Articles

Profile of People Who Inject Drugs in Tehran, Iran

Abstract

The marked shift in the patterns of drug use in Iran, from opium smoking to injecting drug use, has led to serious health-related outcomes. This study was designed to explore characteristics of people who inject drugs (PWID) in Tehran, Iran. Nine hundred and four PWID were recruited from treatment and harm reduction facilities, as well as drug user hangouts in public areas in Tehran. Participants were interviewed using the Persian version of the World Health Organization Drug Injecting Study Phase II questionnaire. The median age at the time of the first illegal drug use, at the time of the first injection and current age was 20, 24 and 32, respectively. In more than 80% of the cases, the first drug used was opium. The transition from the first drug use to the first drug injection occurred after an average of 6.6 and 2.7 years for those who had started drug use with opium and heroin, respectively. Two-thirds of the participants shared injecting equipment within the last 6 months. Difficulty in obtaining sterile needles and thehigh cost of syringes were reported as the major reasons for needle/syringe sharing. Approximately 80% of community-recruited PWID reported difficulties in using treatment or harm reduction services. Self-detoxification and forced detoxification were the most common types of drug abuse treatment in alifetime. Despite a dramatic shift in drug policy in Iran during the past few years, wider coverage of harm reduction services, improvement of the quality of services, and education about such services are still necessary.

Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet 2008; 372: 1733-1745.

Rahimi-Movaghar A, Amin-Esmaeili M, Haghdoost AA, Sadeghirad B, Mohraz M. HIV prevalence amongst injecting drug users in Iran: A systematic review of studies conducted during the decade 1998-2007. Int J Drug Policy 2012; 23: 271-278.

Sharifi V, Amin-Esmaeili M, Hajebi A, Motevalian SA, Rad Goodarzi R, Hefazi M, Rahimi-Movaghar A. Twelve-month Prevalence and Correlates of Psychiatric Disorders in Iran: The Iran Mental Health Survey, 2011. Arch Iran Med 2015; 18: 76-84.

Movaghar AR, Goodarzi RR, Izadian E, Mohammadi MR, Hosseini M, Vazirian M. The impact of Bam earthquake on substance users in the first 2 weeks: a rapid assessment. J Urban Health 2005; 82: 370-377.

UNODC. Drug use in Afghanistan: 2009 Survey, Executive summary. Veinna 2010.

Rahimi-Movaghar A, Amin-Esmaeili M, Hefazi M, Yousefi-Nooraie R. Pharmacological therapies for maintenance treatments of opium dependence. Cochrane Database Syst Rev. 2013: Art. No.: CD007775. DOI: 007710.001002/14651858.CD14007775.pub14651852.

Rahimi-Movaghar A, Vameghi M. Drug addiction. In: Madani S, ed. Social situation report in Iran [In Persian]. Tehran: Rahman Institute; 2011.

Rahimi-Movaghar A, Mohammad K, Razzaghi EM. Trend of drug abuse in Iran: a three decade analysis [Abstract in English, full-text in Persian]. Hakim Research J 2002; 5: 171-182.

Razzaghi EM, Rahimi- Movaghar A, Hosseini M, Madani S, Chatterjee A. Rapid Situation Assessment of Drug Abuse in Iran Tehran: Iranian Welfare Organization and UNDCP; 1999.

Day C, Nassirimanesh B, Shakeshaft A, Dolan K. Patterns of drug use among a sample of drug users and injecting drug users attending a General Practice in Iran. Harm Reduct J 2006; 3: 2.

Iran MoH. Iran, Progress Report on Monitoring of the United Nations General Assembly Special Session on HIV/AIDS. 2012; http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/.

Amin-Esmaeili M, Rahimi-Movaghar A, Haghdoost AA, Mohraz M. Evidence of HIV epidemics among non-injecting drug users in Iran: a systematic review. Addiction 2012; 107: 1929-1938.

Amin-Esmaeili M, Rahimi-Movaghar A, Razaghi EM, Baghestani A, Jafari S. Factors Correlated With Hepatitis C and B Virus Infections Among Injecting Drug Users in Tehran, IR Iran [DOI: 10.5812/HepatMon.806]. Hepat Mon 2012; 12: 24-32.

Alavian SM, Adibi P, Zali MA. Hepatitis C Virus in Iran: epidemiology of an emerging infection. Arch Iran Med 2005; 8: 84-90.

Rahimi-Movaghar A, Razzaghi E. A Qualitative Study on opioid overdose in injecting drug users in Tehran [Abstract in English, Full Text in Persian]. Tehran Univ Med J 2006; 64: 43-53.

Narenjiha H, Nouri R, Akbarian M, Farahani MA, Mirzamani M. The experience of lifetime non-fatal overdose of drugs in Iranian substance abusers [Abstract in English, Full Text in Persian]. Iran J Psychiatry Clin Psychology 2010; 15: 327-333.

World Health Organization. WHO Drug Injecting Study - Phase II Operations Manual Version 4. 2000 [cited 2015 18 January]; Available from: http://www.who.int/substance_abuse/activities/en/WHODrugInjectionStudyOperationsManual.pdf?ua=1.

Rahimi-Movaghar A, Razaghi EM, Sahimi-Izadian E, Amin-Esmaeili M. HIV, hepatitis C virus, and hepatitis B virus co-infections among injecting drug users in Tehran, Iran. Int J Infect Dis 2010; 14: e28-33.

Farhoudian A, Sadeghi M, Vishteh HRK, Moazen B, Fekri M, & Rahimi-Movaghar A. Component Analysis of Iranian Crack; A Newly Abused Narcotic Substance in Iran. Iran J Pharm Res 2014; 13: 337-344.

Malekinejad M. HIV and related risk behaviors survey of injecting drug users using respondent driven sampling in Tehran, Iran. Tehran: Iranian Research Center for HIV/AIDS, UCSF Global Health Sciences; 2008.

Kheirandish P, Seyedalinaghi SA, Hosseini M, Jahani MR, Shirzad H, Foroughi M, et al. Prevalence and correlates of HIV infection among male injection drug users in detention in Tehran, Iran. J Acquir Immune Defic Syndr 2010; 53: 273-275.

Zamani S, Radfar R, Nematollahi P, Fadaie R, Meshkati M, Mortazavi S, et al. Prevalence of HIV/HCV/HBV infections and drug-related risk behaviours amongst IDUs recruited through peer-driven sampling in Iran. Int J Drug Policy 2010; 21: 493-500.

Rahimi- Movaghar A, Amin Esmaeili M, Aaraj E, Hermez J. Assessment of situation and response of drug use and its harm in the Middle East and North Africa, 2012. Lebanon: Middle East and North Africa Harm Reduction Association (MENAHRA); 2013.

Horyniak D, Higgs P, Jenkinson R, Degenhardt L, Stoove M, Kerr T, et al. Establishing the Melbourne Injecting Drug User Cohort Study (MIX): rationale, methods, and baseline and twelve-month follow-up results. Harm Reduct J 2013; 10: 11.

Malekinejad M, McFarland W, Vaudrey J, Raymond HF. Accessing a diverse sample of injection drug users in San Francisco through respondent-driven sampling. Drug Alcohol Depend 2011; 118: 83-91.

Yao Y, Wang N, Chu J, Ding G, Jin X, Sun Y, et al. Sexual behavior and risks for HIV infection and transmission among male injecting drug users in Yunnan, China. Int J Infect Dis 2009; 13: 154-161.

Razzaghi EM, Rahimi-Movaghar A, Green TC, Khoshnood K. Profiles of risk: a qualitative study of injecting drug users in Tehran, Iran. Harm Reduct J 2006; 3: 12.

Narenjiha H, Rafiei H, Baghestani AR, Nouri R, Ghafouri B, Soleimaninia L, et al., eds. Rapid situation assessment of drug abuse in Iran (year 2007) [In Persian]. Tehran: Danjeh publication; 2009.

Rahimi Movaghar A. A review on the prevalence and the patterns of drug abuse in women in Iran [Abstract in English, full-text in Persian]. Social Welfare 2004; 3: 203-226.

Zamani S. Integrated Bio-behavioral Surveillance for HIV Infection among Injecting Drug Users in Iran, 2007. Tehran: Center for Disease Managment, Ministry of Health, Unpublished project report; 2008.

Rafiey H, Narenjiha H, Shirinbayan P, Noori R, Javadipour M, Roshanpajouh M, et al. Needle and syringe sharing among Iranian drug injectors. Harm Reduct J 2009; 6.

Malekinejad M. Assessment of the use of respondent-driven sampling for studying populations most at risk of HIV infection. Berkeley, University of California; 2008.

Sherman SG, Fuller CM, Shah N, Ompad DV, Vlahov D, Strathdee SA. Correlates of Initiation of Injection Drug Use Among Young Drug Users in Baltimore, Maryland: The Need for Early Intervention. J Psychoactive Drugs 2005; 37: 437-443.

Trenz RC, Scherer M, Harrell P, Zur J, Sinha A, Latimer W. Early onset of drug and polysubstance use as predictors of injection drug use among adult drug users. Addict Behav 2012; 37: 367-372.

Narenjiha H, Rafiei H, Baghestani AR, Nouri R, Shirinbayan P, Farhadi MH, et al. Rapid situation assessment of drug abuse in Iran (year 2004): research report [In Persian]. Tehran: Dariush institute; 2005.

Jafari S, Movaghar A, Craib K, Baharlou S, Mathias R. Socio-cultural Factors Associated with the Initiation of Opium Use in Darab, Iran. Int J Ment Health Addict 2009; 7: 376–388.

Razzaghi EM, Rahimi-Movaghar A. Rapid assessment and response Injection Drug Use in Tehran. Tehran: World Health Organization and Iranian Welfare Organization; 2005.

Samimi-Rad K, Toosi MN, Masoudi-nejad A, Najafi A, Rahimnia R, Asgari F, et al. Molecular epidemiology of hepatitis C virus among injection drug users in Iran: a slight change in prevalence of HCV genotypes over time. Arch Virol 2012; 157: 1959-1965.

Roy E, Godin G, Boudreau JF, Côté PB, Denis V, Haley N, et al. Modeling initiation into drug injection among street youth. J Drug Educ 2011; 41: 119-134.

Neaigus A, Gyarmathy VA, Miller M, Frajzyngier VM, Friedman SR, Des Jarlais DC. Transitions to injecting drug use among noninjecting heroin users: Social network influence and individual susceptibility. J Acquir Immune Defic Syndr 2006; 41: 493-503.

Rahimi-Movaghar A, Noroozi A, Page K, Mohraz M, McFarland W, Malekafzali H, et al. Transition to injecting drug use and reverse transition among youth in Tehran, Iran; a qualitative study. Tehran: Iranian Research Center for HIV/AIDS (IRCHA) & The University of California, San Francisco (UCSF). 2013.

Brorson HH, Ajo Arnevik E, Rand-Hendriksen K, Duckert F. Drop-out from addiction treatment: A systematic review of risk factors. Clin Psychol Rev 2013; 33: 1010-1024.

Bridge J. Route transition interventions: Potential public health gains from reducing or preventing injecting. Int J Drug Policy 2010; 21: 125-128.

Hunt N, Griffiths P, Southwell M, Stillwell G, Strang J. Preventing and curtailing injecting drug use: a review of opportunities for developing and delivering "route transition interventions". Drug Alcohol Rev 1999; 18: 441-451.

Zamani S, Vazirian M, Nassirimanesh B, Razzaghi EM, Ono-Kihara M, Ravari SM, et al. Needle and syringe sharing practices among injecting drug users in Tehran: A comparison of two neighborhoods, one with and one without a needle and syringe program. AIDS Behav 2010; 14: 885-890.

Evans JL, Hahn JA, Page-Shafer K, Lum PJ, Stein ES, Davidson PJ, et al. Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO Study). J Urban Health 2003; 80: 137-146.

Rhodes T, Platt L, Judd A, Mikhailova LA, Sarang A, Wallis N, et al. Hepatitis C virus infection, HIV co-infection, and associated risk among injecting drug users in Togliatti, Russia. Int J STD AIDS 2005; 16: 749-754.

Jafari S, Rahimi-Movaghar A, Craib K, Baharlou S, Mathias R. A follow-up study of drug users in Southern Iran. Addict Res Theory 2010; 18: 59–70.

Amin-Esmaeili M, Rahimi-Movaghar A, Sharifi V, Hajebi A, Radgoodarzi R, Mojtabai R, et al. Epidemiology of illicit drug use disorders in Iran: prevalence, correlates, comorbidity and service utilization results from the Iranian Mental Health Survey. Addiction 2016: doi: 10.1111/add.13453

Rahimi-Movaghar A, Khastoo G, Razzaghi E, Saberi-Zafarghandi MB, Noroozi AR, Jar-Siah R. Compulsory methadone maintenance treatment of severe cases of drug addiction in a residential setting in Tehran, Iran (2): Outcome evaluation in two and six-month follow-up [Abstract in English, Full Text in Persian]. Payesh, Health Monitor 2011; 10: 505-514.

World Health Organisation. WHO, UNODC, UNAIDS Technical Guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users – 2012 revision. Geneva: WHO; 2012.

United Nations Programme on HIV/AIDS (UNAIDS), United Na¬tions Development Programme (UNDP). Joint United Nations Programme on HIV/AIDS. UNAIDS report on the global AIDS epidemic. Geneva. 2010 [updated 2010 November 23]; Available From: www.unaids.org/documents/20101123_PR_GlobalReport_ en.pdf.

Kral AH, Malekinejad M, Vaudrey J, Martinez AN, Lorvick J, Mc¬Farland W, et al. Comparing respondent-driven sampling and targeted sampling methods of recruiting injection drug users in San Francisco. J Urban Health 2010, 87: 839-50.

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IssueVol 54, No 12 (2016) QRcode
SectionArticles
Keywords
Intravenous substance abuse Risk behaviors Health service utilization Iran

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How to Cite
1.
Amin-Esmaeili M, Rahimi-Movaghar A, Gholamrezaei M, Razaghi EM. Profile of People Who Inject Drugs in Tehran, Iran. Acta Med Iran. 2017;54(12):793-805.