The evolution of addiction treatment and harm reduction programs in Iran: a chaotic response or a synergistic diversity?

Autor: Ekhtiari H; Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences (TUMS), Tehran, Iran.; Laureate Institute for Brain Research, Tulsa, OK, USA., Noroozi A; Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences (TUMS), Tehran, Iran.; Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences (TUMS), Tehran, Iran., Farhoudian A; Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.; Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran., Radfar SR; Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.; Integrated Substance Abuse Programs, University of California at Los Angeles, Los Angeles, CA, USA., Hajebi A; Research Center for Addiction and Risky Behaviors (ReCARB), Psychiatric Department, Iran University of Medical Sciences, Tehran, Iran., Sefatian S; Demand Reduction Work Group, Expediency Discernment Council of Islamic Republic of Iran, Tehran, Iran., Zare-Bidoky M; Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences (TUMS), Tehran, Iran.; School of Medicine, Shahid-Sadoughi University of Medical Sciences, Yazd, Iran., Razaghi EM; Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran., Mokri A; Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences (TUMS), Tehran, Iran.; Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran., Rahimi-Movaghar A; Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences (TUMS), Tehran, Iran., Rawson R; Integrated Substance Abuse Programs, University of California at Los Angeles, Los Angeles, CA, USA.; Center for Behavior and Health, University of Vermont, Burlington, VT, USA.
Jazyk: angličtina
Zdroj: Addiction (Abingdon, England) [Addiction] 2020 Jul; Vol. 115 (7), pp. 1395-1403. Date of Electronic Publication: 2019 Dec 29.
DOI: 10.1111/add.14905
Abstrakt: Backgrounds and Aims: Iran has 2.1 and 1.8% of its 15-64-year-old population living with illicit substance and opioid use disorders, respectively. To address these problems, Iran has been developing a large and multi-modality addiction treatment system, spanning the time before and after the Islamic Revolution.
Methods: Iran's current drug treatment scene is a combination of services, ranging from medical/harm reduction services to punitive/criminal justice programs. Included in this array of services are drop-in centers providing low-threshold harm reduction services, such as distribution of sterile needles and syringes; opioid maintenance treatment clinics providing methadone, buprenorphine and opium tincture; and abstinence-based residential centers. We will review the evolution of this system in four phases.
Results: In 1980, Iran's revolutionary government shut down all voluntary treatment programs and replaced them with residential correctional programs. The first shift in the addiction treatment policies came 15 years later after facing the negative consequences. Addiction is viewed as a disease, and new voluntary treatment centers offering non-agonist medications and psychosocial services were established. With an increased number of people who inject drugs and HIV/AIDS epidemics, in the second shift an extensive move towards harm reduction strategies and opioid-maintenance programs has been implemented to reduce HIV-related high-risk behavior. The emergence of a methamphetamine use crisis creating an increased number of socially marginalized addicted people resulted in public and political demands for stricter policies and ended in the third shift starting in 2010, with extended compulsory court-based residential programs. Currently, there is a new shift towards reducing the severity of criminal penalties for drug use/sales and promoting proposals for opium legalization.
Conclusion: Iran's evolutionary experience in developing a large addiction treatment program in a complex combination of medical/harm reduction and punitive/criminal justice addiction treatment can be examined in its political, clinical and pragmatic context.
(© 2019 Society for the Study of Addiction.)
Databáze: MEDLINE
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