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Official websites use. Share sensitive information only on official, secure websites. Iranian crack is a new form of narcotic substance that has found widespread prevalence in Iran in the past years. Crack only nominally resembles crack cocaine as it is widely different in its clinical signs. Thus the present study aims to quantify the chemical combination of this drug. The samples included 18 specimen of Crack collected from different zones of Tehran, Iran. All specimens were in the form of inodorous cream solid powdery substance. TLC and HPLC methods were used to perform semi-quantitative and quantitative analysis of the components, respectively. The TLC analysis showed no cocaine compound in the specimens while they all revealed to contain heroin, codeine, morphine and caffeine. All but two specimens contained thebaine. None of the specimens contained amphetamine, benzodiazepines, tricyclic antidepressants, aspirin, barbiturates, tramadol and buprenorphine. Acetaminophen was found in four specimens. HPLC revealed heroin to be the foundation substance in all specimens and most of them contained a significant amount of acetylcodeine. The present analysis of the chemical combination of Crack showed that this substance is a heroin-based narcotic which is basically different from the cocaine-based crack used in Western countries. Studies like the present one at different time points, especially when abnormal clinical signs are detected, can reveal the chemical combination of the target substance and contribute to the clinical management of its acute or chronic poisoning. Crack is the nickname for the freebase form of alkaloid cocaine which is known as a dangerous addictive drug. Through wreaking adverse effect on the central nervous system it results in symptoms such as insomnia, euphoria, alertness and increased energy. Unlike the clinical signs of common crack cocaine, using Iranian crack causes pupil constriction, stress reduction and overt sleepiness. Several hours after use, the patient undergoes symptoms such as obsession and other psychological signs and also physiological signs such as rhinorrhea, epiphoria , pupillary dilation and pain which can be restored by using methadone or buprenorphine. Unlike cocaine, which is a pleasant additive to use with other narcotic substances, the desire to use Crack decreases or is gone through treatment with other narcotics? This shows that the chemical combination of Crack is different from that of the common cocaine because its symptoms and side effects are similar to heroin instead of cocaine. So it seems that the similarity between these two substances is in pronunciation not chemical content. Although there is no official report on the prevalence of Crack abuse in Iran, it seems that due to its inodorousness, simple and rapid preparation, ease of use and highly addictiveness this drug must be very common in Iran 2. Narenjiha et al. Therefore, the widespread use of Crack in Iran has become a serious problem in drug abuse in the Iranian society 2. Since identifying the components of the Iranian crack can help the treatment of the clinical signs of patients, the present study was conducted to analyze the chemical components of this drug. Apart from a previous qualitative study 4 it is notable that this is the only quantitative study on the chemical components of the Iranian crack. The present study was conducted at Bahar Toxicology Laboratory in Tehran. The samples included 18 specimen of Crack collected from different zones of Tehran, Iran and from addicts who sought treatment in addiction treatment centers. To analyze the chemical combination of samples, 0. TLC was performed for the semi-quantitative analysis of the samples for the compounds such as morphine, codeine, thebaine, cannabis, methadone, buprenorphine, amphetamines, cocaine, tramadol, aspirin, diphenoxylate, benzodiazepines, trihexyphenidyl, biperiden, tricyclic antidepressant, caffeine and barbiturates. The methanol and chloroform standards and buffers were made by Merk Germany or Romil England. Since there was no standard sample available for acetylcodeine 6-monoacetyle morphine , its concentration was calculated indirectly by division of the heroin diamorphine under the curve area to the under the curve area of acetylcodeine and multiplying the result by the heroin concentration. Then a certain amount of stock removed, and the dilution was prepared in three concentrations between minimum and maximum sensitivity. Each solution was injected three times into the machine. The mean concentration was calculated and the standard curve was set. Certain amount of unknown samples were taken and dissolved in a suitable solvent and it was injected into the machine. The result was compared with the standard curve. Standard curves for stocks and samples were obtained through both the extraction and direct methods which was similar. The data were analyzed by Autochrome v. All specimens were solid and would crush into powder if pressed between two fingers. They had creamy color. However, the specimens differed slightly in shades of color. They were all odorless. One specimen, which was obtained from an addicted patient, was partially used and stuck to a safety pin. The used part was coal black and dry. In another specimen, opium could be observed with the naked eye. Table 1 shows the results of different substances in the Crack samples using TLC. Obviously, none of the specimens contained cocaine while they all contained heroin, codeine, morphine and caffeine. Figure 1 shows the chromatogram of sample No. As can be observed, all specimens were based on heroin and most showed the substantial combination of acetylcodeine. Figure 3 illustrates the proportion of heroin to acetylcodeine. The present study on the chemical combination of Iranian crack showed that this substance contains heroin, codeine, caffeine, morphine, thebaine, acetaminophen and a significant amount of acetylcodeine. None of the specimens showed stimulant substances such as cocaine, medicines and impurities such as sedatives e. The proportion of heroin to acetylcodeine was low approximately in half of the specimens, indicating the high concentration of acetylcodeine and higher toxicity in those specimens. In line with the experiential findings of addiction treatment practitioners in that the clinical sings and also the overdose signs of Crack appear to be similar to heroin 7 , our findings showed that the Iranian crack is heroin-based and hence different from those found in the West. Heroin and its related compounds were found in all our specimens. In the qualitative study by Kazemifar et al. The results of these studies show that heroin and heroin derivatives constitute the principal substance in the Iranian crack at this time, similar to other studies on heroin 8 - As another finding, these compounds have higher concentration level than typical heroin. In addition, the specimens in our study and Kazemifar et al. Compounds such as caffeine and acetaminophen were found in our study while Kazemipour et al. The impurities in the heroin preparation place are partially due to the alkaloid leftovers, such as morphine, codeine and thebaine and partly due to heroin byproducts such as monoacetyl morphine and acetylcodeine 11 - Other compounds such as acetaminophen and caffeine originate from added impurities. It is common all over the world to adulterate heroin before selling it to users 11 - Impurities can be classified into two groups: additives that increase the bulk, such as sugars e. In addition to adding bulk and a bitter taste, some of these substances, such as caffeine and acetaminophen, expedite heroin evaporation by heat and increase its effect by smoking In line with the findings of other studies on illegal drugs, we also found that our specimens were quite different from each other and they showed different proportions of the constituent compounds Similar findings have also been shown in studies on street heroin The amount of morphine, codeine and acetyl products and the amount of heroin and acetylcodeine and their ratio in the illegal specimens of heroin were used as basic criteria for comparing the specimens and their origin of preparation. It has been observed that theoretically the heroin-acetylcodeine ratio doubles through each stage of chemical conversion of opium to morphine to heroin. The heroin-acetylcodeine ratio in the opium specimens shows significant change from the origin of preparation which is indicative of alkaloid compounds in each area. These profiles allow the comparison of heroin specimens in different areas with illegal heroin specimens of unknown origin and also allow us to determine the geographical place where heroin was made 11 , Although the chemical combination of Crack is very similar to that of the street heroin, it seems that this drug is not exactly concentrated heroin in terms of physical characteristics, usage route or chemical features. Unlike heroin, Crack is solid and inodorous. In addition, we assert that Iranian crack can be used by needle without the need for foil and its injection does not need heating and most users were ex-opium addicts, not heroin users 2. Another difference between Crack and street heroin is the proportion of acetylcodeine. Acetylcodeine 6-monoacetyle codeine is an impurity which is formed in the street heroin due to poor baking and is a marker of street heroin However, pharmaceutically produced heroin contains less than 0. In our study, most specimens of Crack showed a substantial amount of acetylcodeine. As Figure 2 shows, specimens can be classified into two groups by heroin-acetylcodeine ratio: ten specimens having a proportion of heroin times even four times for specimen 17 and eight other specimens with less heroin concentration. Although acetylcodeine in human body is metabolized into codeine and then into morphine, so it is less likely to be abused as a substance. Nevertheless, its overdose releases a great level of histamine in the blood and may lead to anaphylactic shock , convulsion and even death Thus a higher concentration of acetylcodeine in the Crack compared to street heroin is indicative of higher toxicity. It seems that the use of Crack is on the rise in Iran 2 as unlike heroin, opium and cannabis, it is odorless, easy to consume and needless to use many tools. In addition, the drug consumer can use the Crack in the bathroom or washroom in less than a minute or two without leaving any trace of odor in the space. However, the short-lived effect and instant tolerance causes faster withdrawal than heroin and follows higher dose and consequently shifting from sniffing to injection method 4 , 7. Therefore, Iranian crack is more addictive and causes socio-economic fall for the individual. In addition, it has more devastating mental and physical harms than other forms of substances. Therefore, one may argue that although the Iranian crack is based on heroin and not on cocaine, its highly addictiveness nature and mental and psychological effects may ensue illegal financial activities or violent behaviors, as in crack cocaine 7 , 24 and Because of added impurities to illegal drugs, the users are not well aware of their real power or components. Therefore, they are more subject to overdose or death, in particular when a new type of substance is released. Thus, identification of the chemical components of substances in any area, in particular for those new ones, can provide us both with valuable information about their origin and also for the treatment of their clinical signs. The present study is one of the few ones undertaking such an aim. However, this study is limited in several ways. First of all, the sample size was small 18 specimens which is nevertheless justifiable considering the fact that it is an illegal drug and costly for studying samples. Secondly, all specimens were obtained from Tehran, which prevents the results to be generalized to the whole country. However, Kazemifar et al. The present study on the chemical combination of Iranian crack shows that it is a heroin-based substance and hence basically different from crack cocaine found in Western countries. However, the diversity of the components and their different amounts show that the production and distribution of this substance is diverse and may keep on changing into the future. Therefore, such studies at different time points, especially in relation to abnormal clinical signs, can provide relevant information about the clinical management of acute or chronic toxicity caused by these substances. As a library, NLM provides access to scientific literature. Iran J Pharm Res. Find articles by Ali Farhoudian. Find articles by Mandana Sadeghi. Find articles by Hamid Reza Khoddami Vishteh. Find articles by Babak Moazen. Find articles by Monir Fekri. Find articles by Afarin Rahimi Movaghar. Received Apr; Accepted Nov. Sample No. Open in a new tab. 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.
Cocaine is a regular feature at parties among Tehran's richer residents; young people throughout the city smoke marijuana and pop ecstasy pills.
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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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