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Breaking bad in Tehran: how Iran got a taste for crystal meth

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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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