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Activities by an organized crime group involving the illegal entry, transit or residence of migrants for a financial or material benefit. The production, transport, storage and sale of goods that are fraudulently mislabeled or fraudulent imitations of registered brands. The illicit transport, handling and sale of excise consumer goods despite a ban or outside a legal market. Excludes oil and counterfeits. The illicit trade and possession of species covered by CITES convention, and other species protected under national law. The poaching, illicit trade in and possession of species covered by CITES and other species protected by national law. Includes IUU fishing. The illicit extraction, smuggling, mingling, bunkering or mining of natural resources and the illicit trade of such commodities. The production, distribution and sale of heroin. Consumption of the drug is considered in determining the reach of the criminal market. The production, distribution and sale of cocaine and its derivatives. Consumption is considered in determining the reach of the market. The illicit cultivation, distribution and sale of cannabis oil, resin, herb or leaves. Consumption is used to determine the market's reach. The production, distribution and sale of synthetic drugs. Organized crime that results in a monetary loss via financial fraud, embezzlement, misuse of funds, tax evasion and abusive tax avoidance. Clearly defined organized crime groups that usually have a known name, defined leadership, territorial control and identifiable membership. Loose networks of criminal associates engaging in criminal activities who fail to meet the defining characteristics of mafia-style groups. Includes foreign nationals and diaspora groups. The State's role in responding to organized crime and its effectiveness. The degree to which states have put oversight mechanisms in place to ensure against state collusion in illicit activities. A country's supranational structures and processes of interaction, policy making and concrete implementation to respond to organized crime. The degree to which states are able to control their physical and cyber territory and infrastructure against organized criminal activities. Assistance provided to victims of various forms of organized crime, including initiatives such as witness protection programs. Refers to the existence of strategies, measures, resource allocation, programmes and processes that are aimed to inhibit organized crime. Human trafficking is a widespread issue in Iran, primarily involving sex trafficking, forced labour and the recruitment of child soldiers. The country is situated along one of the main human trafficking routes in the region, with young women being trafficked from Asia into Europe and the Gulf. Iranians are also trafficked to countries in the Gulf and Caucasus, as well as to Iraqi Kurdistan. Domestic trafficking is mainly an issue in larger cities such as Tehran, Shiraz and Tabriz, where organ and blood trafficking contribute to the pervasiveness and profitability of this criminal market. Millions of child labourers are estimated to be working in Iran, but due to the country's lack of transparency on the issue, especially on trafficked women and girls, accurate statistics are hard to find. Since the onset of the pandemic, the Iranian population has significantly increased its use and reliance on technology and social media platforms, thereby providing criminal groups with more opportunities to exploit vulnerable people through online channels. The human smuggling market is also pervasive in Iran. The crisis in neighbouring Afghanistan has further driven the demand for irregular migration, increasing fees and boosting financial incentives for smuggling groups. Arms trafficking is a key element of Iran's regional geopolitical strategy. The country is a major supplier of conventional weapons to countries in Western Asia, as well as North Africa and Russia. Many non-state actors in the region also use Iranian arms, ammunition and drones, and Tehran's support contributes to military capacities in Syria, Iraq, Lebanon, Sudan, Yemen, the Palestinian territories and Somalia. There have also been allegations that military equipment and drones are being transferred to Russia to be used in the war in Ukraine. While Iranian involvement in the arms trafficking market is propelling the proliferation of illicit arms sales across Western Asia, the country's domestic illicit arms market is relatively small, largely due to strict gun control laws and low firearms possession rates. A relatively minor market is found in the Baluchistan and Sistan provinces and western Iran. Iran has sizable markets for counterfeit and excisable goods. During the global pandemic, the country saw an increase in fake medicines and medical supplies and, as a result, Iran has become one of the primary transit points for counterfeit pharmaceutical products entering the EU. Most illicit trade into and out of the country occurs through official ports and border crossings, many of which are controlled by the IRGC, leading to accusations of its complicity in smuggling operations. While flora and fauna crimes are present in Iran, they are comparably smaller than other illicit markets in the country. Iran's natural geography includes a diverse range of ecosystems, making it vulnerable to a wide variety of flora crimes. Deforestation in the country is mainly caused by illegal logging and wood smuggling, encroachment on forests, exploitation of natural resources and coal mining. The critically endangered Iranian maple tree is only found in Iran's Hyrcanian forest and is threatened by illicit logging, agriculture and climate change. The pandemic has boosted the traditional medicine industry in Iran, leading to an increased demand for plant species used in alternative treatments. Orchid tubers are illegally collected and exported to neighbouring countries or to South Asia for use in traditional drinks and medicines. Home to several rare species, Iran also offers an attractive market for wildlife crime. In particular, sheep and ram subspecies are poached for meat or to be used as trophies, especially in the Masjed mountain range in Yazd province. Afghan-sourced species also transit Iran before onward travel to the Caucasus, Syria and Iraq. Iran has one of the world's largest oil reserves, and the country's oil exports have increased in recent years despite Western sanctions. Iranian oil supplies are reportedly shipped in large quantities through international waters using Dubai-based tankers, and are primarily destined for Oman, Yemen, Somalia and China. Illicit oil flows also occur on a small scale, leading to some socio-economic and environmental challenges in the country, including the destruction of wildlife and biodiversity, water pollution, degradation of critical farmland, public health concerns and the prolongation of armed conflicts. Fuel smuggling occurs largely in the border regions, especially in Baluchistan and Kurdistan, where smugglers transport Iranian oil and subsidized fuel to neighbouring countries and reap high profit margins. It is estimated that millions of litres of fuel are smuggled out of the country each day. This is allegedly facilitated by corruption among border personnel, including the IRGC. Iran accounts for a large share of heroin seizures worldwide, much of which is sourced from Afghanistan and destined for Turkey, the EU, the Gulf region and beyond. Iran is among the cheapest places in the world to buy heroin, contributing to the country having one the highest addiction rates worldwide. The heroin trade is associated with violence and has resulted in multiple clashes between Iranian border guards and traffickers over the past years. Sanctions have been placed on high ranking IRGC commanders for their alleged involvement in the heroin trade in Sistan-e-Baluchistan. As the second most consumed drug in the country, cannabis is widespread in Iran, and there is relative tolerance towards the drug compared to other narcotics. The cannabis trade has significantly grown over the past decade, resulting in large-scale domestic cultivation fields throughout the country, while small-scale production is believed take place in Tehran. Cannabis resin is also imported from Afghanistan. Iran continues to be a source, transit and destination country for methamphetamine. In recent years, increased methamphetamine production in neighbouring Afghanistan has affected Iran, with low-cost competition leading to an influx of cheaper Afghan methamphetamine into the country. These developments have contributed to the surge in methamphetamine use in Iran over the past few years. Moreover, while the synthetic drug Captagon is spreading across the region, the role of this drug within Iran remains unclear. Iran is known for its strong offensive cyber capabilities, with state-embedded criminal actors believed to be particularly active in conducting cyber-dependent crimes. The increasing reliance on digital platforms in Iran and other countries during the COVID pandemic has created a conducive environment for cybercriminals to exploit. These crimes target both national and foreign private and public sectors, including political dissent, activists, journalists, entities, critical infrastructure and organizations. In recent years, Iranian actors have been increasingly targeting government entities in countries like the US and Israel, as well as in the EU and the Gulf. Iranian actors reportedly collaborate with criminal groups in Russia and North Korea, learning new cyber-attack techniques from one another and constantly adapting their tactics. There has been a particular increase in ransomware attacks by Iranian-backed actors. Financial crime is a pervasive issue in Iran, with economic fraud, misuse of funds, embezzlement and large-scale tax evasion being the most common types of financial crimes in the country. The number of corruption and embezzlement cases in the country has tripled in recent years. The majority of these cases involve either government employees or people appointed to managerial positions at state-run economic entities, exemplified by the presence of bonyads - untaxable and opaque organizations. These bonyads have reportedly diverted trillions of dollars in public funds into the bank accounts of political elites, leading clerics and other prominent Iranians. In addition, phishing has emerged as a growing issue in Iran, with fake text messages impersonating government services and entities being used to scam unsuspecting victims. Tens of thousands of Iranians have fallen prey to these scams, costing them up to thousands of dollars each. The rise in phishing attacks has been linked to the increasing use of mobile phones and the internet, as well as a lack of awareness among the population about how to protect themselves from financial crime. Criminal activities in Iran are mainly carried out by state-embedded actors and criminal networks. In particular, the IRGC allegedly has enduring ties with criminal and terrorist organizations both within and outside the country. State-embedded actors in Iran are believed to be involved in the trafficking of people and drugs, including cocaine, heroin and synthetic drugs, as well as oil smuggling and other non-renewable resource crimes. It is unclear whether state actors are involved in human smuggling or cannabis trafficking, and there is little evidence to suggest that they control flora or fauna crimes. The line between the sale of arms by the state and arms trafficking has also been blurred in recent years. The criminal networks that operate within the country are primarily based in Tehran, as well as in the eastern and western provinces. These networks usually specialize in one or two illicit markets. Some small criminal networks collaborate with similar networks outside Iran to smuggle and traffic people and goods. Loose criminal networks involved in areas such as human trafficking or drugs may have connections to foreign networks. The level of violence perpetrated by these networks varies depending on the illegal activity they are involved in, with heroin trafficking being the most violent. Even though there is less evidence of significant-sized mafia-style groups operating in the country, mafia-like syndicates do exist in Iran and are mostly engaged in money laundering and financial crimes, among others. Iran's lack of a strong private sector and the dominance of state institutions, including the IRGC, is a major factor in driving the private sector towards illicit means of competition. These practices include tax evasion, involvement in the black market and bribery, among others. Ongoing Western sanctions against the country have further strengthened the private sector's illicit activities. The influence of foreign actors in Iran is generally kept to a minimum due to the country's opposition to foreign intervention. However, there are some examples of cross-border cooperation in the drug trade, with joint ventures between Iranian and Afghan partners, as well as smuggling activities in the Kurdish region. Iran has a governance system that is a mix of democratic and religious elements. However, the religious supreme leader has minimal checks and balances, and elected officials struggle to exercise leadership, which makes it difficult for the government to tackle issues such as corruption and organized crime. Anti-corruption efforts tend to be politicized and target opponents rather than addressing the root causes. The IRGC is thought to actively obstruct Tehran's attempts to combat organized crime, as it is reportedly complicit in certain criminal activities. In recent years, there has been growing support for moderate and reformist candidates, and uprisings and protests have emerged from traditionally pro-government communities, underscoring the regime's vulnerability. In , the government violently cracked down on protests, blocking internet access, pressuring media not to cover the protests, and arresting protesters and activists. Iran's cybercrime laws give the government full control over the internet, enabling it to enforce widespread censorship and surveillance, and systematically violating the Iranian people's rights to freely access information and freedom of expression. The government's ongoing efforts to implement strict online surveillance undermine transparency and accountability. Moreover, there have been increasing reports of nepotism, cronyism, corruption and embezzlement among members of parliament and councils throughout Iran. Iran's track record of engaging in international cooperation is limited, with few exceptions. While the country expressed its intention to increase international cooperation on extradition matters, concerns about persecution in the country have hampered such agreements. Furthermore, the government introduced a controversial so-called cyber protection bill in recent years, which is considered draconian and oppressive by human rights organizations. Additionally, Iran has strict drug laws that include the death penalty and prison sentences for people who use drugs in public. The country's laws to combat human trafficking have been widely criticized for being inadequate. The Iranian judicial system is characterized by duality, comprising the ordinary criminal courts and the Revolutionary Courts. However, there is a significant disparity between these two entities. While ordinary criminal court defendants have access to a lawyer and can appeal their cases, Revolutionary Court defendants do not have due process, are not entitled to legal counsel and are often executed without public notice. Most people become involved in the Iranian criminal justice system due to drug trafficking; over a third of all prisoners are incarcerated for drug-related offences. Prison standards in Iran are typically poor, with overcrowding a common issue. Prison officials have denied food and medical care to prisoners, and both physical and psychological torture is prevalent. Thousands of people convicted of drug-related crimes are on death row, and over the past year, Iran has had the highest execution rate in the world, including of children. Recent trials and subsequent sentences, including executions, handed down by the Iranian courts against protestors, demonstrate a concerning disregard for due process. These incidents further highlight the politicized nature of the judicial system in the country. While these entities engage in law enforcement activities, their focus tends to be on counterinsurgency. The country's law enforcement forces were leading players in the suppression of the widespread protests, and their ineffectiveness has been criticized. Corruption is widespread within law enforcement, and security services are often poorly equipped and trained. The lack of functioning equipment in law enforcement agencies has contributed to considerable setbacks in stemming the flow of drugs and tracking criminals throughout the country. Iran's borders are difficult to monitor due to their length and varied terrain. They are also home to armed opposition groups. Heroin and methamphetamine are smuggled into Afghanistan, Azerbaijan and Iraq by drug traffickers. The recent Taliban takeover of Afghanistan has raised concerns about the influx of irregular migrants, as well as fears of a potential resurgence of the Islamic State or a civil war in Afghanistan. Despite these challenges, Iran's territorial integrity remains relatively strong, and it is unlikely to change soon absent significant conflict. The country's deficiencies in fighting money laundering and terrorist financing have landed it on the FATF blacklist. Even though the country made efforts to address strategic deficiencies in its money laundering and terrorist financing systems by introducing new legislation, major strategic deficiencies persist. Iran's economy is heavily dependent on the Basij and the IRGC, which have significant control over the national economy. This can make it challenging for independent businesses to operate. The situation is compounded by corruption and criminal activity at the state level, as well as Western sanctions, which contribute to Iran's ongoing economic decline. The impact of the global pandemic has only worsened this situation, with the country being hit harder than any other country on the continent. As a result, over one-third of the population now lives below the poverty line. Although the government typically releases five-year economic planning documents, it has not made these public since the imposition of sanctions. The Iranian government does not have a cohesive or strategic approach to crime prevention. However, in recent years, the government has shifted its approach to treating drug addiction from punitive measures to a more pragmatic, health-based approach. Drop-in centres and clinics now offer harm reduction services and medical treatment to drug users, including women. The country also has a witness protection programme, but it lacks a policy and practice to protect victims and crime witnesses; international NGOs are not allowed to provide assistance in such instances. Arbitrary arrests of tribunal witnesses and their families based on undefined national security threats have occurred, leading to witnesses concealing their identities during public hearings by wearing masks, sunglasses and headscarves. There are a number of social activities aimed at reducing the incidence of crime, though their effectiveness is questionable. The main form of crime prevention in Iran remains deterrence through rather harsh punishments. The state heavily censors Iran's media, bans social media and undertakes efforts to curb the flow of information from outside the country. Although the space for civil society and media is heavily restricted, civil society organizations have been very active, particularly in drug policy and carrying out prevention programmes. There is no meaningful freedom of assembly in Iran, and authorities have been heavy-handed in their crackdown on protests criticizing the government or other sensitive subjects. Non-state actors also played a role in the protests that began in September The criminal markets score is represented by the pyramid base size and the criminal actors score is represented by the pyramid height, on a scale ranging from 1 to The resilience score is represented by the panel height, which can be identified by the side of the panel. A series of 13 discussion papers, one for each illicit market considered during the development of the Index. We're constantly working to improve the Index. By participating in this survey, you will be providing us with insights and suggestions that will help us make the Index an even better resource. This report was funded in part by a grant from the United States Department of State. The opinions, findings and conclusions stated herein are those of the Global Initiative Against Transnational Organized Crime and do not necessarily reflect those of the United States Department of State. Capital Tehran. Income group Lower middle income. Population 87,, Geography type Coastal. GINI Index Criminal markets 7. An assessment of the value, prevalence and non-monetary impacts of a specific crime type. Human trafficking 8. Human smuggling 8. Extortion and protection racketeering 4. Arms trafficking 9. Trade in counterfeit goods 7. Illicit trade in excisable goods 8. Flora crimes 4. Fauna crimes 4. Non-renewable resource crimes 9. Heroin trade 9. Cocaine trade 5. Cannabis trade 6. Synthetic drug trade 9. Cyber-dependent crimes 8. Financial crimes 9. Criminal actors 6. An assessment of the impact and influence of a specific criminal actor type on society. Mafia-style groups 5. Criminal networks 7. State-embedded actors 9. Foreign actors 6. Private sector actors 5. Political leadership and governance 2. Government transparency and accountability 2. International cooperation 4. National policies and laws 4. A state's legal action and structures put in place to respond to organized crime. Judicial system and detention 3. Law enforcement 3. Territorial integrity 5. Anti-money laundering 2. Economic regulatory capacity 2. Victim and witness support 3. Prevention 3. Non-state actors 2. Analysis Download full profile english. People Human trafficking is a widespread issue in Iran, primarily involving sex trafficking, forced labour and the recruitment of child soldiers. Trade Arms trafficking is a key element of Iran's regional geopolitical strategy. Environment While flora and fauna crimes are present in Iran, they are comparably smaller than other illicit markets in the country. Cyber Crimes Iran is known for its strong offensive cyber capabilities, with state-embedded criminal actors believed to be particularly active in conducting cyber-dependent crimes. Financial Crimes Financial crime is a pervasive issue in Iran, with economic fraud, misuse of funds, embezzlement and large-scale tax evasion being the most common types of financial crimes in the country. Criminal Actors Criminal activities in Iran are mainly carried out by state-embedded actors and criminal networks. Leadership and governance Iran has a governance system that is a mix of democratic and religious elements. Criminal justice and security The Iranian judicial system is characterized by duality, comprising the ordinary criminal courts and the Revolutionary Courts. Economic and financial environment The country's deficiencies in fighting money laundering and terrorist financing have landed it on the FATF blacklist. Civil society and social protection The Iranian government does not have a cohesive or strategic approach to crime prevention. Read the analysis Listen the podcasts View all events. Next Skip. How to measure organized crime? Read more on globalinitiative. Give us feedback We're constantly working to improve the Index.
Socio-demographic characteristics of the addicted inmates of Qom and Tabriz prisons in Iran
Tabriz buy Heroin
Official websites use. Share sensitive information only on official, secure websites. Corresponding author: Hemmat Maghsoudi, MD maghsoudih yahoo. Box , Tabriz , East Azerbaijan, Iran. Phone: , FAX: A five-year prospective study March March of burn victims hospitalized in a major burns centre in Iran was conducted in order to survey the aetiology and outcome of burns in patients who were drug addicts. Three hundred and thirty patients addicted to drugs were identified and stratified by age, sex, burn size, presence or absence of inhalation injury, kinds of abuse agents, and cause of burn. The mean patient age was There were 60 deaths overall The mortality rate was significantly higher in multi-drug abusers than in single-drug abusers. Except for burn incidence, there were no significant differences between males and females. The mean burn size, Inhalation injuries were strongly associated with large burns, and were present in all flame-burn fatalities. Flame burns were the most common type of burns in drug-addicted patients: incorrect use of a lighter and match and falling onto a brazier were the most common causes of flames. There were 11 deaths related to electrical injuries. Large burn size was the strongest predictor of mortality followed by the presence of inhalation injury. The most common agent of abuse was opium, followed by heroin and hashish; there was no difference between males and females in relation to the type of agent of which abuse was made. The principal effects of opioids opiate-like drugs are a significant damping of pain perception along with modest levels of sedation and euphoria. Tolerance of any one opioid is likely to be generated to others i. Each of these opioid substances is capable of producing physical addiction, and the withdrawal syndrome after abstinence from any one of the substances can be treated by administering any of the others. Stimulants are drugs that stimulate the central nervous system. These substances tend to increase alertness and physical activity. They include amphetamines, cocaine, crack, and some inhalants like amyl or butyl nitrites. Caffeine present in tea, coffee, and many soft drinks is also a mild stimulant drug. Different stimulants act on the body in different ways. For example, nitrate inhalants cause the blood vessels to dilate, cocaine and crack interfere with normal levels of the neurotransmitter serotonin, and amphetamines cause the release of adrenalin. Hallucinogens have no legal medicinal uses and are therefore all classed as drugs of abuse. The most commonly seen are LSD, ecstasy, and psilocybin magic mushrooms. Other hallucinogenic substances such as mescaline and DMT are not widely available on the illicit drug market in the United Kingdom. Cannabis is a central nervous system depressant obtained from the plant Cannabis sativa, which grows in many parts of the world. It is available for use as a drug in three main forms: as the dried leaves and buds known as grass or marijuana , as a solid resin hashish or hash which is collected from the buds and flower heads, and as a thick liquid prepared from the flowers or resin hash oil. The main psychoactive i. Hashish is made by taking the resin from the leaves and flowers of the cannabis plant and pressing it into cakes or slabs. It is usually stronger than herbal cannabis and may contain five to ten times as much THC. The attention paid by the general public, the government, and the media to heroin, cocaine, and ecstasy in recent years may have led some adults and young people to assume that cannabis is of less concern. Cannabis availability is at an all-time high. Among teenagers, those who smoke cigarettes are more likely to drink alcohol. Those who smoke and drink are more likely to use cannabis. And those who use all three are more likely to use other illicit drugs. Using cannabis exposes the young to the company and influence of those who use and deal in illicit drugs and may encourage other dangerous and illegal activities. Some estimates suggest that more road accidents are caused by the use of cannabis than by that of alcohol. Heroin is a powerful painkiller that depresses the central nervous system. This produces a feeling of relaxation, security, and well-being. Opium addiction in Iran has long historical roots and is a major social and health problem. Numerous publications have documented the association between alcohol and drug abuse, particularly between alcohol and motor vehicle crashes, injuries to pedestrians and cyclists, falls, burns, drowning, suicides, assaults, domestic violence, and even murder. Most studies have examined the association between alcohol consumption and injury using hospital emergency-department admissions data. In particular, in the case of burn injury, we hypothesized that multi-drug abuse represented a more powerful risk factor for burn injury than single drug abuse. We also hypothesized that, considering the most severely affected substance abusers amongst patients receiving care in a burns unit, opium was the main cause. In this study, we planned to conduct an aetiological survey of burns suffered by abusers of various kinds of opioids, stimulant drugs, hallucinogens, and cannabinoids in patients admitted to the burns ward at Tabriz Sina Hospital, Iran. From 20 March to 20 March , patients with burn injury including patients addicted to opium were admitted to the burns centre at Sina Hospital in Tabriz. Various kinds of abused drugs were classified as opium agents including opium, morphine, codeine, heroin, opium residue, crack, petedine, and methadone , stimulant agents amphetamine, crystal, cocaine, and ecstasy , and hallucinogenic agents LSD, PCD. Between these dates a prospective study of all drug-abusing patients with burn injuries presenting solely at the Tabriz Burns Centre was designed to analyse the association between age, percentage total body surface area TBSA burned, inhalation injury, causes of burn, type of opioid, the risk of death, and the epidemiology of burns. Survival was defined as discharge from the burns unit. A special dossier was prepared to study epidemiological, demographical, and therapeutic data. The patients were categorized by age, sex, percentage TBSA burned, presence or absence of inhalation injury, cause of burn, outcome, educational status, occupational status, length of hospital stay, type of opium addiction, and type of family. The diagnosis of the opiate abuser was made by one of two attending burns surgeons on the basis of the clinical history, which included the patterns of opiate usage, information regarding the possible existence of an antisocial personality disorder, history of chronic pain, search for physical stigmata of misuse e. A blood and urine screen was used to identify opiates in patients in whom misuse was suspected. The diagnosis of inhalation injury was made by one of the two attending burns surgeons, based on the history surrounding the burn event and the physical findings. The factors used to determine the presence of inhalation injury included burns sustained in an enclosed space, presence of facial burns, requirement of mechanical ventilation, carboxyhaemoglobin levels, and presence of carbonaceous sputum. We do not use bronchoscopy and the Xenon lung scan in our institution. There is no accepted way of quantitating the severity of inhalation injury other than by determining whether inhalation injury is present or absent. We chose to use the clinical criteria demonstrated by Shirani et al. Fluid requirements were estimated using the Parkland formula. Urine output was used as the principal resuscitation guideline. Burn cause was determined by history. Follow-up was obtained by examination in clinic. Follow-up examination was scheduled in all patients from 12 to 72 months. The findings were entered on a computer by means of a SPSS The statistical analyses were used to assess the relative predictive power of percentage TBSA burn, age, inhalation injury, type of opium, and cause of burn, as well as different combinations of these five variables, as predictors of mortality. The level of significance was set at 0. During the five years of the study, patients were admitted, of whom were drug addicts 9. In addicted patients, the mean age was The largest single group of patients was the yr age group in both addicted and non-addicted patients. The most common cause of burns among the addicted patients was flame Of the burn cases, There were 47 The mean burn size was The mean fatal size was The mean length of hospital stay was The mean length of hospital stay in addicted burn patients was There were 60 deaths, with an overall mortality rate of Sixty patients There were 31 deaths among the patients without inhalation injury mortality, Inhalation injury was present in 29 of the 60 deaths Inhalation injury was present in All patients with flame burns had associated inhalation injuries. However, inhalation injury was strongly associated with large burns. The distribution of patients by age group, average burn size, presence of inhalation injury, and mortality is shown in Table I. The distribution of patients by mean burn size, presence of inhalation injury, and mortality is shown in Table III. The mortality rate was significantly higher in multi-drug abuse than in single drug abuse Large burn size was the strongest predictor of mortality, while inhalation injury, strongly linked to large burns, was found to be an independent predictor of death. Patient gender when matched with burn size, age, type of agent used, and cause of burn was not predictive of mortality in either addicted or non-addicted patients. There was no difference between males and females according to the type of agent abused. The distribution of patients by type of agent used, inhalation injury, and mortality is shown in Table IV. This figure is more than five times the estimate 0. The government of Iran seems particularly concerned over the sharp increase in intravenous drug abuse. Most observers place the number of drug users in Iran at about 2,,, the great majority males. Opium smoking is the traditional manner of drug of abuse in Iran, but opium is also drunk, dissolved in tea. Opium and its residue are also injected, dissolved in water, by a small number of addicts. Heroin is sniffed, smoked, and injected. Ninety-three per cent of opiate addicts are male, with a mean age of In Iran the situation is exacerbated not only by rampant unemployment but also by general apathy and lack of confidence in the future. The quality of Iranian education is high compared to that of western countries, and the despair of highly skilled young graduates forced to accept menial jobs in small shops is thus reflected more in the drug addiction rates than in employment statistics. One study found that in a group of patients who were substance abusers or who were neurologically or mentally impaired, in-patient care was more costly, more complicated, and more protracted. To determine whether substance users SU differed from controls, burn patients were studied, of whom had a positive drug screen for ethanol, cannabinoids, cocaine metabolites, amphetamines, phencyclidine, or benzodiazepines. In our prospective study, the SU were significantly younger than non-addicted patients The greater incidence of inhalation injury in non-abusers may be due to the greater incidence of suicide in our patients, which presented a higher mean percentage of TBSA burned Burns in opiate-addicted patients have frequently been reported in the literature, which indicates in relation to opiate addiction that men are more likely to become addicts than women, as in our study. As expected, we found that increased burn size led to an increased risk of mortality among addicted and non addicted patients, a finding confirmed by other studies. The non-survivors with small burns in this series are an important reminder that addicted burn patients can die from small burns. The mortality in our overall patient population Like other researchers, 13 , 14 , 16 , 18 we found that the incidence of inhalation injury rose with increasing burn size, but not with advancing age. This is not surprising since, as has already been suggested, larger burns and inhalation injury are more likely to be seen in less mobile patients burned in fires. In the addicted burn population, most burns are flame burns and most are associated with inhalation of smoke. In addition, we demonstrated that in our series of addicted burn patients, the most important predictor of mortality following thermal injury was TBSA burned, with inhalation injury adding little to the accuracy of this in addicted patients. In our study, the mortality rate was significantly higher in multi-drug abusers than in single drug abusers. The most important factors influencing the incidence of thermal injuries are age, sex, and economic status. Addicted patients are the most prone to thermal injury. The greater amount of addiction in burn patients in our study may be due to the higher incidence of addiction in Iran, for various reasons: land routes across Iran constitute the single most important conduit for south-west opiates en route to European markets. The relationship between median family income and burn rate is strong and linear. Addicted burn patients from poor or low-to-middle income families are exposed to burns. We determined that the cause of burns was not an independent predictor of mortality i. We were surprised by the finding that there was no mortality among the 22 patients with scalds presenting a mean burn size of Other studies 13 , 16 , 17 , 18 concluded that the presence of inhalation injury significantly increased mortality and suggested that inhalation injury was the single most important determinant of mortality following thermal injury. In the present study, we too found that inhalation injury was important and that inhalation injury was significantly associated with mortality following thermal injury. However, we found that although inhalation injury was a significant predictor of outcome, it was less important than the size of the burn in predicting mortality. In our study, one key finding was that after burn injury more problems were associated with multi-drug use than with single drugs. The mortality rate was significantly higher in multi-drug abusers. We conjectured that personality traits in drug-abuse dependent persons accounted for the prevalence of the injury to a greater extent than the consumption itself. This is a clear finding, but the issue will require further study. Such individuals constitute a prime opportunity to focus on burn injury prevention within the confines of treatment programmes directly linked to substance abuse. The recognition of the burns centre as place to offer prevention is a unique contribution to this particular field of study. This includes educating patients about the risks of injury as well as making assessments of their living conditions, in order to prevent burn injuries. Identifying patients with depressive symptoms and impulsive behaviour may also be beneficial, so that additional counselling sessions can be provided. Future studies should look at the various prevention strategies offered in detoxification programmes in order to verify their capacity to decrease the consumption of abused drugs and the burn injury rate. In conclusion, our data suggest that although increases in the percentage of TBSA burned and the presence of inhalation injury were associated with increasing mortality, the most important single predictor of mortality in drug-addicted burn patients was the percentage of TBSA burned, while the presence of inhalation injury added little to the possibility of predicting mortality. In no addicted burn patient, no matter how large the burn, what sort of abuse agent, or what type of inhalation injury, could an accurate prediction be made at the time of admission as to whether the patient would live or die. Despite some differences in demographics, the same general rules for rehabilitation apply to the opiate abuser. The basic strategy includes detoxification and general family support. It is also important to establish realistic patient goals and a programme of counselling to increase motivation toward abstinence. A long-term commitment to rebuilding a life-style without the substance is essential for preventing recidivism. Since , public awareness campaigns and the attention of two successive Iranian Presidents, as well as cabinet ministers and the Iranian parliament, have given appeals for reduction of drug abuse a significant boost. Eighty-eight out-patient treatment centres are now operational. Some 30, people are treated per year, and some programmes have three-month waiting lists. Narcotics Anonymous and other self-help programmes can be found in almost all districts as well, and several NGOs focus on drug demand reduction. Understanding how opiates cause addiction could lead to greater insight into the brain processes of addiction to other dependence-producing drugs, and to discovering how to prevent dependence from occurring. Also, research into opiate addiction could increase understanding of the brain networks involved in pain, as opiates and opiate receptors in the brain and spinal cord are involved in pain processes. With a better knowledge of addiction and of pain - another urgent public health issue - scientists will be able to develop specific medication to treat these distinct disorders. Only continued funding for research will help develop better treatments that are selectively targeted, helping more addicts to stay drug-free. Health care practitioners - particularly family physicians and trauma personnel - play a valuable role in detecting substance-abusing patients, intervening on their behalf, and referring them to appropriate care. Addiction is a brain disease. There are many things that can place someone at risk of developing an addiction, and we now know that it can have a genetic basis. It is a chronic disease, just like heart disease, diabetes, and other diseases, and we should bring it out into the open, just as we have done with diseases such as breast cancer and heart disease. Owing to the wide variety of causes of burn injuries related to drug abuse, diverse interventions targeted at those at highest risk e. As public health workers are the most important people involved in such programmes, using them to their full capacity and also using the full capacity of the health system network in Iran are advised if these injuries are to be reduced. As a library, NLM provides access to scientific literature. Ann Burns Fire Disasters. Show available content in en fr. Find articles by H Maghsoudi. Find articles by R Raghifar. Received Sep 2; Issue date Dec 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.
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