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Business is good,' Bijan winks as he flashes his big, gap-toothed smile. Bijan is a cook and dealer of sheesheh — crystal meth — which has exploded on the Iranian drug market and, for the first time, overtaken heroin to become the country's second most popular drug opium still tops the list. Meth production in the country has been expanding at an astonishing rate. According to a study by the United Nations Office on Drugs and Crime, the Iranian government first reported manufacture of the drug just six years ago , when four production facilities were seized. By , though, Iran was the world's fourth highest importer of pseudoephedrine , the main precursor chemical used in the production of crystal meth. Research carried out by the State Welfare Organisation shows that over half a million Tehranis between the ages of 15 and 45 have used it at least once. The country's drug problem is not new; Iran has one of the highest rates of addiction in the world and the interior minister, Abdolreza Rahmani Fazli, announced recently that some six million Iranians are affected by problems related to drug addiction. In Tehran, drugs are everywhere. At one popular spot north of the city, queues of cars pull up to be served under a motorway flyover. Dealers trade on a layby with lookouts and security dotted around them. The peak time is 2am and all are catered for. Cocaine has become a regular feature at parties among Tehran's richer residents; young people throughout the city smoke marijuana and pop ecstasy pills; opium — viewed as an older person's drug — is still widely considered to be culturally acceptable. In seedy corners of south Tehran, addicts gather to inject heroin, as they always have done. But when crystal meth hit the streets it managed to transcend social divides, and could be found everywhere in the city. In a graffiti-daubed side street in the centre of Tehran, a teenager with an emo haircut and a leather jacket pulled over a grey hoodie stands in a doorway, his pockets stuffed with small plastic bags of crystal meth. He has been caught countless times by the police but has always paid his way out of prison. Most of my customers are regular kids like me, students, or they've got office jobs. But rich kids use it too — I either deliver it to their houses, or they turn up in their flash cars,' he says. One of Peyvand's friends, who is also a regular customer, smokes sheesheh once every couple of days. It's much stronger than heroin, much more intense. And it's safer; there's no risk of overdosing. Sheesheh is just a great high. Peyvand says he sells crystal meth at his local gym to bodybuilders and athletes who use it to give them energy while they train, and to a growing number of young women who buy it to lose weight. A few miles north of where Peyvand deals, a queue of women sit on white plastic chairs in a beauty salon set up in a marble-clad apartment block. Drawn by the salon's reputation as a purveyor of the finest Hollywood bikini waxes, they flick through hairstyle magazines and a few outdated copies of Hello! There are housewives, students, a women with her black chador hanging open around her shoulders and a group in their mids with Botox-smooth foreheads clutching Louis Vuitton handbags. The place fizzes with gossip. A fortune-teller works her way up the line, dispensing advice with the flick of a card and extracting generous tips. Also a hit with some of these women are the under-the-counter methamphetamine pills. A couple of years ago, meth was widely available at beauty salons, until a member of parliament called for a clampdown. Even though many places stopped stocking it, demand is still high. It's not like smoking bags of it, which is bad for you. For me, it's like medicine, it's not for enjoyment. Bijan, who is from a family of gangsters, ditched selling more conventional drugs like heroin and opium in favour of crystal meth three years ago. And unlike heroin, you don't have to deal with Afghanistan and all the middle-men along the way, so there's less chance of being caught and fewer people to deal with,' he says. He runs his operation out of a ragged, industrial town just outside the capital. It is a poor, forgotten place surrounded by factories. Here grocery stores still sell blocks of pungent black opium alongside staples such as milk and slabs of white ewe's cheese. Most of the residents are either unemployed or work as day labourers and in recent years it has become home to many paperless Afghan migrants. Even though this is not Bijan's patch — he only sells to dealers in Tehran — the changing face of drug use in the town is emblematic of what is happening in the rest of the country. Ironically, the rapid growth in sheesheh is partly due to the falsely held belief that it is less addictive than heroin. While the country's economy is flailing in the wake of stricter sanctions and the damage wreaked by the populist policies of the former president Mahmoud Ahmadinejad that sent the Rial tumbling and the inflation rate soaring, the illegal drugs trade is booming. Iran has long been one of the busiest transit countries for drugs traffickers moving heroin from Afghanistan to the West and it has the highest rate of opium and heroin seizures in the world. Punishments for people caught are severe. There have been extensive public awareness campaigns, with adverts on the television and radio warning of the dangers of crystal meth. These appear to have had some impact, as unlike opium, sheesheh use is becoming increasingly taboo, especially in the more affluent parts of the city. The government, predictably, says it is stemming the surge in crystal meth production, with Fazli announcing the seizure of 3,kg of crystal meth last year and that meth labs had been discovered — more than double the number in They are definitely putting more resources into fighting it. But for every meth lab they destroy, another lot spring up,' says Bjijan. To keep one step ahead of the authorities, Bijan says he bribes police officers. In return for a small cut of his profits and 'hush' money, the policemen tip him off about raids and investigations that may involve him, and they promise to destroy any files on him, should they materialise. As long as you know a few powerful heavyweights, you'll be fine. It's one rule for the rich and one rule for everyone else. I'm lucky in that I've got money and I know people. That way, you stay out of the noose,' he says, dragging on a cigarette as he makes a hanging gesture with his free hand. In south Tehran there seems to be little indication that the crystal meth craze is abating. Outside a charity for sex workers, two women are slumped on the pavement, their faces scratched and covered in sores and their eyes sunken; the tell-tale signs of crystal meth addiction. One of the women cries as she explains that she is now hooked on sheesheh as well as heroin. Outreach workers here say that the area's most vulnerable and severe addicts have little access to services and are unaware of public campaigns; they complain bitterly that sanctions have halted funding for their rehabilitation programmes. Bijan does not live far from the community of sex workers who are struggling to feed their habits. He has no moral conscience about what he does and blames the selling and buying of drugs on being forced to live in a repressive country. But he prides himself on making pure, safe crystal meth and he is now considering expanding his operation to Malaysia and Thailand, where he says associates are making even more money — the average price of meth pills in Malaysia is at least five times that in Iran. And for those of us who sell it, well, there are no jobs, and if you're not from a rich family, you will never have opportunities in this country. At least making crystal meth has given me the chance to look after my family. Women at a crystal meth rehab centre on the western outskirts of Tehran. Photograph: Maryam Rahmanian. This article is more than 10 years old. Cheap, widely available and used by students and housewives alike, crystal meth is taking the Iranian capital by storm. The author of a new book about the country reports on an addiction that even the repressive regime is struggling to control. Reuse this content. Comments … Sign in or create your Guardian account to join the discussion. Most viewed.

Population Size Estimation of People Who Use Illicit Drugs and Alcohol in Iran (2015-2016)

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Official websites use. Share sensitive information only on official, secure websites. Correspondence to: Mohammad Reza Baneshi Email: rbaneshi2 gmail. Background: Estimating the number of people using illicit drugs and alcohol is necessary for informing health policy and programming. However, it is often challenging to reliably estimate the size of these marginalized populations through direct methods. In this study, we estimated the population size of these groups using the indirect Network Scale-Up NSU method in Iran from to Prevalence estimates were reported per population. The uncertainty level UL was calculated using the bootstrap method. Results: The average age of the respondents was 33 years old, and On average, substance use was 5. Moreover, alcohol use was more prevalent among participants between 18 and 30 years old per population. Conclusion: Although opium continues to be the most prevalent illicit drug in Iran, the patterns of illicit drug use are heterogeneous among different age groups, genders, and provinces. Age-gender specific and culturally appropriate interventions are warranted to meet the needs of people in different subgroups. Given the high prevalence of substance and alcohol use among young people, creating appropriate facilities in the cultural, economic, and social fields for this group seems necessary. Development of general policies for the prevention of alcohol and narcotics use in the country based on the estimates obtained from this article. Reconsideration of the support programs for high-risk groups for human immunodeficiency virus HIV. Allocate the necessary financial resources to prevent and provide prevention programs for drug and alcohol consumers. This study suggests that the prevalence of drug, stimulant and alcohol use in the country is increasing. The prevalence is higher among young people, and the tendency to use synthetic drugs has increased. Although drug use was more prevalent among men, the proportions of synthetic drugs and alcohol use among women is alarming. Considering age, sex, and geographical variations, appropriate intervention programs should be designed to reduce the burden of drug use in the country. Substance use disorders are global public health concerns that have led to social, mental, and physical harms across several communities. Globally, in , Substance use disorders are the third most significant public health concern in Iran. The population of people who use drugs has continuously increased in the past few decades, and it has been shown that young people are more engaged in substance use practices. Moreover, the use of newer drugs, such as hashish cannabis that is collected from the compressed resin glands, called trichomes, which is stronger than the substances obtained from the buds and leaves of this plant 7 and methamphetamine, has increased over time and contributed to human immunodeficiency virus HIV epidemics. The DALYs and death rates attributable to alcohol and drug use have significantly increased among all age groups and both genders in Iran. For example, the DALY rate attributable to drug use disorders among men has increased from Estimating the number of people who use drugs or alcohol is crucial to explore the trends of use over time, to investigate the usefulness of health policies, and to prioritize national plans. Due to stigma and the legal prohibition of drug use in some countries, especially in Iran, studying the prevalence and trend of drug use requires special measures. The Network Scale-Up NSU method provides researchers with a simple, relatively inexpensive, and powerful indirect tool for size estimation of marginalized groups. The classic idea behind the NSU method assumes that the prevalence of a behavior in the network of a sample is more or less the same as that in the general population. For example, the proportion of cancer patients in the network of a sample of respondents is comparable with the prevalence of cancer in the population. The NSU is an indirect method in which members of the general population are asked about the number of people that they know who are in the target population. This method has some practical advantages. It does not require direct access to members of the hidden population, and respondents do not reply to any sensitive questions about themselves. Previous studies on size estimation that calculated the prevalence of drug use in Iran have used direct methods, and their results were prone to underestimation. We found that the annual prevalence of opium and alcohol use were about 1. This cross-sectional study was conducted in all 31 provinces of Iran from October to March In each province, the samples were recruited from the capital and from one of the randomly selected cities. The sample size in each province was half men, half women. The only exception was the Tehran province the capital of the country , where due to its cultural diversity, we recruited subjects. Based on information from civil organizations, each city was divided into three strata with different socioeconomic statuses. In each stratum, two to four public places ie, the main streets, squares, and parks were selected. Using street-based sampling, participants were recruited from selected venues. Data were collected on all weekdays, in the morning and evening. We adopted street-based sampling, as responses to sensitive topics are more reliable in street-based sampling than phone or home-based surveys in Iran. We matched the gender of interviewers with participants. Before the data collection process, verbal consent was obtained from those who agreed to participate. In the NSU method, it is assumed that the prevalence of a behavior in the network of a randomly selected sample is similar to that of the general population. This indicates that the estimation of network size shown by C is a prime factor for NSU studies. To estimate C, we need some reference groups with known sizes shown by e. The final C was calculated as the average of Ci values. We have already estimated the average network size ie, C of the Iranian population as In the current study, we asked respondents to report the total number of people they know who used any one of the following drugs: a at least once in the past 12 months or b frequently defined as two to three times per week. The respondents were asked to stratify their reply by age and gender groups. We should mention that the components of crack available in Iran are not the same as crack cocaine. Instead of cocaine, Iranian crack mostly contains heroin, codeine, morphine, and caffeine with or without other drugs. For data cleaning, replies above 30 were rounded to this threshold. Moreover, 0. To estimate the size of people who belonged to a specific population, we applied the following formula:. One of the assumptions of the NSU method is that the respondents are aware of the sensitive behaviors of the members of their network. As sensitive information may not be transmitted, this assumption is hard to meet. To adjust the NSU method estimates, the crude estimates were divided by the visibility factor. We drew independent samples by replacement from the original data. Using each sample, the prevalence was calculated. Also, the percentiles 2. We stratified the data by province to provide province-level prevalence estimations. Due to the small sample size, the province-level estimates were smoothed by calculating the weighted average of province-level and national estimates. The weights applied to province-specific and national estimates were four and one, respectively. We applied quartiles to categorize the country into four risk zones. All these analyses were performed in R, Excel, and Arc Map version 9. The proportion of respondents in different age groups, marital status categories, and education levels was comparable to that of the general population. Due to the large sample size and sufficient power, we did not statistically compare the difference between proportions. In other words, 4. The most popular drugs in both genders were opium, hashish, and stimulants. The large gender differences were seen in other drugs and alcohol. Drug use was more prevalent among respondents aged between 18 and 50 years old Figure 1. The most popular drug among those aged above and under 30 years old was opium, and they frequently consumed alcohol. A similar pattern was seen among those aged between 18 and 30 years old. Drug injection was mostly popular among those aged between 31 and 50 years old. However, the highest proportion of hallucinogen use was observed in the subjects aged between 18 and 30 years old Figure 1. The prevalence of opium use was found to be higher in the southern and eastern provinces of the country Figure 2. On the other hand, the high-risk zones were large and industrial provinces in terms of stimulant use. Regarding alcohol consumption, the western and southwestern provinces were categorized into the high-risk zone. Finally, the central and western provinces were the high-risk zones for drug injection. Our study was the second phase of a national mission aimed to estimate the prevalence of drug and alcohol use in Iran and to monitor its trend. The first phase was conducted in In phase two, in light of our ongoing experience with the NSU method, we updated our questionnaire and estimated the prevalence of several types of drugs. In , the prevalence of substance use in Iran was reported as 2. Furthermore, in , the results of a national household survey showed that approximately 3. Although the comparison of the results of these studies might be misleading due to methodological and measurement differences, these studies may point to an increasing trend in drug use. In the current study, after alcohol, the most frequently used drugs in both genders and all age groups were opium and hashish. In line with this finding, the most frequently used drugs were opium and methamphetamine in a study in 20 and opium, crack, and heroin in a study in In the previous NSU study conducted in , opium and crystal methamphetamine had the highest annual prevalence at least once. These findings suggested that, over time, PWID tended to use synthetic drugs rather than traditional drugs. This hypothesis has also been confirmed in the findings of some other studies. The current estimates for the prevalence of stimulants and hallucinogens are 0. Moreover, we observed that women were more likely to take methamphetamine to lose weight. Our study showed the annual prevalence of alcohol users was 2. Our previous estimation in reported an estimate of 2. However, we believe our estimates may be more accurate, as we applied an indirect method among members of the general population. The prevalence of drug and alcohol use among men was higher than among women. For example, alcohol use was five times higher among men compared to women. These differences can be attributed to the fact that, culturally, the level of stigma associated with substance use is much higher for Iranian women. An important limitation of our study was that, in each province, the respondents were selected from the capital and one major city. Therefore, the results may not be generalizable to rural areas. Another limitation was that, in a trade-off between representativeness and accuracy, we decided to adopt street-based sampling. Our experience showed that, in Iran, street-based interviews are optimal for prevalence estimation of sensitive characteristics, which may partially be due to its confidentiality. This method suffers from the fact that not all members of the population have an equal chance of being interviewed. Furthermore, due to the stigma around drug-related behaviors and methodological challenges, the estimated sizes should be interpreted with caution. We recommend triangulating our results with other available data to get a more robust size estimate. Moreover, our estimations were based on self-report responses of the respondents on behalf of their network size. Although we applied the correction factors to address the invisibility, the results should be interpreted with caution. Lastly, our estimations were based on data obtained in , so these might not provide a current picture of substance use in Iran. However, these estimations can still be helpful and informative for policy planning and resource allocation. In this research, we observed an increasing trend in the prevalence of drug use in Iran. Opium was found to be the most frequently used drug in all age and gender groups. Also, drug use was more prevalent among men than among women, which may be due to a higher level of stigma and the current cultural context for the population of women. In terms of age groups, drug use was more prevalent among the young and middle-aged populations aged between 18 and 50 years old, which might be due to the higher economic, social, and emotional pressures experienced by these age groups. Our results suggest that a range of interventions programs should be designed for different age and gender groups. The authors are grateful to the provincial interviewers assisting in data collection. We also acknowledge the Ministry of Health and Medical Education for funding this study. We explained the aim of the study to the participants, and only those who verbally agreed to fill in the questionnaires were recruited. The ethics committee of Kerman University of Medical Sciences has approved the research protocol. All authors contributed to the study conception and design. Data collection was performed by AR. All authors read and approved the final manuscript. This work has been granted by the Ministry of Health and Medical Education grant number: Population size estimation of people who use illicit drugs and alcohol in Iran Int J Health Policy Manag. As a library, NLM provides access to scientific literature. Find articles by Azam Rastegari. Find articles by Mohammad Reza Baneshi. Find articles by Ahmad Hajebi. Find articles by Alireza Noroozi. Find articles by Mohammad Karamouzian. Find articles by Mostafa Shokoohi. Find articles by Ali Mirzazadeh. Find articles by Toktam Khojasteh Bojnourdi. Find articles by Naser Nasiri. Find articles by Saiedeh Haji Maghsoudi. Find articles by Ali Akbar Haghdoost. Find articles by Hamid Sharifi. Received Jun 30; Accepted Aug 9; Collection date Demographic Characteristics 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. Demographic Characteristics. Above high school. At-least Once. Frequent Use a. Prevalence b. Frequency c. Any type of drugs. Non-prescription methadone.

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