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Official websites use. Share sensitive information only on official, secure websites. There is cultural support for opium in Iran, and also there is cultural tolerance for tobacco smoking, especially as water pipe smoking, in Iranian families. Alcohol, opium, and cannabis are the most frequently used illicit drugs, but there are new emerging problems with anabolic steroids, ecstasy, and stimulant substances, such as crystal methamphetamine. There is serious drug abuse problem among Iranian high school students. It could be due to role-modeling by parents — mainly fathers — and also cultural tolerance of some substances. Early onset of tobacco smoking, with a daily use rate between 4. Use of all types of drugs, except prescription drugs, is more prevalent among boys. Alcohol is the most frequently abused substance, with a lifetime rate of at least 9. Lifetime rates of opiate use — mostly opium — were between 1. As drug abuse is a frequent problem among Iranian high school students, it is necessary to design and implement drug prevention programs to protect them. Such programs, including life skills training and drug education, have been operating in recent years for Iranian students from kindergarten to the university level. There is a long history of opium use in Iran. Opium use as a recreational substance has been recorded for more than four centuries. One of the first scientific descriptions of opium use in Iran was written by Dr. Jacob Eduard Polak — , a Jewish Austrian physician who worked in Iran between and 1 among teachers of the first Iranian medical school. It is not forbidden and every Iranian who can afford its cost uses it daily. Adolescence is a particularly vulnerable period for initiation of drug use 2 , and younger age at first drug use significantly increases the likelihood of more serious drug problems 3. Iran has the highest rate of abuse of opiates in the world 6 , 7. In recent years, there has been increased use of heroin, crystal methamphetamine, and ecstasy. There is no direct standard survey for finding the prevalence of drug abuse in Iran. But there are surveys that help in estimating the drug use situation. The last nationwide survey of drug use in Iran, carried out in , was a rapid situational assessment RSA This study is based on interviews with drug abusers in treatment centers, the justice department system and prisons, as well as interviews with key informants. It is not a household survey and, therefore, interpretation of the data should consider their limitations. Unpublished data from this survey 8 showed that there are 1. Although traditional drugs of abuse in Iran are opium and cannabis, in recent years there has been more use of heroin, crystal methamphetamine, and ecstasy. In RSA , it is shown that The use of drugs by parents is a particular concern, as parental drug use is a risk factor for offspring Evidence has shown that family environment and mental health are inter-related in opiate addicts Spousal 13 and child abuse 14 are more frequent in drug abusers than the general population. Regarding age in this study, Main substances of use were opium all forms in Comparing these results with a previous RSA in , which found that the main substance was opium at This is the first time in the history of drug use in Iran that heroin use is more prevalent than opium use. Heroin is usually smoked, sniffed, or injected. In RSA , the usual way of drug use for Although the average Iranian drug-dependent person is likely to be married and employed, the average Iranian injection drug user is more likely to be unemployed and single or divorced RSA has shown that, compared with previous reports, there has been a decrease in cannabis use and an increase in crystal methamphetamine use as the main substance used among the total population of drug abusers. Crystal methamphetamine was the main substance in 3. In this article, we review published papers in international and domestic journals as well as existing unpublished data describing substance use by young people in Iran. There are four main studies on drug abuse in high school students in different parts of the country. Drug abuse in these studies is considered to be the use of any illicit substances, including alcohol, cannabis, opiates opium and heroin , ecstasy, and methamphetamine. Information about tobacco use is also included in these studies. In , Ziaaddini et al. This city is near the eastern border with Pakistan and Afghanistan and has a traditionally high rate of drug abuse. In this study Kerman Study , the rate for lifetime use of drugs in high school students was Also In another study, conducted in in Zanjan, a city in the northwest of the country Zanjan study , lifetime prevalence of drug abuse in high school students was The rate was significantly higher among boys than girls In this study, poor school performance, depression, and cigarette-smoking parents were associated with higher rates of drug abuse. Ahamdi and Hasani 21 in Shiraz — a large city located in the southern part of the country Shiraz study — have found rates of lifetime use and current use of drugs to be significantly higher among boys than among girls. In this study, pleasure seeking, modeling, and tension release were the most common reasons for drug use. In a study in Tabriz — another city in the northeast Tabriz study — among male high school students, There are two usual ways of using tobacco among Iranian adolescents: cigarette smoking and a water pipe. The latter has been a common practice for centuries, mostly in the Middle East, but its use appears to be widespread among high school students even in the United States 23 and European countries In the Zanjan study 20 , a history of water pipe tobacco smoking in high school students was twice that of cigarette smoking In Iran, like in most of the Middle Eastern and Islamic countries, there are traditional taboos and social behavioral limitations for girls. For example, in the Zanjan study 20 , lifetime history of cigarette smoking was more than three times higher for boys than for girls, but the sex difference for water pipe smoking was less see Table 1. It seems that smoking a water pipe is more tolerable in families compared with cigarettes, and its use does not bring the same degree of negative stigma for girls. One study in Lebanon has also shown a sex difference in cigarette smoking but not for water pipe smoking Smoking a water pipe is a socially acceptable practice for adolescents in Iran 20 , other Middle East countries 25 — 28 , and in western countries, even for athletes, who are traditionally considered at low risk for tobacco use 29 , and it appears acceptable for both boys and girls. Regular daily cigarette smoking was more prevalent than water pipe smoking The prevalence of daily smoking ranged from 4. There is also a study of middle school students grade 7 , with a mean age of 13 years, which shows 7. Although the purchasing of cigarettes is not allowed in Iran for people under the age of 18, clearly for many youth, the age of smoking onset is much younger. Age of smoking onset was Also there are studies that have shown an association between smoking and mental 35 and physical disorders In Iran, alcohol is considered an illicit drug and its use is banned for all age groups. Unfortunately this situation does not prevent its use among adolescents, and, in fact, alcohol is the most common illicit substance among Iranian high school students, especially among boys 20 — Two studies in Kerman have shown lifetime prevalences for alcohol between In RSA , in a cross-country study, the mean age of first alcohol use was In a study among high-risk grade 11students in Tehran, The rate of alcohol use was similar to the rate for tobacco smoking and much more than the rate for any other substance. In the Zanjan study, the lifetime history of alcohol use was 9. The rate was significantly lower in girls 3. In this study, 16 boys out of 6. Although alcohol consumption is illegal in Iran it is banned by Islam and unlike many other countries there is no alcohol advertising 39 to promote use by youth , it is customary to have alcohol at various parties and ceremonies. In the Kerman study, It seems that there is a tolerant atmosphere in these situations even for adolescents regarding alcohol use. In the Kerman study, among those students with lifetime experience of alcohol use, Whereas there is no comparative study between Muslims and other religious groups in Iran, some studies in Iran have shown that there is more tolerance for alcohol consumption among Christians than among Muslims Iran has a long border with Afghanistan, the biggest producer of opium in the world, and opium use has a centuries-old tradition in Iran Although there is negative stigma for heroin use, there is a traditional supporting culture for opium. In a household survey of people aged 15 and over, As Agahi and Spencer reported nearly three decades ago, the problem for Iranian adolescents is exposure to role models of drug abuse; such models are more likely to be an adult family member than an adolescent peer, a reversal of what is usually found in western countries Modeling is the second most common reason for drug use in the offspring of opium dependents Lifetime prevalence of opium and heroin use was 1. In this study, none of the high school students were current opiate users Ahmadi et al. In Kerman study, one fourth to one third of high school students who had lifetime experience of opiate use — opium or heroin — were daily users of it Although there is no cross-country study of youth drug use, it seems that the southeastern parts of the country, which border Pakistan and Afghanistan, show larger numbers of opioid users. In all studies, the rate of heroin use was far lower than the rate of opium use Table 2. Studies on the epidemiology of drug use in Iran show that all drugs are used more often by males than females 19 — 22 , The situation is the same for high school students. The Zanjan study reported that the lifetime prevalences of opium and heroin use in male students were 3. None of female students had a lifetime history of opium or heroin use. In the Kerman study, among high school students, lifetime history of opium use rates were The numbers for heroin use were 5. Cannabis is used in Iran in both the form of grass marijuana and hashish. Studies have reported lifetime history of cannabis use at 0. The Zanjan study showed a 2. The rate was 5. In the Kerman study, lifetime history of cannabis use was 8. Prevalence of daily cannabis use in this study was reported as 3. There is a lack of studies on methamphetamine or cocaine. Although the four most common substances used by high school students in Iran are tobacco, alcohol, cannabis and opium 19 — 22 , there have been some studies in recent years about other substances. Rates of lifetime and daily use of prescription sedatives mostly benzodiazepines were 2. In the Zanjan study, lifetime use rates for prescription narcotic drugs, including codeine and tramadol, were 9. Codeine is usually supplied and consumed as codeine-containing pain-killer tablets that mostly also contain acetaminophen. Both acetaminophen-codeine tablets and tramadol tablets are prescription drugs, but some pharmacies sell them without a prescription. Actually there are reports that acetaminophen-codeine tablets are one of the best selling drugs in Iran. Significant rates of use of prescription drugs by girls, who report very low rates of illicit drug use, suggest that prescription drug use is less stigmatized than illicit drug use. It is also an important concern that, like in other countries 47 , many users of these tablets are also abusing other substances. In the Zanjan study, the rate of lifetime and daily use of anabolic steroids was 6. Lifetime anabolic use was Shakeri et al. Sepehri et al. The prevalence of ecstasy use among 15—year-old people in Tehran was In another study on ecstasy use among high school students in Lahijan in the north of Iran, 2. The rate in boys 3. There is also one study that has shown that a large number of ecstasy users were high school or university students There are a large number of studies that have shown that various mental health disorders can be concordant with drug abuse problems. Zanganeh 53 stated that social isolation and lower socio-economic status can be associated with psychiatric disorders, including drug abuse. Emami et al. The frequency of such problems was higher in girls than in boys. Alcohol and drug use can be associated with high risk sexual behavior 55 and other risk-taking behaviors in Iranian adolescents 56 and can be a risk factor for HIV transmission. There is evidence that substance-using adolescents in Iran 19 and other countries 57 have greater psychological dysfunction. Childhood and family adverse events are also associated with more drug abuse problems in Iran and other countries 58 — Drug abuse is also reported in association with impulsivity 30 and delinquent antisocial behaviors in Iran 22 as well as other countries 61 — Adolescent drug use in Iran shows co-morbidity with mental disorders, especially depression and anxiety disorders. The Zanjan study, using the Beck depression inventory, found that Pathological anxiety was also more prevalent in high school students with a history of drug abuse, but it did not reach the significance threshold. Drug abuse also has been shown to be associated with academic problems There are very important drug problems among youth in Iran. As drug abuse and addiction are biopsychosocial problems, we should keep in mind relevant cultural factors and co-morbidities. It seems that parents and schools fail to play a significant role in primary prevention in Iran, and families in which the father is a drug user pose a very significant risk factor. Nearly half of drug-using university students in one study had been familiar with drugs since their adolescence Considering this fact and also the rule that earlier first drug use leads to more drug problems later in life, it is necessary to initiate preventive programs as early as possible. Adaptive motivational structure is important 67 , and it has been shown that behavioral control can help Iranian adolescents to resist drugs There are youth and family counseling programs in Iran that can be effective for behavior problems and, as DeJong et al. Although in Iran there are not yet comprehensive family-based or school-based drug prevention programs as in developed countries, some recent programs appear promising. Such programs include drug related life-skills training in kindergartens and primary schools, life skills training and drug education packages in high schools and universities, and parenting skills training programs promoting family bonding. Papers of particular interest, published within the annual period of review, have been highlighted as:. As a library, NLM provides access to scientific literature. Curr Opin Psychiatry. Published in final edited form as: Curr Opin Psychiatry. Find articles by Saeed Momtazi. Find articles by Richard A Rawson. PMC Copyright notice. The publisher's version of this article is available at Curr Opin Psychiatry. Cigarette Water pipe Girls 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. Ziaaddini et al. Mohammadpoorasl et al. Nakhaee et al. Momtazi et al.