country. Methamphetamine use among Iranian heroin kerack-dependent women: implications for treatment. Alam Mehrjerdi Z. Crystal in Iran: methamphetamine or heroin kerack. Djamshidian A. Neurobehavioral Sequelae of Psychostimulant Abuse. Int Rev Neurobiol. Correlates of shared methamphetamine injection among methamphetamine-injecting treatment seekers: the first report from Iran. The guidelines for the development and implementation of drug abuse rapid situation assessments and responses. Diagnostic and statistical manual of mental disorders. Brief cognitive behavioural interventions for regular amphetamine users: a step in the right direction. A comparison of contingency management and cognitive-behavioral approaches for stimulant-dependent individuals. Methamphetamine use and methadone maintenance treatment: an emerging problem in the drug addiction treatment network in Iran. Int J Drug Policy. Quality of life among treatment seeking methamphetamine-dependent individuals. Am J Addict. Lashkaripour K, Torbati E. Methamphetamine dependency. Current research on methamphetamine: epidemiology, medical and psychiatric effects, treatment and harm reduction efforts. Addict Health. Methamphetamine use among patients undergoing methadone maintenance treatment in iran; a threat for harm reduction and treatment strategies: A qualitative study. Prevalence and complications of drug-induced seizures in Baharloo hospital, Tehran, Iran. Iran J Toxicol. The methamphetamine problem in the United States. Annu Rev Public Health. Will the methamphetamine problem go away? J Addict Dis. Methamphetamine dependence and human immunodeficiency virus risk behavior. J Subst Abuse Treat. Porter J. Subst Use Misuse. Treatment utilization and barriers to treatment: results of a survey of dependent methamphetamine users. Subst Abuse Treat Prev Policy. J Addict Behav Ther Rehabil. We use cookies to provide you with the best possible experience. They also allow us to analyze user behavior in order to constantly improve the website for you. However, there are no literature reports on ATS dependence in the community. Objectives: The current study aimed to investigate the prevalence of ATS-dependence, the reasons associated with this problem and the treatment barriers among a group of adults in 22 districts of Tehran. Materials and Methods: A rapid situation assessment was conducted. A mixed quantitative-qualitative methodology was applied. A researcher-made checklist was designed to collect data. Results: In total, individuals were randomly recruited and interviewed. Among them, participants were ATS-dependent. A desire to increase performance and reduce psychiatric problems, beauty-related issues and a desire to stop opiate use were the main reasons for the illegal use of ATS. Poor knowledge of ATS treatment services in the community, poor knowledge of the side effects of the illegal use of ATS and stigma were the main current treatment barriers. Conclusions: The study results indicated that ATS-dependence was present among the study participants. This issue necessitates treatment, which should be considered by health policy makers. Prevention programs should be provided on the large scale in the Persian community to prevent ATS use and dependence. Background The illegal use of amphetamine-type stimulants ATS is a global health concern with medical, psychiatric and social impacts. Objectives Literature is not well documented on the prevalence of ATS dependence and the reasons associated with this problem in Iran. Materials and Methods 3. Study Site and Sample Collection The study sites included 22 districts in Tehran; via the following official information resources, 22 districts with considerable rates of illegal use of ATS in the past two years were identified. Hospitals especially emergency rooms, 2. Drug treatment and harm reduction canters, 3. Courts, 4. Prisons, 5. Police reports of arrest figures and ATS confiscation, 6. Official reports of ATS-related deaths, 7. Crime-related reports, 8. Police reports of ATS use and vending and 9. Interview Team Based on the study guideline 7 , to increase the chance of finding ATS dependents in each district, 10 to 12 former ATS users with good communication abilities were recruited and trained. Study Measures A checklist was designed with the collaboration of three senior drug researchers at the Substance Abuse and Dependence Research Centre in Tehran. Study Procedure The study was conducted between September and January Data Analysis Quantitative data were analyzed using Chi-square test, independent samples t-test and logistic regression in SPSS version Results 4. Participants in Each Study Site Of the 22 districts, districts one and three were of high socio-economic status. Table 1. Table 2. Table 3. Variables Characteristics No. References 1. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4. Leave a comment here:. Cookie Setting We use cookies to provide you with the best possible experience.

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Varying public views on cannabis use across countries may explain the variation in the prevalence of use, policies, and research in individual countries, and global regulation of cannabis. This paper aims to describe the current state of cannabis use, policies, and research across sixteen countries. PubMed and Google Scholar were searched for studies published from to Searches were conducted using the relevant country of interest as a search term e. Official websites of respective governments and international organizations were also searched in English and non-English languages using countries national languages to identify the current state of cannabis use, policies, and research in each of those countries. The main findings were inconsistent and heterogeneous reporting of cannabis use, variation in policies e. Although global cannabis regulation is ongoing, the existing heterogeneities across countries in terms of policies and epidemiology can increase the burden of cannabis use disorders disproportionately and unpredictably. There is an urgent need to develop global strategies to address these cross-country barriers to improve early detection, prevention, and interventions for cannabis use and related disorders. Cannabis is one of the most frequently used recreational psychoactive substances globally with an estimated million users of cannabis in , 1 1. Cannabis epidemiology: a selective review. Curr Pharm Des. Cannabis use and suicide attempts among 86, adolescents aged years from 21 low- and middle-income countries. United Nations World Drug Report. Drug use and health consequences \[Internet\]. Cannabis use is much more common in North America and high-income countries in Europe and Oceania than in low and middle-income countries LMICs , where it has been increasing only remaining low in Asia. Public health implications of legalising the production and sale of cannabis for medicinal and recreational use. Lancet Lond Engl. Despite growing public support for its use in many countries, this substance is known to be associated with risk of mental health conditions, including suicidality, depression, 5 5. Association of cannabis use in adolescence and risk of depression, anxiety, and suicidality in young adulthood: a systematic review and meta-analysis. JAMA Psychiatry ; Meta-analysis of the association between the level of cannabis use and risk of psychosis. Schizophr Bull ; Cannabis use has also been linked to adverse functional outcomes e. An economic analysis of the demand for cannabis: some results from South Africa. Drugs Educ Prev Policy. Marijuana use and high school dropout: the influence of unobservables. Health Econ. Cannabis use during pregnancy and its relationship with fetal developmental outcomes and psychiatric disorders. A systematic review. Reprod Health. Cannabis dependence or problematic use is often influenced by sociopolitical environments, religion, culture, clinical practice, and policies and programs across countries. J Drug Issues. Bostwick JM. Blurred boundaries: the therapeutics and politics of medical marijuana. Mayo Clin Proc. Most culturally distinct groups have used cannabis and other psychoactive substances throughout the ages, and they have accepted cannabis use as an established code of behavior. Heath DB. Culture and substance abuse. Psychiatr Clin North Am. Moreover, acculturation has been associated with increased use of cannabis use. The role of acculturation and alcohol problems on frequency of cannabis use among Latinas at risk of an alcohol-exposed pregnancy. Subst Use Misuse. Recent cannabis use among adolescent and young adult immigrants in the Netherlands--the roles of acculturation strategy and linguistic acculturation. Drug Alcohol Depend. Understanding the epidemiology of cannabis use or dependence, policy measures, and research across countries is valuable to quantify the global extent of cannabis use and changes over time as well as to assist lawmakers, governments, and funding bodies in their decision-making regarding services and policies. Nevertheless, few organizations regularly compile epidemiological data. Global statistics on alcohol, tobacco and illicit drug use: status report. Addict Abingdon Engl. World Drug Report. Nova Iorque: UN; Limited information about the various current legalizations, national harm reduction strategies, research trends, programs, and prevalence of cannabis use or dependence is available. MedSPAD Committee: an insight into alcohol, tobacco and other drugs in the Mediterranean Region: socio-economic, policy context and patterns of use among adolescents \[Internet\]. This hampers the development of global strategies to understand the extent and impact of cannabis use and address problems that result. Nowadays, many countries and country regions are advancing with or considering legalization and there is little evidence on which to base assessments and foresee the impact of these challenges. Considering the health and social welfare impacts of non-medical cannabis legalization. World Psychiatry. Medicinal cannabis: history, pharmacology, and implications for the acute care setting. Therefore, it is crucial to collate this information to obtain a global understanding of cannabis use and dependence and interventions to address them, highlighting critical gaps in these domains to enable better collaborative efforts and progress evaluations within the framework of the Sustainable Development Goals. Sustainable development goals \[Internet\]. Moreover, building capacities capable of framing and accompanying any open and extensive legal use of cannabis is necessary and must be considered. Strategies in this regard should emphasize both legal and medical frames. This might involve multiple stakeholders such as psychiatrists, general practitioners, pharmacists, etc. Against this background, we conducted a narrative review with the following aims: firstly, to describe the epidemiology of cannabis use or dependence, legalizations, and any existing harm reduction strategies i. These sixteen participants contributed with data from their countries, which we grouped by WPA geographical divisions regions and zones. The narrative review and critical analysis of available literature were conducted as per protocol. Wilczynski SM. Other sources of evidence. In: Wilczynski SM. A practical guide to finding treatments that work for people with autism. Defining and analyzing the problem. Behavioral intervention research in hospice and palliative care. The first author RR requested all country representatives to conduct independent searches of literature from their respective countries. Online databases PubMed, Google Scholar were searched for peer-reviewed articles including case reports and letters to editors published from January to December ; a time frame that would provide a decade-long perspective. Country representatives also searched official policy documents, statements, and websites from their governments. National peer-reviewed general medical or psychiatric journals were searched manually. Results that did not pertain to cannabis use or dependence and those focused on biotechnological aspects of the tetrahydrocannabinol THC or cannabidiole CBD molecules were excluded. Group discussions were held via online messaging and conferencing platforms. Subsequently, the two authors not involved in data collection RR and VP-S compiled and summarized the data retrieved, seeking clarifications when needed; the information collected from participant countries was summarized and tabulated under the following domain headings: epidemiology, legislation, harm reduction strategies, and research areas. A higher prevalence of cannabis use or dependence was found among teenagers or younger adults than among elderly adults in European Italy, Spain , African South Africa, Kenya, Ethiopia , 17 In comparison, some Asian countries Thailand have reported that the number of cannabis users is shrinking. In the literature reviewed, cannabis use has often been associated with aggressive behavior, early onset of schizophrenia, and comorbid use of other substances such as opioids Iran 25 Prevalence of cannabis lifetime use in Iranian high school and college students: a systematic review, meta-analyses, and meta-regression. Am J Mens Health. Prevalence of cannabis use disorder and associated factors among cannabis young adult users at Shashemene Town, Oromia Region, Ethiopia, Psychiatry J. It has also been strongly associated with mood and anxiety disorders, 27 Prevalence and correlates of depression among adolescents in Malaysia. Asia Pac J Public Health. Risk factors for illicit drug use among Malaysian male adolescents. Jatchavala C, Vittayanont A. Post-traumatic stress disorder symptoms among patients with substance-related disorders in the restive areas of south Thailand insurgency. Songklanagarind Med J. The prevalence of cannabis use seems higher among males and those with a family history of cannabis dependence and poor peer support. In most countries e. World drug report \[Internet\]. Furthermore, researchers worldwide India, Nepal have attempted to determine the relationship between cannabis use and psychotic, mood, or anxiety disorders and comorbidities with substance use disorders. Study to determine the prevalance of substance use and factors associated with it, in first-episode of psychosis. Ind Psychiatry J. Prevalence of substance use in first episode psychosis and its association with socio-demographic variants in Nepalese Patients. J Psychiatr Assoc Nepal. A study of depression among patients of substance use disorder. J Kathmandu Med Coll. Variations were also observed in terms of the patterns of cannabis use in national surveys when conducted e. Magnitude of substance use in India. The process of lifting prohibitions against cannabis use is known as legalization, while sparing criminal sanctions such as fines, prison, or mandated treatment against people possessing or using it is known as decriminalization. Mo Med. Cannabis consumption is legally prohibited in most countries. Country-specific details on these prohibitions and decriminalization laws are listed in Table 2. Almost all countries have adopted legal prohibitions as one of the core strategies to reduce cannabis use. Legal prohibitions seem to have substantially reduced cannabis use in many countries e. Some countries have harsh policies e. In Spain, article of the Penal Code distinguishes between drugs that cause and do not cause serious health damage. Given that drug-induced harm is related to drug quantity, a person may possess up to grams of cannabis for personal consumption. Arana X. Most of the countries in our review have prevalent positive social attitudes towards the future legalization of cannabis Table 2. However, political and religious factors are affecting the implementation of cannabis legalization in almost all countries. Medicinal cannabis policies and practices around the world. Panicker B. Legalization of marijuana and the conflict with international drug control treaties. Table 3 lists national and local level harm reduction strategies adopted in the countries represented by our team. Efforts in training and education of service users, service providers, the general public, youth, and adolescents are currently being carried out in all of these countries. Simultaneously, school-based programs are being run in some countries, such as Nepal, France, and Spain, while in other countries like India 91 Pattojoshi A, Tikka SK. School-based substance use disorder prevention in India: a brief appraisal. Indian J Psychiatry. New Dir Youth Dev. One initiative in Spain to raise awareness about substance abuse among schoolers and university students is based on short film contests. Tu Punto. Awareness programs targeting the general population were found across the countries represented by our team. In Malaysia, compulsory classroom-based antidrug education programs are being delivered in secondary schools. Cannabis is depicted negatively in the media to increase risk awareness France, Spain, Kenya, and Iran. Alonso Ayuso AT. Rehabilitation services along with outpatient and inpatient services supervised by psychiatrists are the mainstay treatment for patients with cannabis disorders in all countries. Some high-income countries harness digital tools to provide support programs. Short- and long-term effects of digital prevention and treatment interventions for cannabis use reduction: a systematic review and meta-analysis. Thumbnail Table 3 Preventive and therapeutic strategies for cannabis use across countries. Some components of cannabis are approved and legal for medical use in some countries Table 2. Additionally, some countries Thailand have permitted household cannabis cultivation. Many countries have already permitted cannabis for research purposes, so it is currently being used for many conditions such as an appetite stimulant for cachexia and anorexia, loss of appetite in cancer patients or in patients who have acquired immunodeficiency syndrome AIDS , and in anorexia nervosa; and in glaucoma, targeting a hypotensive effect. Figure 1 depicts the trend of publication of cannabis-related articles indexed on the PubMed database over time to Over this decade, cannabis research was disproportionately dominated by European countries Italy, Spain, Germany, and France. In most of the Asian and African countries included in our sample, researchers have mainly focused on cross-sectional India, Nepal and retrospective chart reviews India , and there are only a few prospective studies Table 4. Systematic-reviews, meta-analyses, cross-sectional, prevalence, and comorbidity studies, government reports, census reports at rehabilitation centers, and single-center studies at medical institutions were all identified in the literature reviewed. Large-scale general population studies are lacking due to inadequate funds and stringent policies in Asian countries. Studies of the benefits of cannabidiol as measured by electroencephalography EEG signals and genetic diversity studies were recently conducted in Morocco, France, Italy, and Iran. Figure 1 Trends of publication of articles about cannabis use or dependence indexed on the PubMed database over time to However, it is far less common than alcohol, tobacco, or opioids in many countries. Among those countries Morocco, Nepal, and India , some possible reasons for the higher prevalence may be unemployment poverty, lack of harsh punishment, Touw M. The religious and medicinal uses of cannabis in China, India and Tibet. J Psychoactive Drugs. It has not been possible to challenge the deep-rooted acceptance and religious basis of cannabis consumption in the culture in some countries India and Nepal , which may hamper harm reduction strategies globally or nationally. Furthermore, the surge in cannabis use or dependence in European countries could be due to low risk perception, cultural acceptance, and acculturation. Cross-cultural effects of cannabis use disorder: evidence to support a cultural neuroscience approach. Curr Addict Rep. Also, a higher prevalence of cannabis use was found among the adolescents with migration background 1. Orth B, Merkel C. Der Cannabiskonsum Jugendlicher und junger Erwachsener in Deutschland. Ergebnisse des Alkoholsurveys und Trends. BZgA-Forschungsbericht Also, published literature suggests that the quality of epidemiological data is often poor in LMICs due to a lack of national surveys and research funding. The state of psychiatric research in the Asia Pacific region. Asia Pac Psychiatry. Furthermore, the lack of homogenous data collection methods, periodicity, or standard definitions of cannabis use in surveys may affect international efforts to develop national or global cannabis prevention strategies or interventions. Overreliance on self-report of substance use, barriers to marginalized populations e. While many countries have conducted national surveys, they lack information regarding clinical characteristics, comorbidities, and interventions. Also, since use of cannabis is banned in many countries, epidemiological research is mostly conducted in clinical populations. We observed that cannabis-related research is limited in terms of interventions or policies in high-income countries due to low prevalence and LMICs due to lack of resources or financial and legal constraints. Inequity in distribution of psychiatry trainee seats and institutes across indian states: a critical analysis. J Neurosci Rural Pract. Regional efforts should gather detailed findings in clinical and non-clinical samples and on interventions and trends. Cannabis use is commonly associated with being young, male gender, having lower levels of education, unemployment, adverse childhood events, being unmarried, and low socio-economic status in almost all studied countries. PloS One. Also, countries across world regions have reported an increase in the prevalence of cannabis compared to previous surveys. Legal prohibition is the most commonly adopted measure against cannabis use across the countries reviewed. Malaysia was found to have the lowest prevalence of cannabis use or dependence among the countries studied. This could be due to potential underreporting because of harsh legal prohibition and punitive drug policies. Furthermore, this has affected cannabis-related research initiatives. Harsh policies also affect access to de-addiction services, research, and service development. The extent of public health interventions such as awareness-raising campaigns, skills training in these countries was deficient, probably leaving behind many patients and at-risk people. The Malaysian example suggests that punitive drug policy has failed to yield the expected benefits of reduction in cannabis use; therefore, countries like it are considering the decriminalization of possession of drugs for personal use. Aris NA. We failed in war on drugs despite huge funds, says Wan Azizah \[Internet\]. Punitive policies also seem to have led to negative social and health outcomes: higher drug use relapse, overcrowding of prisons and detention centers, potential outbreaks of infectious diseases, social stigma, unemployment, and an increase in socioeconomic distress. Some countries e. Still, many barriers e. Hosp Pharmacol-Int Multidiscip J. Medical cannabis in Serbia: the survey of knowledge and attitudes in an urban adult population. In some countries, specific regions have allowed household production of cannabis e. However, this may lead to an increase in the prevalence of cannabis use or dependence in the future, as observed in Germany. After this decision, cannabis-based products started to be sold in pharmacies all over Brazil. However, the decriminalization of cannabis possession for consumption and plant cultivation is still pending judgment by the Brazilian Supreme Court. Cannabis: dicol delibera sobre plantio e registro \[Internet\]. Cannabis legalization, even with market regulation, will increase cannabis use-related disorders. In the United States, cannabis use and dependence increased in states that legalized medical use with a high prevalence of cannabis use disorders and severe psychiatric disorders, in addition to automobile accidents. The cannabis legalization experiment in other countries simply repeated the histories of other substances and their impact on public health. Prevalence of marijuana involvement in fatal crashes: Washington, Technical Report. Washington, D. Considering the future possibilities of cannabis legalizations, efforts should be made towards ensuring the existence of sufficient specialized medical workforce and health services across countries, creating awareness of harmful use and rigorous monitoring of dependence and awareness and prevention campaigns. Ferreira S. Rev Bioet. Despite growing cannabis use and its potential risks, research in many countries is limited due to religious India , political, cultural, economic, and political barriers e. Cannabis researchers in many countries may struggle to obtain institutional support or funding for mental health-related research. We have not investigated trends in cannabis use or dependence, but most countries e. This narrative review has facilitated identification of knowledge gaps and the scope of existing literature through extensive searching of literature both published and gray. The critical evaluation of literature by independent reviewers has reduced the potential for group-based-bias entering the conclusion compared to the consensus approach. The lack of closely matching criteria across the reviewed countries precluded us from conducting a systematic review. Despite these limitations, this review with a critical approach is the first primary source of evidence. It is therefore valuable for development of global strategies for cannabis use disorders and harmonization of cannabis research worldwide. The study findings will be helpful precursors to future scoping, systematic reviews, and meta-analyses. Our cross-country literature review involving all WPA regions, eight zones, and 16 countries provides several critical directions for research in epidemiology, policy, clinical programs, research, and international collaboration related to cannabis. In many countries it is necessary to establish national surveillance systems to monitor the changes or patterns of cannabis use and focus on developing preventive, diagnostic, and rehabilitation strategies. There is also a need to develop comprehensive research and service strategies for individual countries and globally, blending evidence-based and culturally-sensitive perspectives to design effective public health policies. Open menu Brazil. Trends in Psychiatry and Psychotherapy. Open menu. Text EN Text English. Abstract Introduction Varying public views on cannabis use across countries may explain the variation in the prevalence of use, policies, and research in individual countries, and global regulation of cannabis. Methods PubMed and Google Scholar were searched for studies published from to Results The main findings were inconsistent and heterogeneous reporting of cannabis use, variation in policies e. Conclusions Although global cannabis regulation is ongoing, the existing heterogeneities across countries in terms of policies and epidemiology can increase the burden of cannabis use disorders disproportionately and unpredictably. Cannabis; policies; legalization; global health; research. Introduction Cannabis is one of the most frequently used recreational psychoactive substances globally with an estimated million users of cannabis in , 1 1. Data collection The narrative review and critical analysis of available literature were conducted as per protocol. Table 2 Current status of cannabis-related prohibitions, decriminalization, and legalizations across countries. Table 3 Preventive and therapeutic strategies for cannabis use across countries. Substance use among third year medical students of Nepal. J Nepal Health Res Counc. Substance use among medical students in Kathmandu valley. Trends in the use of illicit substances in Thailand: Results from national household surveys. Drug Alcohol Rev. Prevalence and distribution pattern of mood swings in Thai adolescents: a school-based survey in the central region of Thailand. BMC Psychiatry. Epidemiology of illicit drug use disorders in Iran: prevalence, correlates, comorbidity and service utilization results from the Iranian Mental Health Survey. Iranian mental health survey: design and field proced. Iran J Psychiatry. National report: Serbia \[Internet\]. European Drug Report \[Internet\]. Germany Country Drug Report \[Internet\]. Turkey Country Drug Report \[Internet\]. Descriptive norms influence alcohol use among high-school students: a social norms study from Istanbul. J Subst Use. Ministerio de sanidad. France country drug report \[Internet\]. Is there a cannabis epidemic model? Int J Drug Policy. Pan Afr Med J. S Afr Med J. South African medical research council. Drug use in a rural secondary school in Kenya. Subst Abuse. Alcohol and substance use among first-year students at the University of Nairobi, Kenya: Prevalence and patterns. PLoS One. Some ES. Misuse of drugs: perceptions of household heads in Kisumu district, Kenya. East Afr Med J. Adverse childhood experiences among patients with substance use disorders at a referral psychiatric hospital in Kenya. Intersoft Consulting. Substance use disorder and associated factors among prisoners in a correctional institution in Jimma, Southwest Ethiopia: a cross-sectional study. Indian J Psychol Med. Fisher J. Cannabis in Nepal: an overview. In: Rubin V, editor. Cannabis and culture. Boston: De Gruyter Mouton; Thai law: FDA to allow private medical cannabis production: cannabis and marijuana industry news \[Internet\]. Siam Legal. Legalization of cannabis for medical use in Thailand \[Internet\]. Narcotics Act \[Internet\]. Binti Md Isa Y. Harm reduction in the context of drug use in Malaysia, a critical analysis of its justification and its compatibility with the criminal justice approach \[dissertation\]. Bailrigg: Lancaster University; Girelli G. The death penalty for drug offences: global overview \[Internet\]. Sensi Seeds. Cannabis in Iran — laws, use, history, and other info \[Internet\]. Drug law offences in the Western Balkan region: from definition to monitoring \[Internet\]. Serbia: early warning system profile \[Internet\]. Cannabis als Medizin \[Internet\]. Narcotic drugs laws amended. Cannabis prescription for seriously ill patients \[Internet\]. J Pain Res. Article Fruscalzo R. Regulation of cannabis in Italy: use in food and cosmetics. Therapeutic use of cannabidiol: the lawsuit in the state of Pernambuco, Brazil. Saude Soc. Drugs and politics in the Americas: a laboratory for analysis. Heidelberg: Springer; The Brazilian drug policy situation: the public health approach based on research undertaken in a developing country. Public Health Rev. National Council for Law Reporting. Narcotic drugs and psychotropic substances control act. Republic of Kenya. The Marijuana control bill \[Internet\]. Dalal PK. Changing scenario of addiction psychiatry: challenges and opportunities. Methamphetamine dependence treatment rehabilitation in Thailand: a model assessment. J Med Assoc Thai. Design and implementation of a factorial randomized controlled trial of methadone maintenance therapy and an evidence-based behavioral intervention for incarcerated people living with HIV and opioid dependence in Malaysia. Contemp Clin Trials. Hotlink \[Internet\]. A positive association between anxiety disorders and cannabis use or cannabis use disorders in the general population-a meta-analysis of 31 studies. Cannabis use and cannabis use disorders and their relationship to mental disorders: a year prospective-longitudinal community study in adolescents. Controlled administration of cannabis to mitigate cannabis-attributable harm among recreational users: a quasi-experimental study in Germany. Pathways connecting socioeconomic variables, substance abuse and gambling behaviour: a cross-sectional study on a sample of Italian high-school students. BMJ Open. Trends of major depressive episode among people with cannabis use: findings from the national survey on drug use and health — Subst Abus. Cannabinoids use in adolescents and young adults with cancer: a single-center survey. Tumori J. Relationship between cannabis use and erectile dysfunction: a systematic review and meta-analysis. Are schizophrenic disorders with or without early cannabis use neurobiologically distinct disease entities? A meta-analysis of magnetic resonance imaging studies. Psychiatry Res. Disposition of phytocannabinoids, their acidic precursors and their metabolites in biological matrices of healthy individuals treated with vaporized medical cannabis. Cannabidiol as a potential treatment for anxiety and mood disorders: molecular targets and epigenetic insights from preclinical research. Int J Mol Sci. Use of medicinal cannabis and synthetic cannabinoids in post-traumatic stress disorder PTSD : a systematic review. Medicina Mex. Plan national de mobilisation contre les addictions \[Internet\]. Jungerman FS, Laranjeira R. Rev Panam Salud Publica. Braz J Psychiatry. Publication Dates Publication in this collection 08 July Date of issue History Received 17 Mar Accepted 22 Oct This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Jibril I. Figures 1 Tables 4. CD: 0. Age: years CU lifetime : 0. Clinical population: Nepal Age: years CU last 12 month : 3. Thailand Age: years CU lifetime : 5. Age: years CU last 3 month : 2. Clinical population Age: years CD last 3 months : 6. Age: years CU lifetime : 4. Cannabis use 0. Germany Age: years CU lifetime : 1. CU last 12 months : 6. CU last 30 days : 2. CD: 3. Age: years CU last 12 months : 1. Younger adult Age: years CU lifetime : CU last 30 days : 0. Age: years CU last 30 days : 2. Young adults Age: years CU last 12 months : 1. Spain Age: years CU lifetime : CU last 12 months : CU last 30 days : In , Cannabis Italy Age: years 43 CU lifetime : Cannabis experimentation: College students Age: years CU lifetime : Street children Age: years CU lifetime : Female Age: years CU lifetime : 2. CU last 12 months : 3. No country-wide epidemiological data for age group years 17 Kenya Age: years CU lifetime : 4. CD: 1. Household heads CU lifetime : 0. Ethiopia Age: not specified CU lifetime : NA Prison population CU lifetime : 3. Nepal No No No Not permitted Prohibition: cultivation, possession, trafficking, and consumption of all cannabis preparations except bhang. Punishment method: monetary fine and imprisonment, No harsh punishment. Thailand Yes Yes Yes 71 Prohibition: trafficking. Malaysia No No No No Prohibition: cultivation, possession, trafficking, and consumption of all cannabis preparation. Iran No 75 No 75 Serbia No No No No Prohibition: cultivation, possession, trafficking, and consumption of all cannabis preparation. Germany No No No Yes 79 Prohibition: possession, trafficking, and purchase of recreational cannabis. Prohibition: possession, trafficking, sale, and purchase of recreational cannabis. Spain Yes only for personal use 66 Yes only for personal use. Prohibition: production and trafficking. Cannabis clubs claim to help patients to obtain cannabis for medicinal use. Self-cultivation is allowed in a quantity of up to six female plants per person, up to a limit of five persons, with authorization for storage corresponding to the annual harvest. Italy Yes No No a new law is currently under discussion in parliament Yes, for medical conditions such as chronic pain, multiple sclerosis, spinal cord injury, nausea and vomiting caused by chemotherapy, radiotherapy Prohibition: trafficking, and selling cannabis even free of charge. Possession for personal use is permitted with a maximum threshold of the narcotic principle \[THC\] set between 0. France No No No Yes, only for medical indications since October Prohibition: possession, production, trafficking, and distribution. Brazil No No Pernambuco state so far 86 Yes, for medicinal use such as palliative care without other therapeutic alternatives, refractory epilepsy, multiple sclerosis Prohibition: possession, production, and distribution other than personal and private use. Morocco Under consideration in parliament Under consideration in parliament No Not for medicinal use; permitted for research. Harvesting of cannabis for medicinal and industrial use is permitted. South Africa Yes to be ratified by parliament No Yes 7 7. No for medicinal use; permitted for research. Prohibition: Cultivation, possession, and trafficking. Marijuana Control Bill, in parliament seeks to legalize cannabis for medical and recreational purposes. Ethiopia No No No No Prohibition: cultivation, possession, trafficking, and consumption of all cannabis preparations. But there is no policy or law. Punishments for violations of legal regulations include imprisonment and fines across all countries. Country Commonly used preventive and therapeutic strategies or programs for cannabis use India Rehabilitation programs for drugs including cannabis, integrated rehabilitation centers for addicts MoSJE , 96 Spain The action plan on addictions establishes several prevention programs at different levels 1. Risk awareness raising through media 2. Universal school-based programs 3. School-based surveys for early detection 4. Rehabilitation programs 5. Market control through military and police forces Additionally, cannabis clubs claim they protect consumers from unlawful distribution and problematic use. Italy The new national action plan is logically divided into five main areas of intervention: 1. Prevention — early information, universal and selective prevention, early detection of use of drugs early detection , and educational approach; 2. Treatment and diagnosis of drug addiction — early contact, prompt reception, diagnosis, and appropriate therapies and contextual prevention of related diseases; 3. Rehabilitation and reintegration — social and work; 4. Monitoring and evaluation; 5. Legislation, law enforcement, and juvenile justice — both on the ground and on the internet. The five areas indicated are grouped into two large containers: 1. Demand reduction: prevention, treatment and diagnosis, rehabilitation, and reintegration; 2. Reduction of supply: monitoring and evaluation, legislation, law enforcement, and juvenile justice. France Special follow-up for young people, motivational therapy, rehabilitation programs Brazil Specific psychosocial attention centers, rehabilitation program, dedicated centers Morocco Limiting the area harvested and limiting production, presenting alternatives for cannabis farmers, media sensitization, and school education, extending and increasing addiction centers, replacement therapy methadone South Africa School or youth-based programs, The South African National Council on Alcoholism and Drug Dependence SANCA runs seasonal campaigns to raise risk awareness through media. Kenya Public education through broadcast and print media, Cognitive behavioral therapy is also used in dual treatment with comorbid psychiatric disorders in Ethiopia. The new GDPR has been affecting epidemiological research since 63 Motivation of researchers, clinicians, and government Spain National surveys and university or clinical research mainly cross-sectional or cohorts , qualitative research. Italy Cross-sectional studies, France Epidemiological studies prevalence and correlates Inadequate funds and human resources for interventional studies or large-scale general population study Brazil Epidemiological studies, Legalization of cannabis, motivation of researchers, clinicians, and government. Stay informed of issues for this journal through your RSS reader. PDF English. Google Google Scholar. Current state of cannabis use, policies, and research across sixteen countries: cross-country comparisons and international perspectives. Age: years CU lifetime : 3. Age: years CU last 12 month : 3. Medical students CU NA : Age: years CU lifetime : 5. Age years CU lifetime : 1. Age: years CU last 12 months : 0. Age: years CU lifetime : 7. Age: years CU lifetime : 1. Age: years CU lifetime : 2. Age: years CU lifetime : Age: years 43 Young adults Age: years 43 Age: years CU lifetime Adolescents and college students CU lifetime : 1. Age: not specified CU lifetime : Prison population CU lifetime : 3. Prohibition: cultivation, possession, trafficking, and consumption of all cannabis preparations except bhang with a maximum threshold of the narcotic principle \[THC\] set between 0. Prohibition: cultivation, possession, trafficking, and consumption of all cannabis preparations except bhang. Yes 71 Prohibition: cultivation, possession, trafficking, and consumption of all cannabis preparation. Yes 79 Yes, Sativex oromucosal spray for medical conditions 82 Yes only for personal use 66 Yes, for medical conditions such as chronic pain, multiple sclerosis, spinal cord injury, nausea and vomiting caused by chemotherapy, radiotherapy. Prohibition: trafficking, and selling cannabis even free of charge. Prohibition: possession, production, trafficking, and distribution. Pernambuco state so far 86 Yes, for medicinal use such as palliative care without other therapeutic alternatives, refractory epilepsy, multiple sclerosis. Prohibition: possession, production, and distribution other than personal and private use. Yes 7 7. Prohibition: cultivation, possession, and trafficking. Prohibition: cultivation, possession, trafficking, and consumption of all cannabis preparations. Rehabilitation programs for drugs including cannabis, integrated rehabilitation centers for addicts MoSJE , 96 Matrix model of outpatient stimulant abuse treatment, 97 Rehabilitation programs, holistic health recovery program in the criminal justice system, 98 Matrix model, relapse prevention services, brief interventions at outpatient treatment centers for substance use disorders, school-based programs for early detection, life skills training programs in schools, social media-based approaches e. Government action plan for suppressing abuse of drugs for the period , 99 Cooperation between insurance providers, the government, non-governmental institutions, policy measures reducing the availability of illicit drugs, school-based prevention activities e. The action plan on addictions establishes several prevention programs at different levels 1. The new national action plan is logically divided into five main areas of intervention: 1. Special follow-up for young people, motivational therapy, rehabilitation programs Limiting the area harvested and limiting production, presenting alternatives for cannabis farmers, media sensitization, and school education, extending and increasing addiction centers, replacement therapy methadone. Public education through broadcast and print media, Motivational therapy is the most commonly used psychotherapy for cannabis use in Ethiopia. Legalization of cannabis, most Indian studies are on co-morbidities, inadequate funds for interventional studies. Cross-sectional, prevalence studies, government reports, census report at rehabilitation centers, and single-center studies at medical colleges. Cross-sectional studies, epidemiological studies, national survey, systematic review, meta-analyses, co-morbidity survey, service utilization, chemistry, pharmacological and toxicology, efficacy of cannabidiol treatment for anxiety, fear, and PTSD. National surveys, epidemiological studies, community cross-sectional studies on attitudes, and knowledge about medical aspects of cannabis. Comorbidities, National surveys and university or clinical research mainly cross-sectional or cohorts , qualitative research. Cross-sectional studies, Inadequate funds and human resources for interventional studies or large-scale general population study Epidemiological studies,

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