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Official websites use. Share sensitive information only on official, secure websites. To self-medicate substance dependence, many substance users consume herbal medicines delivered in herbal medicine shops which are prepared through non-standard methods using a variety of different materials. Hence, the present study was carried out aiming to investigate and analyze the content of such herbal medicines. Four herbal medicine shops were selected from each of the 22 zones of Tehran City, Iran, and a total of 95 samples were purchased. A package containing 6 types of medication that was advertised by a satellite TV channel, was also purchased. Using high-performance liquid chromatography HPLC method, the samples were analyzed in the laboratory to detect different types of materials. Among the samples, 23 and 72 samples were uncovered compressed pills Dragon pills and capsules filled with colored powders handmade self-medicating substance dependence capsules , respectively. The package advertised in the satellite TV was prepared in 6 various forms. The findings of this study showed that handmade capsules and pills used for self-medicating substance dependence and also medicines advertised in the satellite TV channels contain different amounts of opioids, amphetamine, benzodiazepines, tramadol, codeine, and other substances that cause problems for substance users who are going to abandon substance abuse. Keywords: Substance withdrawal, Herbal medicine, Dragon, Component analysis, High-performance liquid chromatography. Drug addiction remedies are often provided and prescribed rudimentarily and unsafely by unprofessional individuals without observance of health issues and without any supervision on them. In some cases, herbalists are not aware of the ingredients and consider them to be safe, while it has been found that at least one chemical substance is used for the preparation of these medicines. Given the increasing use of non-standard herbal medicines provided by herbal medicine shops and advertised by satellite TV channels, this study was conducted with the aim to investigate and analyze the content of handmade pills and capsules used for self-medicating substance dependence. This study was conducted in in Tehran, the capital of Iran. Four herbal medicine shops were selected from each of the zones of Tehran and several pills or capsules were purchased from each shop. As the shop keepers did not provide all individuals with self-medicating substance dependence capsules or pills, the researchers asked several motorcycle rider ex-addicts who were treated to purchase the medicines. The treated ex-addicts were equipped with a voice recorder and all conversations were recorded all the time they were in the herbal medicine shop. Moreover, pills and capsules were chosen in a variety of colors and sizes. A total of 95 self-medicating substance dependence capsules or pills were bought from 88 herbal medicine stores and were delivered to Bahar laboratory Tehran, Iran. Furthermore, a package containing 6 types of medication that was advertised by a satellite TV channel was also purchased and sent to the laboratory. In the laboratory, the samples were analyzed using high-performance liquid chromatography HPLC to detect different types of opioids opium, opium extract, Sokhteh, Sokhteh extract, heroin, compressed heroin, and morphine powder , amphetamines, benzodiazepines, tramadol, codeine, and other substances. Then, the overall amount of each substance was expressed by rate and percentage. Characteristics of the samples: Of the 95 self-medicating substance dependence capsules and pills purchased from the herbal medicine shops in Tehran, 23 samples were uncovered compressed pills known as Dragon pills which were colored dark and light green, dark and light brown, white, and milky, each weighing 1. The self-medicating substance dependence package advertised by satellite TV channel, known as REXON, contained 6 types of medicine with a brochure written in Persian including instructions for their use. The package included a capsule green-yellow , a pill for depression or insomnia light blue , a jelly capsule for analgesia and hangover blue , a supplementary solution for hangover pink , an anti-temptation drops, and a detoxification solution or syrup Figure 3. Analysis of the samples: Table 1 shows the results of sample analysis. The most common substances present in all of the samples respectively were diphenoxylate, tramadol, opioids, acetaminophen, and codeine. In addition, the most common ingredients present in Dragon pills included tramadol, diphenoxylate, opioids, codeine, and acetaminophen, respectively; however, no trace of methadone was found. Moreover, the most common ingredients available in handmade capsules were diphenoxylate, tramadol, opioids, codeine, and acetaminophen, respectively. Rate of main substances including opioids, codeine, tramadol, diphenoxylate, and acetaminophen present in the illegal drugs for self-medicating substance dependence. The most common ingredients present in Dragon pills included tramadol, diphenoxylate, opioids, codeine, and acetaminophen, respectively. In addition, the most common ingredients present in handmade capsules respectively were diphenoxylate, tramadol, morphine, codeine, and acetaminophen. Furthermore, diphenoxylate, morphine, codeine, acetaminophen, benzodiazepine, and methadone were found in a large number of handmade capsules. Rahimi Movaghar et al. However, as reported by Rahimi Movaghar et al. For example, in the study conducted by Abasi and Nazeri, 2 the investigation was performed only on the samples that consumers were complaining about, while in the present study and the study by Rahimi Movaghar et al. In the study by Rahimi Movaghar et al. As stated by the producers of handmade drugs, herbalists use a variety of chemical compounds, most of which are addictive and psychoactive substances like diphenoxylate, acetaminophen codeine, amitriptyline, methadone, diclofenac, diazepam, clonidine, boosting capsules, and even 3,4-methylenedioxy-methamphetamine or ecstasy powder. In addition, many of these substances are controlled and are considered as abusive drugs. In addition, the prescription of any anonymous drug by anyone, even if a physician, is a violation of law. As substance abuse is different from other illnesses and is considered as a crime in Iran, substance users are less likely to refer to judicial centers and make a complaint; thus, those who provide this type of service, especially herbalists, are more prone to fraud and abuse. Finally, it can be stated that none of the handmade self-medicating substance dependence medicines and those advertised by the satellite TV channels were not usable for the treatment of substance dependency, and even a drug was not found to be eligible. Furthermore, because of the false belief that medicine treatment is the only possible method for self-medicating substance dependence, a culture of self-medication has emerged. Substance dependence capsules and pills supplied in herbal medicine shops and those advertised by satellite TV channels contain different amounts of opioids, amphetamine, benzodiazepines, tramadol, codeine, and other substances with the potential for causing complications among individuals who want to stop substance dependence through using such medications. None of the drugs present in the capsules and pills were capable of treating substance abuse and some of them could cause very severe complications. In addition, the herbalist that mixed the mentioned substances was not aware of drug interactions. Furthermore, mixing more than 5 drugs in a capsule can be a risk. Moreover, the use of high amounts of tramadol is associated with the risk of convulsion; therefore, a substance abuser who does not receive any instruction for taking these medications may also be at risk of convulsion. Hence, health policymakers and authorities not only must prevent the supply of such drugs, but also must have more supervision over herbal medicine shops and enhance the public awareness on the use of self-medicating substance dependence medicines advertised by satellite TV channels. As one of the weaknesses of this study, a self-reported questionnaire was not used to investigate the effect of the self-medicating substance dependence medicineson substance abusers who used such medications. Moreover, it was not possible to investigate handmade medicines supplied in other cities of the country. However, as one of the strengths of this study, medicines advertised by satellite TV channels were analyzed and compared with handmade herbal medicines prepared by herbalists. The results of field studies have shown that the sale of medicines advertised by satellite TV channels is significant. In addition, in this study, 4 samples were obtained from each of the municipality zones which were more than the number of samples obtained and analyzed in the study performed by Rahimi Movaghar et al. The results of this study showed that none of the handmade self-medicating substance dependencemedicines and those advertised by satellite TV channels were usable for the treatment of substance dependency, and even a drug was not found to be eligible. The authors in this study appreciate all individuals who collaborated in the sample collection and also the Bahar laboratory staff who collaborated on the analysis of the samples. As a library, NLM provides access to scientific literature. Addict Health. Find articles by Hamid Reza Khoddami-Vishteh. Find articles by Hooman Narenjiha. Find articles by Roya Noori. Find articles by Azadeh Olyaei. Find articles by Afsaneh Fard-Sanei. Find articles by Monir Fekri. Find articles by Ali Farhoudian. Received Sep 13; Accepted Nov 8. Open in a new tab. Findings of component analysis of the illegal drugs for self-medicating substance dependence. Conflicts of Interest The Authors have no conflict of interest. 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.
Exploring Self-medication Behavior among Clients of Pharmacies in Kerman Province of Iran
Urmia buying MDMA pills
Federal government websites often end in. Before sharing sensitive information, make sure you're on a federal government site. The site is secure. NCBI Bookshelf. Ghiabi M. The sanction regime imposed on Iran added pressure on a situation that was already deemed critical, contributing to the perception among Iranians and their political leaders, of a permanent crisis haunting the country. In and , a second and third round of sanctions began with UNSC and was further tightened with the sanction regime imposed by the United States under Barack Obama, closely followed by the European Union. On top of all these, the drug phenomenon entered into a new dimension, one that the state had not foreseen and found difficult to deal with. The changing nature of drug ab use — the phenomenon of shisheh — buttressed the formation of a crisis that had been a feature of the reformist period, as described in Chapters 4 and 6. The dynamics of post-reformist society characterised by the use of new stimulant drugs and non-traditional sexual norms, situated the post-reformist government in a paradoxical situation. The outcome of this situation was expected to be a reaction based on normativity and condemnation of new societal trends, followed by a reversal of the progressive policies, such as the controversial harm reduction legislation. Contrary to expectations, however, the Ahmadinejad government did not reverse the trend in favour of harm reduction and it generally continued the process of expansion of civil engagement in the field of drug policy. It scaled up progressive policies on addiction into a nationwide project. In view of the threat of shisheh , state representatives stressed the need to make distinctions between different substances, pointing out that the institutions should encourage shifting to less harmful drugs, such as opium. Under Ahmadinejad, drug consumption underwent further changes. The average age of drug use dangerously decreased; more women were using hard drugs than ever before; traditional drugs were supplanted by domestically produced synthetic drugs, while the government spent considerable financial resources on drug control programmes. In line with the style of president Ahmadinejad, the government maintained a populist approach towards drug policy, often circumscribed by an aura of secrecy and bombastic promises. While many of the promises remained unfulfilled e. It acted through a modality of indirect government of the crisis. As seen in the previous Chapter , the principle modality of intervention in the post-reformist time was embodied by the art of managing disorder. This chapter elucidates the practices born of the post-reformist moment. While in the previous chapter I discussed the on-the-ground mechanisms of management made up of informal and clandestine elements, in this section I engage with the way government and civil society cooperate in drugs politics. This is produced by the institutionalisation of methadone clinics and the governmentalisation of NGOs operating in the field of addiction. The aim is not only to illustrate how the reformist-supported policy of harm reduction metamorphosed under post-reformism, but also to connect the daily operations of public and private institutions within the broader framework of state formation and interactions between state and social phenomena. Withdrawal from formerly state-prerogative fields and the appeal for massive privatisation of non-key public assets were two key features of this era. The Constitution of the Islamic Republic, under article 44, allows privatisation of public assets, a plan that had occurred in several instances in the post-war period. With the approval of harm reduction policies, the state authorised the creation of private methadone clinics MMT , where people seeking treatment could initiate a treatment process. Methadone clinics soon became a vibrant phenomenon in the market of medical services, providing a steady source of revenue for medical practitioners, often GPs with no specialisation in addiction recovery Figure 8. Methadone Clinics — In , there were about , people registered in private clinics for methadone; in , the number had gone up to almost , people. More interestingly, while the number of public clinics has remained stable, that of private clinics has multiplied constantly up to , when they allegedly reached saturation level. Drug ab users unable to register in private clinics, were supported through a network of state-run clinics, where the cost of methadone was heavily subsidised. These were usually connected to state-run compulsory camps under the management of the therapeutic police. Methadone Maintenance Treatment Patients — The post-reformist state admitted that it needed the private sector to fulfil its governmental duties. Today, Iran is self-sufficient in methadone production Figures 8. Following approval of harm reduction, public pressure mounted on the provision of insurance on addiction recovery. Often recovering in psychiatric hospitals and clinics, drug ab users seeking addiction recovery could not benefit from insurance coverage. In response of this situation, the DCHQ director for treatment and social support explained that medical insurance did not cover addiction, as it involved consumption of illicit substances, and therefore fees could not be covered by public funds. Addiction remained an ambiguous pathology in the state vision; tactically, this implied that the state was not responsible for the financial coverage of costly psychiatric treatment. By , approximately , people were known to consume methamphetamine, with polydrug use — the combination of different illicit substances — being on the rise. This legibility risked undermining the political order and its decade-long attempt at moralising to the public. Covering the data by a thick veil of ambiguity guaranteed economic saving and political gains Figure 8. Number of People Admitted to Rehab Centres. This was a prelude, it might be argued, to the outsourcing of governmental duties to the private, or pseudo-private, sector. I shall now introduce how the machine of government reacted and what techniques of government unfolded in response to the fluid drug phenomena of the s. With the political backing for reform fading away, the new government moved towards a securitisation of social activism, especially those groups supporting reforms on civic issues. In a matter of a few years, most of the key social agents that had supported harm reduction were defused of their reformist clout. In June , Iranian authorities arrested Kamiar and Arash Alaei, the two brothers who piloted the successful Triangular Clinics, on charges against the security of the state. They were accused of cooperating with foreign government to destabilise the Islamic Republic. In , Said Madani, author of one of the first books about drug addiction in Iran, was arrested and sentenced to six years in prison and ten years of exile in Bandar Abbas for his political activities related to the Nationalist-Religious Movement. Besides, the post-reformist government targeted, systematically, reform-oriented academics and members of the scientific community, when in it reportedly forced numerous scientists and professors to resign from their post or to accept early retirement. By weakening the academic profile which had been behind the push for innovation and change, the government enhanced its political control and centralisation over drug policy institutions. This did not mean a setback for civil society participation in addiction recovery and drug policy. Although observers considered the coming to power of Ahmadinejad as a direct threat to the progressive harm reduction system, practices of support to drug ab users continued and effectively widened their quantitative scope following his election in By , there were 51 government facilities, private outpatient centres and an additional 26 transition centres. Drugs politics pursued a discontinuous, unsettled path. During his eight years of government, Ahmadinejad appointed three different directors to the highest post at the DCHQ. First, he selected Fada Hossein Maleki —7 , who then moved to occupy the post of special ambassador to Afghanistan, a key anti-narcotics role. Apart from the change in the directorship of the organisation, this period was characterised by a lack of direct political management in the DCHQ. The overlapping duties — as ministers and head of anti-narcotics — of the DCHQ directors meant that the DCHQ suffered from the lack of an independent strategy and scrupulous management. Internal sources to the DCHQ confirm that both the president and DCHQ directors rarely participated in the weekly meetings, leaving the organisation mostly in a state of disarray and decisional confusion. Loosely speaking, however, Ahmadinejad designed the post-reformist priorities in countering drug and drug ab use. Maleki was the exception, but both Ahmadi-Moghaddam and Najjar represented the security-oriented and policing side of drug policy. Once appointed, Ahmadi-Moghaddam went on reassuring that the entry of the police at the head of the DCHQ did not imply that all prevention programmes will be stopped. His compromise with the medical side of the problem was taken into account, in his view, by appointing as a caretaker of the DCHQ his deputy in the NAJA, who had a previous career as a medical professional. Another aspect that characterised this period is the attempt at centralisation and de-bureaucratisation of drug policy. With the involvement of the police in the daily affairs and, hence business of treatment, the DCHQ tended also to centralise both budget and strategic decision-making in Tehran. The charging of NAJA as supervisor of the DCHQ preluded to a process of centralisation, which was meant to quicken state response to changing drug consumption patterns, while also ensuring implementation of agreed policies. Centralisation meant that the government had the authority to change direction in drug policy — as much as in other fields of interest. It helped the rise of groups and agents aligned with the vision of the ruling cadres. That also enabled a faster and controlled privatisation of welfare and social services, outsourcing them to groups that reproduced the ideology of those in power, or those holding political capital. The oxymoron of centralisation and de-bureucratisation fine-tuned this game. Victims of this trend were scientific and expert groups in matters of drug policy as well as economic policymaking. It also suggests that the politics of drugs went hand in hand with wider political confrontations, usually categorised under the register of factionalism. Instead, it was intergovernmental infighting that characterised policy implementation during this period. This is evidenced by a set of different issues, such as the contrasting statistics and data that different ministries provided on the number of drug users, the existence, or not, of drug ab use among students, the supervisory authority with regard to rehab camps and, most problematically, the allocation of the budget. In , the budget allocated to the DCHQ by the Majles totalled 77,, USD — with a 40 per cent increase compared to — 45 per cent of which was allocated to supply reduction activities i. During the bountiful years, the DCHQ expanded its activities to such different fields as filmmaking, cultural events, sport training and musicotherapy, without much supervision and control, despite the reiterated calls for centralisation. Part of it was dedicated to research projects and the creation of doctoral degrees focused on drug phenomena. While research and scientific investigation were sought to support policy interventions, the content of a considerable number of these academic programmes was limited in scope and methodology, and bounded to a framing of drug issues as exclusively epidemiological or, for that matter, moralising. Abundance of research into aspects of religious exegesis and drug use is one evidence of this; endless epidemiological publications is the other side of the coin. By , however, only 3 per cent of all research on drugs and addiction could be said to belong to the social sciences, sensu lato , most of which lacked fieldwork engagement and critical analysis. A case in point about the lack of practical results from investments in research is given by the murky and secretive nature of drug statistics Figure 8. Reiterated calls for transparent numbers about drug use led to the creation of a national committee on addiction data in This prompted other officials to argue that up to 30 per cent of the 3. One reason for this is provided by the fact that the DCHQ has only disclosed fragmentary information about its epidemiological studies of drug abuse, allegedly, due to the weak methodology of the study. Percentage of Drug Control Budget in in millions of rials. When not spent in research, DCHQ money was often mismanaged. The lack of a supervisory budgetary system and the negligence of bureaucratic procedures made governmental action in the field of drugs, to say the least, adventurous and haphazard. This does not signify, however, that a strategy did not exist during this period. On the contrary, the strategy for intervention occurred, even systematically, through indirect channels, intermediaries of the state and outsourcing mechanisms. The mushrooming of NGOs during this period stemmed from the same logics that determined the privatisation of addiction recovery, notably the methadone clinics. In the same way as medical practitioners opted to run methadone clinics, often with only rudimentary knowledge of drug abuse problems, charities and support groups for addiction recovery were being registered by former drug users and laypeople out of philanthropic, personal or familiar interest in the field of rehabilitation. Many also realised, perspicaciously, that the field of addiction treatment was lucrative. In Iran, most NGOs operating in the field of addiction benefit from some kind of governmental support, however limited it may be. Especially during the first years of the post-reformist government, NGOs benefited from the largesse of the DCHQ; once the generous financial support came to an end following the drop in oil prices in the early s, there were considerable recriminations against the paucity of support and consequent budgetary tightening. The methods and philosophy of action among these NGOs differed significantly and, in some cases, rivalry between different organisations reached the point of conflict. A rather hilarious case was represented by the banner exposed by a leading NGO, Congress 60 Figure 8. As the number of these organisations does not allow adequate and thoughtful consideration of all, or even some, of them, I shall pay heed to those more paradigmatic Table 8. Based on the frame of its mother organisation in the United States, Narcotics Anonymous is an Iranian NGO with numerous centres across all cities and villages of the country, which operates as a self-help group following the philosophy of the twelve-step programme common also to Alcoholics Anonymous. By the early s, arguably, every city and many villages had at least one NA group within their districts. Although it is problematic to quantify the membership, NA followers exceeded half a million, and its self-help groups regularly met in prisons, treatment and rehab camps, and often within the meetings and spaces of other NGOs. In , there were about 18, weekly NA meetings in Iran, with the capital Tehran also offering English-language meetings. At the time of its first appearance in , many regarded the organisation with suspicion. Its founder Foruhar Tashvigi had come in contact with the NA system while living in the USA and, once back in Tehran, faced with friends and family members seeking support for their drug ab use, decided to start self-help groups in the capital. The accusation of proselytising and staging confessions — a practice which is alien to Islamic practices and may be a derivation of Catholic rituality — were moved against the NGO, which stopped its activities for the public in The meetings were also a steady relief for recovered drug users to whom the state could hardly provide help. The Ahmadinejad government did not hamper NA activities either. With its priority on prayer, responsibility and aggregation, Narcotics Anonymous chartered in friendly waters with the populist, yet highly spiritualising, religiosity of the post-reformist president. Alike the prayers of NA meetings and the devotion of its members, it defied, ambiguously, the schemes of religious orthodoxy and the clergy. Personal encounters with NA members confirmed the consonance of this organisation with the broader post-reformist govern mentality. On several occasions, NA members asked me what I believed in. There are also episodes in which the NA system, through the personal network that it establishes, facilitates the life of its members, for instance, in finding a job, an accommodation or even a partner. The application of the twelve-step philosophy in the context of the Islamic Republic has given birth to a melange of universalising spiritualism with Islamic reference. Ist NA nothing but a secular expression of a religious sentiment? Or is it a spiritual profession of Iranian secularity after the demise of the modernist dream, embodied in its fight against addiction? When the Narcotics Anonymous world service in the United States was invited to visit the Iranian branch of NA , the amalgam of religious enthusiasm with mass participation astonished the US visitors. From a governmental perspective, NA amalgamated, spontaneously, with the post-reformist push for entrusting social and health programmes to the drug ab users themselves, minimising, in one move, both financial expenditure and moral involvement in the pernicious affair of addiction. The entire organisation runs with money from the members and donations from those who benefit from its meetings, a principal reason it is considered less politicised. NA distributed 1. Based on its status as a non-governmental entity, the prize was received by its sister NGO, Rebirth Tavalod-e Dobareh. In order to strengthen therapeutic support for drug users, the founder of NA Iran created Tavalod-e Dobareh in Since then, Tavalod-e Dobareh has provided support to drug ab users in the guise of rehab centres, shelters for homeless drug users and counselling services. Tavalod-e Dobareh was initially conceived as a sister organisation of NA , which followed the twelve-steps philosophy. It did not seek external support and operated through a strictly non-profit vision. It became a major beneficiary of public funds in the field of addiction recovery and, for that matter, drug policy. Recently, it has also started a vast, long-term programme on addiction studies, which is meant to establish the NGO as a research hub on drug abuse in the MENA region. Yet, this drive towards academic production does not simply concern an attempt to build public awareness or to integrate the world of policy with that of research — a mirage called also evidence-based policymaking. Infatuation with the academic world — the director read for a PhD degree in Economic Management in the island of Kish — is a common trait of policy circles where status is buttressed by titles and degrees. Research prestige goes hand in hand with the imperative of securing funding for the NGO and being competitive against other organisations. What distinguishes this NGO from the multitude of other organisations is not its research drive, but its nationwide structure of intervention with regard to addiction recovery and its complementarity with the post-reformist governmental strategy. Instead, the twilight nature of Tavalod-e Dobareh unfolds how the state retreats from those spaces and situations posing a threat or challenge, or where its interference is unproductive and cumbersome. Tavalod-e Dobareh manages a large number of rehab camps and has been charged by the government with the provision of services, through DICs and shelters for homeless people. The fact that the director of this organisation speaks a language that policymakers understand — notably the language of numbers and of capital \[ sarmaye in Persian\] — has helped Tavalod-e Dobareh gain further legitimacy. Because resources and support from the central office of Tavalod-e Dobareh are limited, the local DICs and rehab camps demand support from the community or from the families of the service-seekers, an endeavour which is made more difficult given the marginal location of these centres and the lack of family relationships among most of the people frequenting them. Indeed, few of the people who help running these centres stay longer than a few months, because the stipends they receive are too meagre. The organisation counts on the fact that many recovered addicts want to take part in the management of the activities and tend to accept little or no pay. Among the three volunteers that I met during a week spent in the Farahzad Shelter, none of them received financial support from the NGO. The three-man team would fulfil multiple duties, including that of outreach team providing clean needles and condoms, collecting used needles, nursing infections and scars and referring drug users to rehab and clinics. Working with no money was probably a consequence of the NA ecosystem to which Tavalod-e Dobareh belonged initially. There, the personnel, most of whom had a history of drug abuse and went through the NA path, were given relatively good stipends, vouchers for lunch and transportation, and could benefit from other amenities that are part of the NGO assets. But it also unwrapped the ways in which the marketization of drug treatment even when charitable and non-profit had materialised during post-reformism. Once again, the drug market engendered a pathological marketization. In a way, the rehab camps that this NGO operated complemented the state-run camps, supplementing their organisational and logistical incapacity to address the multitude of drug ab users. These plans have received support from the government of Mahmud Ahmadinejad, who identified in Tavalod-e Dobareh , a model of civil society responsive to un civil phenomena. From the late onwards, the Addiction News Agency ADNA became the centre of gravity of most information related to public statements and debates around drug policy reform and, although it presented conflicted opinions and different policy perspectives, it operated in order to put pressure on policymakers. In ADNA , the drug policy community displays its public face and struggle. With its nationwide network of centres and a multitude of people willing to engage in its activities, Tavalod-e Dobareh had the infrastructure and means to complement the state in an area of intervention which had become troublesome ethically e. The NGO covers also harm reduction practices across Tehran and other major cities, providing shelter facilities, mobile clinic centres in Southern Tehran, DICs as well as in-patient and detox venues of all kinds, including for younger people. It operates twelve major centres both DICs and rehab centres in Tehran, ten in the province of Shiraz and a dozen more across other regions. Some minor NGOs, which operate at local levels, associate themselves with this umbrella NGO, often with the purpose of increasing their chance to acquire funding, visibility and legitimacy. But the contribution of Tavalod-e Dobareh has gone beyond these calculations. By proposing a vision based on hierarchy, self-management, quantitative results and individual responsibility, without tackling deep-seated political shortcomings, the NGO embodies an authoritarian model at a grassroots level. Indeed, this has been opposed by Tavalod-e Dobareh rather vehemently. Instead, this model enacts strict rules of inclusion in the community — which is the NGO itself — for those individuals who wish to recover, by redeploying former drug ab users as working elements in the daily operations of the NGO. As a confirmation of this mechanism, the director explained in a letter to the state authorities, that the weakening of harm reduction services in the DICs is problematic because these centres provide employment to the recovered addicts and involve them in social activities. That Tavalod-e Dobareh acquired a governmental role within drugs politics is also confirmed by its collaboration, on a regular basis, with law enforcement units. In fact, one could argue that with its involvement in arrests and referrals to compulsory camps, the NGO has defied the fundamental ethics of harm reduction, which is rooted in the absence of judgement on drug use and opposition to policing methods. Instead, it has operated as a mechanism of grassroots control, with the task of legibility, management of critical phenomenon and facilitator of state intervention. The NGO operates as a rhizome from the Greek, mass of roots of the state, which, instead of reproducing vertical lines of control and power relations, becomes diffused and horizontal — similar to the roots rhizomes of a plant. When societal control is practiced, this is cropped out through the rhizomes that stem from the horizontal roots of the state itself, camouflaged as other forms of intervention, i. For those arguing that post-reformist Iran witnessed increased top-down security, the metaphor of the rhizome is a reminder that power and authority operate through diffused and grassroots lines of production. This form of governance is what I define as the art of managing disorder Figure 8. Rhizomes and Grassroots Authoritarianism. Drawing courtesy of Italian artist, Federica di Violante, aka Fruk. A week ahead of the event thousands of street drug users, as well as large numbers of homeless vagrants, were gathered and sent to state-run rehab camps to, allegedly, be treated for addiction. The collaboration with the police goes beyond material support. Tavalod-e Dobareh has been discussing the possibility of taking over the management of compulsory camps — currently under the supervision of the NAJA. One can interpret the nature of this super-NGO, through the ambiguous combination of welfare activities with a securitising persuasion. The outcome, it seems, blurs and contaminates the confines and boundaries of what is normatively regarded as the Iranian state, described as a top-down project with grassroots participation, and what is numbered under the constellation of civil society, which is hereby re-enacted as a grassroots model of authoritarianism, and not a panacea enabling democratic transition. What materialised, instead, in the field of state intervention was more consonant with practices of neoliberal governance in times of crisis. The coexistence of a moralising rhetoric and securitising gaze, with a push for privatisation and outsourcing, went hand in hand as the post-reformist government sought to ease the burden of a publicly visible and financially cumbersome drug phenomenon. The field of addiction, over this period, increasingly became the turf of private clinics and, along its margins and more problematic populations, of NGOs. In this, it produced a rupture with the past. The maintenance of a security-oriented approach was deemed necessary but not prevalent in countering drug ab use. While adopting a language of quantification of social phenomena, cost-and-benefit analysis and epidemiological surveys — neglecting societal and politological introspection — the state and prominent NGOs, such as NA and Tavalod-e Dobareh , worked along compatible, intertwining lines. These differed substantially from the ways civil society had engaged with the state — and vice versa — during the reformist period. At that time, mentioning critical phenomena, such as HIV epidemics, played a constructive role in formulating new approaches to drugs and drug ab use. Later, in the post-reformist era, the lines of enquiry insisted, on the one hand, on the return to religious-revolutionary orthodoxy as a solution to the multiple, oft-denied, crises. The contours of state imperatives were drawn, consequently but unsystematically, by the economisation of political interventions, through a combination of medicalisation through methadone and harm reduction securitisation, one via clinics, the other via NGOs and charities, managing addiction recovery in the camps. This art of governing crisis and managing disorder was distinctive to the post-reformist state, whose mechanisms of power did not arise from either strict ideological rules, nor monolith interest groups, but evolved from the confluence of multiple lines of interventions, which had the ultimate objective of containing, dispersing also topographically the crises. In this example, one can find new empirical material for understanding governance under post-reformism. Thus, populism managed the crisis. Jam-e Jam , May 12, Again, one has also to bear in mind that the data are not transparent. The account is a recurrent theme of my interviews with managers of therapeutic communities and rehab camps. Declaration by head of the DCHQ. Interview with public official in the field of drugs policy, September This phenomenon alone would deserve ample space, which falls beyond the study presented here. Today the site is also popular with Afghan hazara visiting or residing in Iran. Tavalod-e Dobareh participated actively in the 8th and 9th International Conference on Addiction Studies in Tehran, presenting several poster studies and research material. Sharq , June 28, and Etemad-e Melli , August 9, Development and Change 37, no. Development and Change 47, no. Summer ; discussions with drug users in several patoqs ; confirmed also by Aftab-e Yazd , September 19, All versions of this work may contain content reproduced under license from third parties. Permission to reproduce this third-party content must be obtained from these third-parties directly. This work is in copyright. It is subject to statutory exceptions and to the provisions of relevant licensing agreements; with the exception of the Creative Commons version the link for which is provided below, no reproduction of any part of this work may take place without the written permission of Cambridge University Press. An online version of this work is published at doi. You may not distribute derivative works without permission. Monographs, or book chapters, which are outputs of Wellcome Trust funding have been made freely available as part of the Wellcome Trust's open access policy. Turn recording back on. Help Accessibility Careers. Show details Ghiabi M. Search term. The Ahmadinejad government has nine crises every day of government. Fararu , August 1, Figure 8. Harm Reduction Revisited With the political backing for reform fading away, the new government moved towards a securitisation of social activism, especially those groups supporting reforms on civic issues. Table 8. The Plateau of Ten Thousands NGOs The lack of a supervisory budgetary system and the negligence of bureaucratic procedures made governmental action in the field of drugs, to say the least, adventurous and haphazard. Narcotics Anonymous: Recovering Spirituality Based on the frame of its mother organisation in the United States, Narcotics Anonymous is an Iranian NGO with numerous centres across all cities and villages of the country, which operates as a self-help group following the philosophy of the twelve-step programme common also to Alcoholics Anonymous. Where these numbers came from, I must admit, remained vague. Moreover, Tavalod-e Dobareh follows the NA philosophy and therefore its treatment facilities do not provide pharmaceutical cures, like methadone, which alone require higher expenditure. In addition, the organisation maniacally keeps track of the number of syringes that it distributes and collects, of condoms it provides during outreach programmes, of leaflets and brochures and meetings. Another key aspect of the rehab centres managed by the NGO is that these services, per se, function as employment venues for many former drug users. Yet, this form of occupation is not faultless. While visiting different centres of Tavalod-e Dobareh in Tehran, several lower-ranking members expressed their disaffection with the management as well as payment of stipends. Sharq , September 24, Mardomsalari , September 16, Interview with Abbas Deylamizadeh, Tehran, March Discussions with Tavalod-e Dobareh employees in Tehran, March Its vision is in tune with North American halfway houses. In this Page. Other titles in this collection. Recent Activity. Clear Turn Off Turn On. Follow NCBI.
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