Substance abuse

Because of a long-established habit of opium use in the Islamic Republic of Iran, there has always been strong pressure by policy-makers for supply-reduction strategies. Therefore, during the 1980s, demand-reduction activities were disregarded banned in favour of supply reduction. Thus, almost all of the current drug demand-reduction activities in the country were started in the 1990s. Previously, from the legal view point, using drugs was simply a crime and there was no possibility of treatment. As a result detention centres were filled with drug users. When it became evident that such a strategy was not effective, the first national programme on demand-reduction was worked out in 1994. In the same year, the first outpatient clinic started working at a governmental health facility. Concurrently, Narcotics Anonymous, a self-help group, was established with a few members and now serves more than 10 000 people. Currently, there are almost 130 outpatient clinics and 300 beds available for treatment of drug users at governmental health facilities. At the same time, many refresher and training workshops have been held for physicians, nurses and social workers on demand-reduction issues. This, along with the easing of regulations made by the Ministry of Health and Medical Education, has led to the involvement of hundreds of physicians in the treatment of drug users. Numerous guidelines on treating drug users have been published by different health authorities. It is estimated that in the governmental facilities alone, some 60 000 drug users are admitted annually.

Based on the current data on drug use in the country, it has been estimated that there are 1.5 million drug-dependent individuals. Opium is the most commonly used drug at a rate of 37%, followed by cannabis and heroin with rates of 21% and 19% respectively. The mean age of drug users is 33 years, while the mean age at starting using drugs is 22 years. The proportion of injecting drug users has been estimated at 29%. Not surprisingly, 63% of HIV/AIDS cases in the Islamic Republic of Iran are known to have a history of injecting drug use [ 24,25 ].

Although, the current established treatment schedules do not include drug substitution regimes, harm reduction strategies are due to start soon at some prisons.

Regarding primary prevention, numerous programmes are already functioning at the community level; most of them include the participation of schools. The media have also been widely involved in campaigns against drug use and a pilot project is underway to assess the possibility of integrating a prevention programme of substance abuse disorders within the PHC system.