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Official websites use. Share sensitive information only on official, secure websites. To provide prevention programs and educate drug users DUs , the estimation of their population is necessary. This cross-sectional study was performed in summer on people selected through a multistage sampling method based on 14 region of the municipality of Isfahan. The data collection tool was a questionnaire that was previously used in Dr. Banshi's national plan without any changes. The Cronbach's alpha value of the questionnaire was 0. Using correction factors such as transparency of response and the ratio of social network size used in previous national studies, the number of people with high-risk behaviors was estimated. The results were analyzed through NSUM based on survey analysis. Among all kinds of DUs, men were the largest consumers. In both sexes, the prevalence of using opium and its nectar and illegal treatment with methadone and buprenorphine was higher in people of over 30 years of age, while the prevalence of consuming cannabis, ecstasy, tramadol, tobacco products, and stimulants was higher in the age group of 18 to 30 years. The results indicated that the prevalence of different DUs in Isfahan city, especially among men was higher than the reported average especially in young men of years of age. Since the prevalence of drug use varies based on the type of substance used among age groups, targeted preventive planning based on the type of drug used and age group is recommended. To estimate the population size of hidden groups such as drug users DUs is a challenge for researchers and health care practitioners as well as society. The amount and type of drug use differ throughout the world. In a review in , the prevalence of drug injection was estimated to be 0. Despite frequent efforts, for many reasons such as legal prohibition, stigma and discrimination, and lack of social acceptance in many countries of the world including Iran, these groups remain hidden and inaccessible, which makes it difficult to estimate their population size. There are 2 methods for estimating the population size of hidden groups, direct and indirect. Then, considering the social network size in the general population and some other indicators, the size of the hidden population is estimated. This method was used for the first time in to estimate the population size of people lost in the Mexican earthquake. The results of this study can be helpful to provincial policymakers and experts in estimating the extent, direction, and type of preventive activities required, the costs, and required manpower as well as to obtain economic and executive support. The sample size was estimated at about people considering the drug use prevalence of 0. Sampling was performed using non-random multistage sampling; 14 districts of Isfahan municipality were considered as stratified and, based on information obtained from the Health Deputy of Isfahan University of Medical Sciences, the sample size was determined proportionate to the size of each of these districts. Then, a list of crowded areas of the city as clusters was prepared and two clusters were randomly selected from within each district cluster. Within the clusters in the regular days of the week and at busy hours and , a passer-by was randomly selected once every 15 minutes. The study inclusion criteria included residing in Isfahan for at least 2 years, being 18 years of age and older, and having the mental ability to answer the questions. The exclusion criteria included completion of the questionnaire in the previous days and not willing to participate in the study. A standard questionnaire was used for data collection; its validity was evaluated by the experts in the Ministry of Health's Mental Health Bureau and its Cronbach's alpha was 0. Its reliability was evaluated in a pilot study and the kappa coefficient was estimated at 0. Each question is divided into 2 parts based on gender, male and female, and has three age groups: under 18, 18 to 30, and over In each section, if the respondents knew someone, they would report the number of people. The last part included demographic questions i. Four interviewers 2 women and 2 men were selected and trained through a roleplaying method Mr. Tavasoli, Mr. Torkan, Ms. Rezaei, and Ms. Talebi Por. The interviewers were assigned to different districts according to the timetable and based on the age-sex sampling table; they selected the passers-by and asked them for an informed consent. Ethical considerations: All questionnaires were completed anonymously and all information remained confidential. In order to persuade people to answer the questions, the interviewers tried to find a relatively secluded place. Due to the possibility of increasing unwillingness to take part in the study, verbal consent was obtained rather than a written one. In this study, the transparency coefficient varied from 0. The indicators of mean, standard deviation, frequency, and frequency percentage were used to data analysis and independent t-test and chi-squared test were used for data analysis. Thus, participants from each of the 14 regions were weighted based on the population of that area probability weight. The selected clusters from each area were also coded 1 to 4 as primary sampling units. The sex variable was considered as a stratum. A Finite population correlation was used to determine the odds equivalent in selecting the samples. The age of the participants ranged from 18 to 73 years. The mean age SD of the participants was In both genders, most of the participants had a diploma. Most of the participants were married. In all types of drugs, the prevalence of drug use was higher in men than women. Among men, cannabis was the third most used drug after tobacco, and opium and its nectar, while it was the second most used drug among women. In both sexes, the prevalence of opium and Shireh use and illegal treatment with methadone and buprenorphine among people over 30 years of age was higher than that in other age groups. Likewise, the prevalence of cannabis, ecstasy, hallucinogens, tramadol, tobacco, stimulants, and zolpidem among men of years of age was higher than that among the older and younger age groups. In addition, the prevalence of cannabis, stimulants, ecstasy, tramadol, zolpidem, and tobacco, legal treatment with methadone and buprenorphine, and injecting drug use was higher in women of 18 to 30 years of age. Furthermore, the prevalence of injecting drug use and legal treatment with methadone and buprenorphine was 0 in women under 18 years of age Table 2. The results indicated a high prevalence of use of different types of drugs in Isfahan. Tobacco use was had the highest prevalence, followed by opium and cannabis in men, and cannabis and opium among women, respectively. The highest prevalence of drug use in Isfahan was related to tobacco. In a study by Meysamie et al. Evidently, easy and low-cost access to different drug compounds and purity rates are other reasons for increase in drug use. The highest prevalence of the use of ecstasy pills in the city of Isfahan, which was first estimated by the NSUM, was in the sexually active age group of years. Prolonged duration of ejaculation may be one of the reasons for the use of ecstasy pills. The present study estimated the prevalence of zolpidem in Isfahan through NSUM for the first time, and the results indicated that the use of this hypnotic drug was much higher than the expected medical consumption, especially in people of 18 to 30 years of age. There have been reports of zolpidem addiction in athletes, physicians, and students, necessitating attention to this modern addiction and examination of the causes of young people's tendency to take this drug. The prevalence of injecting drug use in Isfahan was lower than estimations in the studies by Baneshi , 2 and Nikfarjam et al. Female sex workers, homosexual men, and injecting drug users IDUs are the 3 most vulnerable groups of a society at risk of developing HIV. In the present study, it was estimated that more than one-third of men who inject drugs had a constant behavioral addiction, while the prevalence of injecting drugs in women was 0. The results of this study indicated that the prevalence of different drug abuse types among men is more likely than women. According to the results of the present study, the highest prevalence of drug use among men and women was observed in the age groups of 18 to 30 and over 30 years, which is in line with the study by Nikfarjam et al. Evidently, it is also important to pay attention to children of less than 18 years of age. A study by Ranjbaran et al. One of the limitations of the present study was the impossibility of household-based random sampling due to the sensitivity of the considered subject, i. Therefore, through multistage sampling and random selection of people at specified intervals, we attempted to approach the sampling systematically. Second, there is likely reporting bias because some refusing people to participate in the study may recognize many DUs in their social network. However, due to the inability to track people, it was not possible to check and compare the characteristics of DUs with those participating in the study. Third, the size of the social network of DUs is smaller than that of the general population, 7 which will cause underestimation. Moreover, the size of the social network of the general population may vary by gender and age, and even by various regions of the country. However, due to the lack of accurate information in this regard, it was decided to use the indices used in earlier studies in Iran. The results of the present study showed that the prevalence of drug use in Isfahan city, especially in men, is significant and in some cases even higher than the average reported in other studies in the country. Since the prevalence of drug use varies by the type of substance used in the age groups of and over 30 years, targeted preventive planning by type of drug and age group is recommended. The authors would like to thank all those who helped us with this project, including the interviewers. They would also like to thank the Social Deputy of the Police Command of Isfahan who assisted in the performance of our citywide survey, Ayandeh Pazhouhi Center associated with Kerman University of Medical Sciences for providing the questionnaires and scientific advice, and Dr. Marjan Meshkati and Dr. Ramin Radfar for their scientific and practical advice. Collected data, analysis, and wrote the original draft: MAJ; statistics advisor- contributed to analysis: MB; contributed to analysis, review, and editing: MN. As a library, NLM provides access to scientific literature. Addict Health. Find articles by Meysam Abshenas-Jami. Find articles by Mohamadreza Baneshi. Find articles by Maryam Nasirian. Received May 17; Accepted Jul Open in a new tab. Conflicts of Interest The Authors have no conflict of interest. Similar articles. Add to Collections. Create a new collection. 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A Sufi in Ecstasy in a Landscape. Iran, Isfahan (c. 1650-1660)

Buy Ecstasy Isfahan

Iran J Psychiatry Behav Sci. Drug abuse is a complex public health problem that is linked to the increased risk of serious infectious diseases, injury, death, family and social disruptions, unemployment, violence, crimes, and insecurity of the community 1. Drug-related deaths are unacceptable and preventable deaths; however, an estimated number of , drug-related deaths were reported in in the world 2. Opiates and its derivatives are at the top of the list of drugs that cause the greatest burden in terms of disease and drug-related deaths worldwide. In the United States, the death rate due to opioid overdose raised from 7. Overdose deaths are responsible for a third to a half of all drug-related deaths in Iran. Iran in recent decades has seen a high risk for substance abuse and addiction. The country has a long history of drug abuse with poppy plants being grown in the region for several thousand years. Opium from the plant has been used and abused for its pharmacological and psychotropic effects. In , the country developed outpatient treatment centers in all provinces, designed prevention programs, developed self-help groups, and created educational films and publications addressing drug abuse. Although current laws still consider drug use as a crime, they also offer treatments for drug abuse. Despite many efforts, drug abuse is still the biggest health and social problem in Iran. Recent reports have shown a rapid increase in heroin dependency and injecting drug use. The first large-sample nationwide study conducted in estimated the users of opium and heroin at about 3. Due to the stigma surrounding drug use and the criminalization of drug abuse in Iran, the real number of addicts and recreational users is unknown or under-reported. Legal restriction and social stigmatization have led drug users to deny and hide their actions. In addition, drinking alcohol is a crime and sin. Opium, its derivatives, and synthetic drugs are cheap, potent, and readily available in Iran. Socio-economic conditions in recent decades, American and European outrageous sanctions, high rates of youth unemployment, and high inflation rates have directly and indirectly resulted in turning ever more Iranians to hard drugs 2. The level of accuracy of the data collected depends on the methods used to obtain the information. Drug abuse is a criminalized behavior and therefore, traditional epidemiological methods often lead to varying degrees of underestimation. One indirect method of estimating the issues of drug abuse is using secondary information sources such as rapid situation assessment RSA. A rapid situation assessment RSA was conducted in Iran in An investigation using secondary sources such as the RSA on the status of drug abuse was conducted in For example, in the U. This investigation attempts to recreate the circumstances surround the death by conducting a scene investigation, searching the death scene, reviewing medical and drug abuse history, and interviews with family, friends, co-workers, and the police. The body undergoes an external and internal examination and body fluids blood, urine, bile, and eye fluids undergo toxicological analysis. The analysis provides a list of the concentration and number of compounds detected within the body fluids 8. However, currently, this level of forensic investigation is not possible within the county of Iran. At present, data on the prevalence and incidence of substance abuse in Iran cannot be directly measured due to social stigma and limits within the legal and forensic systems. However, many nations, like Iran, have relied on indirect sources of information to provide prevalence estimates. In the past, these indirect sources involved surveys, extrapolation from police reports, treatment centers, and drug-related mortality data 7. With the current limitations related to the forensic investigation, social stigma, and other cultural factors, the real numbers of addicts, recreational users, and drug-related deaths are underestimated; therefore, other methods should be used to estimate the drug epidemic in Iran. One promising method is to use mathematical and statistical models as an alternative approach to estimate the number of addicts, recreational users, and drug-related deaths. For the study of processes in various disciplines, the dynamical system approach has turned out to be a valuable tool. The system dynamics approach is suitable to address the dynamic complexity of many public health issues 9 , This mathematical modeling approach also has been used in the study of alcohol consumption in Spain and its economic cost 11 and other contexts such as obesity, ecstasy, and heroin addiction We applied dynamical system approach to assess the transmission dynamics and the prediction of drug abuse in Isfahan province, Iran. Additionally, utilizing this model, we estimated the number of recreational users and addicts and estimated the impact of drug abuse on drug-related deaths for the years - In this study, we evaluated a system dynamics approach to model drug-related deaths in the next 10 years in Isfahan province. In this retrospective descriptive study, we modified the alcohol abuse model proposed by Santonja et al. To develop the model, the population of 15 - 64 years of age was divided into three subpopulations; namely, class A comprising individuals susceptible to becoming drug users, class M comprising individuals who were recreational users, and class R comprising individuals who were regular drug users addicts meaning that they consumed a considerable amount of drug in a habitual manner. That is, each person could contact any other person. If these persons increase their intake of drugs, they will become a risk consumer, R t. An individual in R t transits to A t at a rate proportional to the size of R t. Under the above assumptions, the dynamic drug abuse model for the Isfahan population is given by the following nonlinear system of ordinary differential equations:. Figure 1 shows the diagram for the preliminary system modeling of drug abuse. Subpopulations are shown by boxes and transitions between them by arrows. Arrows are labeled by the parameters of the model. One of our objectives was to fit data to the model to scale the model. Therefore, we used the following idea for scaling the model 11 :. Adding Equations 1 - 3 one gets:. Dividing both members of Equation 5 by P t , we have:. Equation 6 can be transformed into the Equation 8 :. On the other hand, computing the derivative defined in Equation 7 and using Equation 8 , we have:. In addition, using Equation 9 and substituting by the corresponding rates defined in Equation 7 , one gets:. The calculations were based on an epidemiological mathematical model that predicts the drug abuser proportions in Isfahan in the next 10 years. Figure 2 shows a diagram of the dynamic drug abuse model. Over the past few decades, Iran has been severely damaged by the consequences of substance abuse. Iran is suffering from the second most severe addiction to opioids in the world 8. Currently, data on the prevalence and incidence of substance abuse in Iran cannot be directly measured due to reasons such as social stigma and limits within the legal and forensic systems. However, these sources have own limitations. We propose the next phase of determining the prevalence and incidence of drug abuse by introducing system thinking and system dynamics modeling to estimate the number of addicts, recreational users, and drug-related deaths in Isfahan province in the next 10 years. For the study of processes in various disciplines, the dynamical systems approach has turned out to be a valuable tool. A system dynamics modeling approach has the potential to integrate our awareness about multilevel causes of health and their template of action, reaction, and feedback, and to promote our knowledge about how policy interventions affect the health of communities and populations Dynamic modeling can be a very powerful tool for drug use epidemiology and monitoring at national and international levels and complementary to indicators and direct data analysis Dynamic models describe the behavior of a distributed parameter system in terms of how one qualitative state can turn into another. System dynamics approach is a tool or a field of knowledge for understanding the changes and complexity of a dynamic system over time. It is assumed that the model can accurately study the behavior of this process under different conditions by changing parameter values and observing changes in the results to describe a real-life process We suggest that the potential capability of this method be considered and believe that epidemiologists eventually will overcome their challenges with this method and complex dynamic models. We also expect that applying regression models will soon be used in the field of epidemiology. By using a system dynamics approach, we can estimate the economic burden of drug abuse in Iran in the next few years in terms of the direct costs of drug abuse, including health and non-health costs such as treatment of drug-related morbidity and deaths, and indirect costs related to decreased productivity. Drug N, Household S. Australia ' s health United Nations Office on Drugs and Crime. World drug report. United Nations publication; Increases in drug and opioid overdose deaths--United States, A forensic epidemiological study of homicide in isfahan province and review of the literature. Am J Forensic Med Pathol. Unnatural deaths among children and adolescents in Isfahan province, Iran: A forensic epidemiology study of postmortem data. J Forensic Nurs. Profiles of risk: A qualitative study of injecting drug users in Tehran, Iran. Harm Reduct J. Calabrese BJ. Holding the line. Zarghami M. Iranian common attitude toward opium consumption. System dynamics modeling for public health: Background and opportunities. Am J Public Health. Rossi C. The role of dynamic modelling in drug abuse epidemiology. Bulletin on narcotics. Alcohol consumption in Spain and its economic cost: A mathematical modeling approach. Math Comput Model. PLoS One. Causal thinking and complex system approaches in epidemiology. Int J Epidemiol. Drug user dynamics: A compartmental model of drug users for scenario analyses. Drugs: Educ Prev Polic. Hannon B, Hannon B. Modeling dynamic biological systems. Comput Math Appl. 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. Corresponding Authors:. Currently, data on the prevalence and incidence of substance abuse in Iran cannot be directly obtained. We propose the next phase of determining the prevalence and incidence of drug abuse by introducing system thinking and system dynamics modeling to estimate the number of addicts, recreational drug users, and drug-related deaths. Objectives: In this study, we evaluated a dynamical system approach to model drug-related deaths in the next 10 years in Isfahan province. Methods: We proposed a general model for drug abuse that can easily be specified to study the dynamics of drug-related deaths. These estimations were based on an epidemiological mathematical model to predict the proportions of drug abusers over the next ten years in Isfahan. Conclusions: The dynamical system approach is suitable to address the dynamic complexity of many public health issues. It has the potential to integrate our awareness about multilevel causes of health and their template of action, reaction, and feedback, and to promote our knowledge about how policy interventions affect the health of communities and populations. Objectives In this study, we evaluated a system dynamics approach to model drug-related deaths in the next 10 years in Isfahan province. Materials and Methods In this retrospective descriptive study, we modified the alcohol abuse model proposed by Santonja et al. Building the Dynamic Model 1- We assumed the population has a homogeneous mixture. Under the above assumptions, the dynamic drug abuse model for the Isfahan population is given by the following nonlinear system of ordinary differential equations: Equation 1. Equation 2. Equation 3. Equation 4. Figure 1. Flow diagram of the mathematical dynamic model of drug abuse. Table 1. Equation 5. Equation 6. Equation 7. Equation 9. Equation Table 2. Year Population Death Isfahan Province Subgroup A Subgroup M Subgroup R Recreational Users Addicts 4,, 3,, , 99, 29 5,, 3,, , 59 5,, 3,, , 89 5,, 3,, , 5,, 3,, , 5,, 3,, , , 5,, 3,, , , 5,, 3,, , , 5,, 4,, , , 5,, 4,, , , Figure 2. The diagram of the dynamic drug abuse model. 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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