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Mohebbi, E. International Journal of Health Policy and Management , 8 4 , International Journal of Health Policy and Management , ; 8 4 : Toggle navigation. Background Providing population-based data on awareness, attitude and practice of drug and stimulant use has policy implications. A national study was conducted among Iranian general population to explore life time prevalence, awareness and attitudes toward opioids and stimulant use. Methods We recruited subjects from 5 provinces with heterogenic pattern of drug use. Participants were selected using stratified multistage cluster sampling. Data were collected using a validated self-administered questionnaire. Logistic regression model was applied to identify the variables that are associated with drug and stimulant use. Results In total respondents including men Two-third of respondents had good awareness about adverse effects of opioid use. Corresponding figure in terms of stimulants was The lifetime prevalence of opioid use and stimulant use were Conclusion While the attitude of Iranian adults toward opioid and stimulant use was negative, their awareness was not that adequate to prevent the drug use. Men and those with lower socio-economic status SES should be the focus of health promotion programs regarding opioid use. However, regarding stimulants use, promotion programs should target younger age groups and those with higher SES status. Maqbool S. UNODC report documents expansion in opioid crisis, prescription drug abuse. Published The global burden of mental, neurological and substance use disorders: an analysis from the Global Burden of Disease Study PLoS One. Arch Iran Med. Family, religiosity, and the risk of adolescent drug use. J Marriage Fam. World Drug Report Vienna: United Nations; Violence and Injury Prevention: Global status report on violence prevention. Accessed December Iran Census Statistical Center of Iran website. Epidemiology of illicit drug use disorders in Iran: prevalence, correlates, comorbidity and service utilization results from the Iranian Mental Health Survey. Brief overview of the status of drug abuse in Iran. Samii AW. Drug Abuse: Iran's 'Thorniest Problem. Substance-dependent professional drivers in Iran: a descriptive study. Traffic Inj Prev. Arch Rehabil. An overview of Iran drug treatment and harm reduction programs. Textbook of Addiction Treatment: International Perspectives. Milano: Springer; Crystal in Iran: methamphetamine or heroin kerack. Health outcomes associated with methamphetamine use among young people: a systematic review. Implications of chronic methamphetamine use: a literature review. Harv Rev Psychiatry. Neurocognitive effects of methamphetamine: a critical review and meta-analysis. Neuropsychol Rev. Effects of international financial and energy sanctions on Iran's informal economy. New York, NY: Springer; Potential effect of opium consumption on controlling diabetes and some cardiovascular risk factors in diabetic patients. Addict Health. Determinants of drug abuse in high school students and their related knowledge and attitude. J Pak Med Assoc. Momtazi S, Rawson R. Substance abuse among Iranian high school students. Curr Opin Psychiatry. A quantitative study of Iranian nursing students' knowledge and attitudes towards pain: implication for education. Int J Nurs Pract. Subst Use Misuse. Baseline assessment of community knowledge and attitudes toward drug use and harm reduction in Kabul, Afghanistan. Drug Alcohol Rev. Development and validation of a multi-dimensional instrument for assessing outcome of treatment among opiate users: the Opiate Treatment Index. Br J Addict. Furnham A, Thomson L. Lay theories of heroin addiction. Soc Sci Med. Histories of substance use and risk behavior: precursors to HIV seroconversion in homosexual men. Am J Public Health. Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users. West J Med. Drug-related knowledge, attitudes and beliefs in Ireland: report of a nation-wide survey. Substance use in Southern Africa: knowledge, attitudes, practices and opportunities for intervention: summary of baseline assessments in South Africa, the United Republic of Tanzania and Zambia. Geneva: WHO; Exploring knowledge, attitudes, and practices related to alcohol in Mongolia: a national population-based survey. BMC Public Health. A survey of attitudes towards patient substance abuse and addiction in the Emergency Centre. Afr J Emerg Med. Evaluation of the knowledge of rural high school students in Yazd about drugs. An investigation in knowledge, attitude and performance of high school students regarding ecstasy abuse, Zahedan The rate of knowledge and attitude toward psychoactive drugs and its abuse prevalence in Gonabad University students. Horizon Med Sci. Amphetamine-type stimulants in a group of adults in Tehran, Iran: a rapid situation assessment in twenty-two districts. Iran J Psychiatry Behav Sci. Perceived barriers to methadone maintenance treatment among Iranian opioid users. Int J Equity Health. History of opium and opium users Tarikh-e-Teriyak va Teriyaki. Tehran: Mohammad Ali Elmi; Prochaska JO. Transtheoretical model of behavior change. Encyclopedia of behavioral medicine. Opium use and mortality in Golestan Cohort Study: prospective cohort study of 50, adults in Iran. The household survey of drug abuse in Kerman, Iran. J Appl Sci. Prevalence and correlates of hepatitis C infection among male injection drug users in detention, Tehran, Iran. J Urban Health. Prevalence of opium addiction in Iranian drivers J Med Sci. The prevalence of cigarette smoking, alcohol consumption, psychostimulant and cannabinoid drugs abuse among 15 to 35 years old Tehranis. Methamphetamine use and treatment in Iran: A systematic review from the most populated Persian Gulf country. Asian J Psychiatr. Pinkham S, Malinowska-Sempruch K. Women, harm reduction and HIV. Reprod Health Matters. Opium use in a rural area of the Islamic Republic of Iran. East Mediterr Health J. Brady KT, Sinha R. Co-occurring mental and substance use disorders: the neurobiological effects of chronic stress. Am J Psychiatry. J Youth Adolesc. Causes of increasing trend of divorce in Iranian community: what do the experts think? J Fam Med. Comparison of three interview methods on response pattern to sensitive and non-sensitive questions. Iran Red Crescent Med J. Int J Health Policy Manag. Volume 8, Issue 4 April Pages Profile on PlumX. How to cite.

Out-patiesnt treatment of opium addicts: report of a pilot proj ect in Shiraz

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Author: M. Traditional methods of treatment relying on hospitalization and intensive medical care have proved unsatisfactory in terms of outcome; they also require an interruption in the ordinary social and economic activities of the addict. The general unavailability of physicians and in-patient treatment facilities in developing countries make such an approach to the problem of addiction even more impractical. The present study outlines the results of such an experimental programme launched in a provincial city, Shiraz, in Iran. The nature and extent of narcotic addiction in Iran has been reviewed by Azarakhsh and Mclaughlan and Quinn , who found that the main problem was opium addiction. Moharreri and Mehryar a presented a detailed historical account of the development of opium addiction in Iran and current medico-legal aspects. As an indication of the extent of the problem it may suffice to note that there are over , officially registered opium addicts in this country of whom over 50 per cent are below the age of This figure, which corresponds to over 50 per 10, of Iran's total population, is believed to represent only between one-third to one-half of the real number of the addict population. The magnitude of the problem of providing treatment facilities for these addicts may be better illustrated by reference to the fact that the total number of medical doctors authorized to practise psychiatry is under ; and of this number over 80 per cent live in Tehran. Moreover, in there was only one hospital, located in Tehran, specializing in the treatment of drug addiction. Shiraz is the administrative capital of the southern province of Fars and has, over the past decade, enjoyed one of the highest rates of urban growth in Iran. With its long-standing reputation as one of the main centres of Iranian civilization, the city has re-established its scientific and cultural leadership by founding a modern university of national and international reputation Pahlavi University and by organizing the annual Shiraz Arts Festival. The population of the city which was around , in , is estimated to have reached , by Besides being the administrative and economic city of the Fars Province population over 2,, , Shiraz has developed into one of the main centres of Iran's growing tourism industry. Recent years have also witnessed considerable investment in the electronic and related industries in Shiraz by the Iranian Govern- ment, which is bound to bring about a drastic change in the traditional set-up and occupational activities of the population of this city. All in all, this is a rapidly growing urban centre where mental health and addiction problems are bound to follow an upward trend. The number of officially registered opium addicts in Shiraz city was just over 7, in Of this number, over 53 per cent were below the age of 60, and were under the obligation to seek treatment for their addiction. The total number of opium addicts is estimated to be between 15,, During the period covered by this study August April , cases were seen by the author in one of the three main out-patient treatment facilities with which he is associated:. Patients attending this clinic mainly belong to economically lower income groups seeking free treatment. A private psychiatric clinic in the evenings catering mainly for upper and middle class income groups who can pay for their treatment. A part-time clinic run by one of the university hospitals, Hafiz hospital, which attracts mainly students, employees of the university and government employees covered by existing health insurance schemes. The Treatment Team consisted of the following personnel: one psychiatrist director of the project ; two psychiatric residents in their second year of residency; five health-corps workers-young women with a degree in psychology who are trained and required to spend about two-thirds of their military service working with the public health department. They were responsible for interviewing the patients and filling out questionnaires reported on elsewhere Moharreri and Mehryar b. One assistant social worker female who, in collaboration with the health-corps workers helped with the preparation of case reports, the collection of data, the follow up, and supervision of patients. One assistant pharmacist for handling prescriptions, and other hospital staff, as required. It should be noted that all the personnel listed above combined working on this project with their other day-to-day duties. Selection of cases for out-patient or in-patient treatment on the basis of information collected in stage 1. Preparation of the patient for out-patient treatment by motivating him for and giving him guidance on the problems and process of treatment. Establishment of a drug regimen. The drugs used were either methadone or an 'opium pill' developed by the Iranian Ministry of Health. The latter contains opium extract 80 mg and Largactil Chlorpromazine, 8 mg. The dosage varied according to the type, severity and duration of addiction and in some cases starded with up to 30 'opium pills' or c. Reduction of the dosage was gradual but flexible, its amount varying according to the established need and tolerance of each case. Duration of therapy was between 40 to 60 days. Regular contact with patients was maintained throughout the treatment period. Simple psychotherapy of a supportive nature was offered by women of the health corps. In some cases it was continued for six months. Patients were followed up regularly after the termination of drug treatment. This was done either through visits to clinics by patients at given intervals or through home visits by the assistant social worker. A major difficulty in this respect was that some patients had given false or incomplete addresses. During follow-up visits, a forty-item questionnaire detailing the course of post-treatment adjustment was filled in for each patient. No side-effects were observed in cases treated with methadone. In cases treated by 'opium pills', however, dry mouth, constipation, and other side-effects usually associated with Largactil use were not uncommon. Psychotropic drugs were prescribed whenever indicated, either to deal with the psychological effects of withdrawal or to counterbalance the physical side-effects of the 'opium pill'. Some inevitable abuse and black marketing of prescribed drugs were also noted and immediately dealt with. During the period of this study cases were seen. Of these, patients completed the prescribed course of treatment. The were considered as 'successfully treated' cases Of the remaining cases treatment had to be terminated in 20 cases because there was evidence that medication was misused for black marketing or trafficking in opium. In 65 cases Another 54 cases Seventeen cases could not be traced for follow-up. Leaving these cases aside, there were cases where treatment did not seem to be successful; it had to be discontinued. This number corresponds to Table 1 summarizes the maintenance regimen used with these two groups. The main point of interest in table 1 is that a slightly higher proportion of addicts treated by the 'opium pills' is found in the successful group. The success rate is highest among the small group treated with a combination of 'opium pills' and Methadone. Socio-economic characteristics of the successfully treated group are presented in tables 2 to 5. In these and the following tables the three sub-groups treated in different facilities are presented separately. From table 2 it would appear that the majority subjects are young, only 23 Tables 3 and 4 indicate the low socio-economic status of the majority of subjects. This is in line with other evidence on the socio-economic characteristics of opium addicts in Iran Mehryar and Moharreri, a. In this context the differences between the groups using different treatment facilities are also of interest. The large proportion of married subjects table 5 tends to confirm the general observation that opium addiction does not necessarily lead to a disruption of family life in Iran. Tables summarize information pertaining to the addictive behaviour. This is obtained by boiling the residue of smoked opium which accumulates inside the pipe. Only a small minority are reported as heroin addicts 5. As to the mode of drug use table 7 , swallowing From table 8 it would appear that the majority of subjects Table 9 indicates that the majority of subjects have been addicts for less than five years. This is not surprising in view of the relative youthfulness of the group table 2. Only 14 per cent of subjects have reported an addiction history extending for over 10 years. The distribution of addicts according to the daily cost of addiction is given in table From this table it would appear that for the majority of subjects Usually Shireh is more expensive than opium and heroin costs more than either opium or Shireh. Information on the duration and outcome of treatment is summarized in tables From table 11 it would appear that in a large majority of cases treatment lasted for less than six weeks. Despite this relatively brief duration of treatment, the majority of subjects regarded as successfully treated had not reported any signs of relapse at the time of follow-up. The time interval between the termination of treatment and follow-up varied from less than 4 weeks to over six months table Of the small group of 21 who had relapsed at the time of follow-up table 13 , 3 had been treated by methadone, 14 had been treated by the 'opium pill' and 4 by a combination of the two. Thus, there would seem to be some difference between methadone and the 'opium pill' in terms of the probality of later relapse. Being the first report on the outcome of out-patient treatment of opium addiction in Iran, the findings of this report should be viewed as being only descriptive and provisional. In view of the lack of any well-defined experimental control over the selection of cases for treatment and the use of different maintenance regimens, the results can hardly be generalized or compared with the outcome of other treatment programmes. Despite these limitations, the findings may be of interest both in terms of presenting descriptive data on a segment of the addict population in this country and for indicating the feasibility of short-term out-patient treatment of opium addiction. The latter indication has been encouraging enough for the author and his colleagues to have induced them to embark upon an expanded and more rigorous application of methadone maintenance in this part of Iran. It is hoped that the results of this expanded programme will cast further light on the course and outcome of treatment of opium addiction in Iran. The preparation of this paper was partially supported by a research grant from the Research Council of Pahlavi University. Behin and M. Haj-Mohammadi for their ungrudging support of and collaboration with the treatment programme described in this report. The technical assistance of the Director and staff of the Pahlavi Population Centre in the preparation of this report is also gratefully acknowledged. Azarakhsh, H. Tehran: Central Treaty Organization, McLaughlin, G. Iowa Law Review, , vol. Mehryar, A. Some socio-demographic characteristics of of registered opium addicts in Fars Province. Shiraz: Pahlavi Population Centre, a mimeographed, in Persian. Hoharreri, M. Opium Addiction in Iran. Shiraz: Pahlavi Population Centre, a mimeographed. United Nations. Office on Drugs and Crime. Site Search. Topics Crime prevention and criminal justice. Out-patiesnt treatment of opium addicts: report of a pilot proj ect in Shiraz Sections The setting of the project Addict population and the treatment cohort The method of treatment Findings and outcome of treatment Findings and outcome of treatment Acknowledgement Bibliography Details Author: M. The setting of the project Shiraz is the administrative capital of the southern province of Fars and has, over the past decade, enjoyed one of the highest rates of urban growth in Iran. Addict population and the treatment cohort The number of officially registered opium addicts in Shiraz city was just over 7, in During the period covered by this study August April , cases were seen by the author in one of the three main out-patient treatment facilities with which he is associated: The Mental Health Clinic of the Provincial Health Department run by the author on a three days per week basis. The method of treatment It consisted of the following sequence of activities: Interviews with patients and taking case histories. Findings and outcome of treatment During the period of this study cases were seen. United Nations Office on Drugs and Crime.

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