Zahra Alammehrjerdi

Methamphetamine use and treatment in Iran: A systematic review from the most populated Persian Gulf country

AIM Methamphetamine use is a new health concern in Iran, the most populated Persian Gulf country. However, there is no well-documented literature. The current study objectives were to systematically review all published English and Persian studies of the prevalence of methamphetamine use, the general physical and psychiatric-related harms and the availability of methamphetamine treatment and harm reduction services for adult users in Iran. MATERIALS AND METHODS A comprehensive search of the international peer-reviewed and gray literature was undertaken. Multiple electronic and scientific English and Persian databases were systematically searched from January 2002 to September 2014. Additionally, English and Persian gray literature on methamphetamine use was sought using online gray literature databases, library databases and general online searches over the same period of time. RESULTS Nineteen thousand and two hundred and eight studies, reports and conference papers were identified but only 42 studies were relevant to the study objectives. They were mainly published in 2010-2014. The search results confirmed the seizures of methamphetamine (six studies), the prevalence of methamphetamine use among the general population (three studies), drug users (four studies), women (nine studies) and opiate users in opiate treatment programs (five studies). In addition, methamphetamine use had resulted in blood-borne viral infections (one study), psychosis and intoxication (ten studies). Different reasons had facilitated methamphetamine use. However, the Matrix Model, community therapy and harm reduction services (four studies) had been provided for methamphetamine users in some cities. CONCLUSION The current situation of methamphetamine use necessitates more research on the epidemiology and health-related implications. These studies should help in identifying priorities for designing and implementing prevention and educational programs. More active models of engagement with Persian methamphetamine users and the provision of services that meet their specific treatment needs are required.

Drug use treatment and harm reduction programs in Iran: A unique model of health in the most populated Persian Gulf country

Because of the proximity of Persian Iran to Afghanistan, the main opium producer in the world, drug use especially opium use has a long history in Iran. Opium and its residues are the traditional drugs while heroin, heroin Kerack, norgesic, temgesic, and methamphetamine use and injection have emerged more recently. In recent decades, heroin smoking and injection have presented challenges to the Persian health policy makers to accept and develop the internationally-approved programs of drug use treatment and harm reduction. The current paper summarizes the overall picture of main drugs used and the history of establishing the nationwide movement of drug use treatment and harm reduction programs after the 1979 revolution until the end of 2014. The paper concludes that Persian Iran has a well-developed healthcare system in the provision of drug use treatment and harm reduction programs in the south-west of Asia especially the Persian Gulf region. These therapeutic and harm reduction-related programs are required to be strengthened by opium supply reduction and eradicating drug production in Afghanistan. The provision of prevention programs, drug education via mass-media, employment and inexpensive leisure activities are required in Iran. In addition, conducting household surveys of the prevalence of drug use and evaluating the clinical effectiveness and treatment outcomes of the provided drug treatment and harm reduction programs are required. National and regional collaborations are rigorously suggested to manage supply reduction along the borders and implement demand reduction inside the borders.

Opioid use, treatment and harm reduction services: the first report from the Persian Gulf region

Abstract Objective: The objective was to review all the available published studies and reports with particular emphasis on the prevalence of opioid use and the availability of opioid treatment and harm reduction services for adults in nine countries of the Persian Gulf region. The countries are the members of the Middle and North Africa Harm Reduction Association (MENAHRA). Methods: Data were collected by searching Pub Med, Med line and EMBASE, by reviewing the reports of the United Nations Office on Drugs and Crime (UNODC), World Health Organization (WHO), Ministries of Health (MoH) in each country, regional databases, conference presentations and annual AIDS progress reports over the last one decade. Results: We found that with an exception of Iran, there is a paucity of research on opioid use in the region. With an exception of Iran, opioid substitution therapy (OST) is not developed but in some countries, needle and syringe programs (NSPs) are slowly emerging. Voluntary counselling and testing (VCT), HIV testing and antiretroviral therapy (ART) have been widely addressed. Non-governmental organizations (NGOs) are generally inactive. Islamic prohibitions against opioid use and stigma have prevented developing opioid treatment and harm reduction in the region. Conclusion: An exchange of knowledge and experience on opioid use prevention, treatment and harm reduction is required between Iran and the region. Collaborations among religious leaders, mass-media, clinicians and policy makers are rigorously suggested to remove Islamic prohibitions and stigma and make opioid treatment a social norm.

Women-only drug treatment services and needs in Iran: the first review of current literature.

BackgroundIran (Persia) has a women-only drug treatment system. However, literature is not documented. The current study aimed to review the development of women-only drug treatment and harm reduction services (WODTHRS) and the factors associated with treatment entry and outcomes in Iran. The review was based on a comprehensive search for all literature focusing on WODTHRS in Iran.MethodsData were collected by conducting systematic searching of scientific English and Persian databases and grey literature. This was done in line with Cochrane Guideline for conducting systematic reviews. Overall, 19,929 studies were found. But, only 19 original studies were included after excluding non-relevant studies.ResultsThe review findings indicate how WODTHRS have been developed in the past 15 years. The review findings underscore the roles of numerous factors in treatment entry such as the side effects of illicit drug use. In addition, cognitive-behavioral interventions, methadone treatment and some factors outside drug treatment such as family support increase positive treatment outcomes among women.In contrast, financial problems as well as other factors such as insufficient medical, psychiatric and social work services hamper treatment entry and positive treatment outcomes.ConclusionsThe review results highlight that eliminating barriers to treatment entry and positive treatment outcomes should be addressed. Conducting randomized controlled trials is needed to evaluate the effectiveness of WODTHRS. This issue should address the factors influencing service utilization to incorporate the best practice for women. The evaluation of the long-term efficacy of WODTHRS is a critical research gap which should be addressed in future studies.

Prevalence of Drug Injection, Sexual Activity, Tattooing, and Piercing Among Prison Inmates

Prisoners engage in a range of risk behaviors that can lead to the transmission of viral infections, such as HIV, hepatitis B and hepatitis C. In this review, we summarize the epidemiologic literature from 2007 to 2017 on 4 key risk behaviors for human immunodeficiency virus and hepatitis C virus among prisoners globally: drug injection, sexual activity, tattooing, and piercing. Of 9,303 peer-reviewed and 4,150 gray literature publications, 140 and 14, respectively, met inclusion criteria covering 53 countries (28%). Regions with high levels of injection drug use were Asia Pacific (20.2%), Eastern Europe and Central Asia (17.3%), and Latin America and the Caribbean (11.3%), although the confidence interval for Latin America was high. Low levels of injection drug use in prison were found in African regions. The highest levels of sexual activity in prison were in Europe and North America (12.1%) and West and Central Africa (13.6%); low levels were reported from the Middle East and North African regions (1.5%). High levels of tattooing were reported from Europe and North America (14.7%), Asia Pacific (21.4%), and Latin America (45.4%). Prisons are burdened with a high prevalence of infectious diseases and risk behaviors for transmission of these diseases, and, commonly, a striking lack of evidence-based infection control measures, even when such measures are available in the surrounding community. Given that most prisoners return to these communities, failure to implement effective responses has repercussions not only prisoner health but also for public health.

The Persian methamphetamine use in methadone treatment in Iran: implication for prevention and treatment in an upper-middle income country

As the most populated Persian Gulf country in West Asia, methamphetamine use in methadone maintenance treatment (MMT) is a new health concern in Iran. Methamphetamine use in MMT can originate in methadone misconceptions or the stimulant effects of methamphetamine use. Several research studies have highlighted the prevalence of methamphetamine use in Iran and conducting further studies on this issue is being developed. Opiate use is treated with MMT. But, there is no effective pharmacological treatment for methamphetamine use and cognitive-behavioral interventions have still remained the best practice. As a psychostimulant drug, methamphetamine use can lead to poor treatment outcomes or even treatment failure among patients in MMT. Therefore, the implementation of methamphetamine education and prevention programs in MMT is required. Prescribing adequate methadone dose and the treatment of comorbidities as well as, doing a series of activities outside treatment is underscored. Methamphetamine use has a chronic nature and methamphetamine treatment is a long-term procedure with a high rate of relapse. Therefore, the implementation of long-term motivational interviewing, teaching necessary skills to prevent relapse and case management is highlighted. A long-term collaboration between treatment teams, patients and their families is suggested to manage methamphetamine use in MMT.

Methamphetamine dependence in methadone treatment services in Iran: the first literature review of a new health concern

BACKGROUND Methamphetamine dependence is a serious health problem among Iranian methadone patients. AIM The current study is the first research that reviewed the prevalence of methamphetamine dependence and the associated harms among Iranian methadone patients. The other aims were to review the history of receiving methamphetamine treatment among methadone patients and the evaluated psychosocial treatments for methamphetamine dependence and/or associated harms. METHODS Searching included both peer-reviewed literature and grey literature in English and Persian. Reference lists of the relevant papers and reports were searched manually for more information. The time period between 1 January 2005 and 28 October 2017 was set for searching. FINDINGS Available evidence indicated that methamphetamine dependence increased from 3.9% among the two genders in 2007 to 60.3% among men in 2014 and 89.5% among women in 2015-2016. The prevalence of methamphetamine dependence was higher among female methadone patients than their male counterparts. Methamphetamine dependence was associated with multiple health problems in the social and health contexts of the two genders especially women. However, receiving methamphetamine treatment was negligible. The review indicated that cognitive-behavioural therapy improved psychological well-being. The Matrix Model led to abstinence from methamphetamine and improved psychological well-being. Motivational interviewing increased attendance in treatment. Family therapy improved the quality of life and social support. However, more similar studies were needed. CONCLUSION Despite a serious increase in methamphetamine dependence, there were a few evaluated psychosocial treatments. There is an immediate need to evaluate efficacious psychosocial treatments especially for women. Methamphetamine treatment should be provided in methadone treatment services.

HIV Responses in Arab States on the Southern Persian Gulf Border: The First Review

Context There is no review of HIV responses in Arab states on the southern Persian Gulf border. This narrative review aimed to describe and synthesize HIV responses in Kuwait, Qatar, Bahrain and the United Arab Emirates (UAE). Evidence Acquisition A review of scientific databases and grey literature was conducted based on an international guide. Overall, 16 original studies and reports were found. Results The review indicates that HIV has been found present in each Arab state based on sporadic case finding. The prevalence of HIV is the result of heterosexual relationship and/or drug injection. Mandatory testing of the nationals and expatriate workers is the main route of HIV detection. In general, HIV knowledge and education are poor. Only Bahrain has some non-governmental organizations that provide HIV education. Lack of identifying key populations and high risk behaviors has been reported in all of the states. HIV responses are mainly for Arab and Arabic-speaking nationals. Effective strategic plans for HIV have not been developed in all of the states. The provision of antiretroviral therapy for the nationals is the main HIV response. Only Qatar has paid for the treatment of Qatari and non-Qatari HIV-infected patients. As a HIV response, drug treatment is based on short-term inpatient rehabilitation. Only Qatar has voluntary HIV counseling and testing. Lack of needle and syringe programs has been reported for people who inject drugs with HIV problem in all of the states. Conclusions To conclude, HIV problem needs a comprehensive policy response in each state. Providing effective strategic plans for HIV and sero-surveillance data systems is required. Empowering human resources and infrastructural development are suggested.

Methamphetamine Use Disorder Untreated Among Women in Methadone Treatment in Iran

Background: Methamphetamine (MA) use disorder is a new health problem among female methadone patients in Iran. However, there are few studies about the characteristics of this group. Objectives: The current study is the first research that aimed to investigate the demographic, drug use and treatment characteristics of a group of regular MA-using women in methadone treatment. Methods: Methadone-maintained women who reported at least weekly MA use were recruited from four methadone treatment centres in Tehran. Participants’ drug use, severity of MA dependence, psychiatric distress, social functioning, criminality and high risk sexual behaviours were measured among the participants. Urinalysis was done to confirm MA use. Results: Between 28 July 2014 and 15 May 2015, 120 participants completed an interview. Mean duration of MA use was 5.4 (SD 2.1) years. Only 9.2% of the participants reported prior MA treatment. Mental health was poor among all participants. Overall, 61 participants (50.8%) reported long duration of MA use (i.e. five years or more) while 59 participants (49.2%) reported less than five years of MA use. Severity of MA dependence (P = 0.38), psychiatric distress (P = 0.36), social functioning (P = 0.12) and criminality (P = 0.82) were not significantly associated with duration of MA use. However, participants who reported long duration of MA use were more likely to be engaged in high risk sexual behaviours (P = 0.01) compared with those reporting short duration of MA use Conclusions: The study results indicated that participants had multiple health problems. High risk sexual behaviours were high among participants with long duration of MA use despite being in methadone treatment. Participants had little or no previous treatment for MA use disorder. Treatment services should be expanded to address MA use disorder and its harms among this group.

Erratum to: Women-only drug treatment services and needs in Iran: the first review of current literature

Erratum Following publication of the original article in DARU Journal of Pharmaceutical Sciences [1], it was brought to our attention that the following sentences are incorrect: “Smoking opium has a long history in Iran which dates back hundreds of years before the tribal Arab invasion to Iran.” The sentence should read: Smoking opium has a long history in Iran which dates back hundreds of years before the brilliant era of Zoroaster. “Therefore, a center for at-risk women was established in Shiraz and Esfahan near the Persian Gulf of Iran in 2007.” This sentence should read: Therefore, two centers for at-risk women were established in Shiraz and Esfahan near the Persian Gulf of Iran in 2007. “In addition, such programs are needed to address special needs of at-risk women such as trauma, rape or poly drug use [45, 46].” This sentence should read: In addition, such programs are needed to address special problems of at-risk women such as trauma, rape or poly drug use [45, 46]. Also, the header “Motivation for treatment entry and positive treatment outcome” should read: Motivations for treatment entry and positive treatment outcomes. We apologize for the inconvenience.