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Rafiee M, Karamouzian M, Sharifi M, Mirzazadeh A, Khezri M, Haghdoost AA, Mehmandoost S, Sharifi H. Non-injection drug use among incarcerated people in Iran: Findings from three consecutive national bio-behavioral surveys. Harm Reduct J 2024; 21:147. [PMID: 39138501 PMCID: PMC11323345 DOI: 10.1186/s12954-024-01072-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 08/02/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Prisons often serve as high-risk environments for drug use, and incarcerated people are at a high risk for substance use-related mental and physical harms. This study aimed to determine the prevalence of non-injection drug use inside the prison and its related factors among incarcerated people in Iran. METHODS We utilized data from three national bio-behavioral surveillance surveys conducted among incarcerated people in Iran in 2009, 2013, and 2017. Eligibility criteria were being ≥ 18 years old, providing informed consent, and being incarcerated for over a week. Overall, 17,228 participants across all surveys were recruited through a multi-stage random sampling approach. Each participant underwent a face-to-face interview and HIV test. The primary objective of the study was to assess self-reported non-injection drug use within the prison environment within the last month. A multivariable logistic regression model was built to determine associated covariates with drug use inside prison and an adjusted odds ratio (aOR) with 95% confidence intervals (CI) were reported. RESULT The prevalence of non-injection drug use inside the prison was 24.1% (95% CI 23.5, 24.7) with a significant decreasing trend (39.7% in 2009, 17.8% in 2013, 14.0% in 2017; p-value < 0.001). Overall, 44.0% of those who used drugs were also receiving opioid agonist therapy (OAT) and we noted that in 2017, 75.1% of those on OAT used stimulants. In the multivariable logistic regression model, the year of interview (2013: aOR = 1.43 and 2009: aOR = 5.60), younger age (19-29: aOR = 1.14 and 30-40: aOR = 1.37), male sex (aOR = 3.35), < high school education (aOR = 1.31), having a history of previous incarceration (aOR = 1.26), and having a history of lifetime HIV testing (aOR = 1.76) were significantly and positively associated with recent non-injection drug use inside the prison. CONCLUSIONS Approximately one in four incarcerated people in Iran reported drug use within the last month inside prisons. While a declining trend in non-injection drug use was noted, substantial gaps persist in harm reduction programs within Iranian prisons. In particular, there is a pressing need for improvements in drug treatment programs, focusing on the integration of initiatives specifically designed for people who use stimulants.
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Affiliation(s)
- Mahkameh Rafiee
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mohammad Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Mehrdad Khezri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
| | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Soheil Mehmandoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA.
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Kumar G, Jnaneswar A, Rai S, Vinay S, Jha K, Singh A. Substance use and oral health sensations among substance users residing in rehabilitation centres in an Indian City. Indian J Dent Res 2022; 33:7-13. [PMID: 35946237 DOI: 10.4103/ijdr.ijdr_213_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The term substance is usually used to address psychoactive/psychotropic drugs which include both licit and illicit drugs. These substances have varied consequences, including long-term and short-term effects, which include sensations post-consumption. Aim To determine patterns of substance use and short-term oral health effects among substance users. Materials and Methods A self-administered questionnaire-based study was conducted on the inmates of drug deaddiction and rehabilitation centres in Bhubaneswar city. Results All the subjects were males and majority (60.6%) were polydrug users. Alcohol (87.3%) was the most commonly used substance, followed by ganja (57%), bhang (35.3%) and brown sugar (33%). A wide range of oral health sensations like dryness of mouth, taste change, numbness in mouth, feeling like chewing something, loose teeth and stammering/difficulty in speaking were found to be significantly associated with substance use. The age of start of substance use (P < 0.0001), socioeconomic status (P = 0.026) and marital status (P < 0.0001) were significantly associated with the pattern of substance use. About 37.6% of inmates felt that they had very good oral health before starting drug use, while only 15.4% described their oral health as very good at present. Having no oral health problem was the most common reason for not visiting a dentist, followed by ignorant attitude towards oral health. Conclusion A wide range of oral health sensations were found to be caused due to substance use. Understanding of oral health sensations can aid practitioners detect and report cases of substance use in its early phase.
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Affiliation(s)
- Gunjan Kumar
- Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Avinash Jnaneswar
- Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Shilpa Rai
- Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - S Vinay
- Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Kunal Jha
- Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Arpita Singh
- Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
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Ansari M, Rostam-Abadi Y, Baheshmat S, Hamzehzadeh M, Gholami J, Mojtabai R, Rahimi-Movaghar A. Buprenorphine abuse and health risks in Iran: A systematic review. Drug Alcohol Depend 2021; 226:108871. [PMID: 34214882 DOI: 10.1016/j.drugalcdep.2021.108871] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Buprenorphine maintenance treatment (BMT) is widely used in Iran, and its use is growing continuously. We reviewed studies on buprenorphine use, non-prescribed use, use disorder and treatment-seeking for it, buprenorphine-associated poisoning, and mortality in Iran in the current systematic review. METHODS An Iranian database (Scientific Information Database; SID) and three International electronic databases (PubMed, Scopus, and Web of Science) were searched for publications up to August 2020 for the relevant data. Opportunistic methods (Contact with experts and backward citation tracking) were also used for this purpose. Identified records were screened for eligibility criteria, and data of included studies were extracted. For context, the trend of BMT in the country was also examined. RESULTS Ten studies were found on the prevalence of non-prescribed buprenorphine use, seven were on the regular use and use disorder, and two studies on buprenorphine poisoning. The last 12-month prevalence of non-prescribed use was lower than 0.5 % in the general population, university, and high school students. The indicator was 2.5 % among persons who use drugs in a 2018 national study. The proportion of buprenorphine poisoning was 4.9 % among all illicit substance poisoning cases admitted to a hospital. The proportion of buprenorphine poisoning cases among all acute pediatric drug poisoning cases increased from 1.2 % to 2.5 % in a 3-year study. CONCLUSION Despite the expansion of BMT in Iran in the last decade, the adverse health consequences associated with buprenorphine are infrequent, when compared to other opioids used in Iran, suggesting the safety of BMT for future expansion.
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Affiliation(s)
- Mina Ansari
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.
| | - Yasna Rostam-Abadi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.
| | - Shahab Baheshmat
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran.
| | - Marziyeh Hamzehzadeh
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran.
| | - Jaleh Gholami
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.
| | - Ramin Mojtabai
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA.
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.
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Ghaderi A, Eghtesadi R, Esmaili-Shahzade-Ali-Akbari P, Shahmirzaei F, Banafsheh H. Evaluation of thallium levels in opioid substance users: A case–control study. INTERNATIONAL ARCHIVES OF HEALTH SCIENCES 2021. [DOI: 10.4103/iahs.iahs_109_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mirzazadeh A, Hosseini-Hooshyar S, Shahesmaeili A, Bahramnejad A, Barshan A, Mousavian G, Najafi E, Sharifi H, Haghdoost AA, Briceno A, McFarland W, Page K. Barriers and motivators to participation and retention in HIV/HCV cohort studies among people who inject drugs: a community consultation in Iran. Subst Abuse Treat Prev Policy 2020; 15:56. [PMID: 32758246 PMCID: PMC7405425 DOI: 10.1186/s13011-020-00298-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/22/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The lack of robust estimates of HIV/HCV incidence among people who inject drugs (PWID) in Iran calls for well-designed prospective cohort studies. Successful recruitment and follow-up of PWID in cohort studies may require formative assessment of barriers PWID are faced with in participation and retention in cohort studies and factors they think may facilitate their engagement in such studies. Using a focus group discussion (FGD) format, we conducted a consultation with PWID in southeast Iran to recognize those barriers and motivators. METHODS Using targeted sampling and through snowball referrals, we recruited PWID (aged≥18, injected in last 6 months) from community-based drop-in centers (DICs), homeless shelters, and through outreach efforts to participate in four FGDs (one women-only). Socio-demographic characteristics, injection behaviors and self-reported HCV/HIV testing and diagnosis history were obtained. Then, a semi-structured FGD guide was applied to explore barriers and motivators to participation and retention in cohort studies among study participants. All FGD sessions were recorded and transcribed verbatim, removing any identifying information. The content of FGDs were analyzed by thematic analysis using an inductive approach. RESULTS In total, 30 individuals (10 women) participated in the study. The median age of participants was 35 (IQR 31-40), with majority (73.3%) reporting injecting drug use within the last month. Only 40.0% reported ever being tested for HCV whereas a larger proportion (63.4%) reported ever being tested for HIV. While the majority were willing to participate in cohort studies, breach of confidentiality, fear of positive test results, perceived required commitment, and marginalization were reported as barriers to participation and retention in such studies. Monetary incentive, the thought of a better life, protection from police interventions and trust between health workers and PWID were addressed as motivators of engagement in cohort studies among PWID. CONCLUSIONS Strategies to enhance data security and reduce stigma associated with injecting drug use along with involving peer workers in research, providing pre and post-test counselling and education and addressing the needs of more marginalized groups potentially through integrated healthcare programs and housing support are among few approaches that may help address barriers and strengthen the motivators for successful cohort studies among this population.
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Affiliation(s)
- Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
| | - Samira Hosseini-Hooshyar
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Armita Shahesmaeili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | - Ghazal Mousavian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Esmail Najafi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali-Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Alya Briceno
- University of California San Francisco, San Francisco, CA, USA
| | - Willi McFarland
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
- University of California San Francisco, San Francisco, CA, USA
| | - Kimberly Page
- Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Oveisi S, Stein LAR, Babaeepour E, Araban M. The impact of motivational interviewing on relapse to substance use among women in Iran: a randomized clinical trial. BMC Psychiatry 2020; 20:157. [PMID: 32272923 PMCID: PMC7147038 DOI: 10.1186/s12888-020-02561-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women in Iran are in great need of effective substance abuse services. The current study was conducted to investigate the effectiveness of motivational interviewing (MI) for women in treatment for drug use in Iran. METHOD The sample (N = 60) included women in a drug treatment center in Qazvin (Iran) from August to December of 2017. The research sample included 60 female drug users randomly assigned to MI or Standard Care (SC). Prior to randomization women completed a baseline questionnaire and the Relapse Prediction Scale (RPS), which measures desire (urge) to use and probability of using/not using in risky situations (self-efficacy). MI consisted of eight 60-min group sessions over a 1-month period, twice weekly. At 2-months follow-up, data were gathered using a questionnaire similar to baseline. Mixed Model Analysis were used to determine group differences. RESULTS Mean age of participants was 30 years and average addiction duration was 7 years. Although the scores of the desire to use and the probability of drug use were not significant before the intervention, after the intervention, scores on desire to use and probability of use improved about 81.1% (F: 2230.15, P < 0.001, degrees of freedom: 63, 15) and 81.9%, (F: 749.39, P < 0.001, degrees of freedom: 79, 77), respectively, compared to those of control group. CONCLUSION The results showed that motivational interviewing could decrease desire to use and probability of use among female drug users. Motivational interviewing could play an important role in improving women's health in Iran. TRIAL REGISTRATION IRCT registration number: IRCT20140907019077N4 Registration date: 2017-12-12, 1396/09/21 Registration timing: registered_while_recruiting Last update: 2017-12-12, 1396/09/21.
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Affiliation(s)
- Sonia Oveisi
- grid.412606.70000 0004 0405 433XDepartment of Pediatrics, Faculty of Medicine, Metabolic Disease Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - L. A. R. Stein
- grid.20431.340000 0004 0416 2242Psychology Department, University of RI, Kingston, RI USA ,grid.40263.330000 0004 1936 9094Behavioral & Social Sciences Department, Brown University School of Public Health, Providence, RI USA ,RI Training School, Cranston, RI USA ,grid.40263.330000 0004 1936 9094Center for Prisoner Health & Human Rights, Brown University Medical School, Providence, RI USA
| | - Elham Babaeepour
- grid.412606.70000 0004 0405 433XDepartment of Midwifery, Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Marzieh Araban
- Department of Health Education and Promotion, Public Health School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Noroozi M, Noroozi A, Sharifi H, Harouni GG, Marshall BDL, Ghisvand H, Qorbani M, Armoon B. Needle and Syringe Programs and HIV-Related Risk Behaviors Among Men Who Inject Drugs: A Multilevel Analysis of Two Cities in Iran. Int J Behav Med 2019; 26:50-58. [PMID: 30460445 DOI: 10.1007/s12529-018-9758-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many studies have found significant differences in HIV risk at the community and socioeconomic levels. However, few have considered variations in needle and syringe program (Jin et al., Oral Dis. 1;22(7):609-19) coverage and other community characteristics on HIV risk behaviors among people who inject drugs (PWIDs). Our objective was to study the relationship between individual factors and city-level characteristics (such as the city's coverage of harm reduction programs) on HIV risk behavior among PWID residing in two cities in Iran. METHODS The study was conducted from March to August 2016 in Tehran and Kermanshah provinces. One thousand PWID were recruited by a convenience sampling recruitment at local NSP Drop-in Centers (DIC) and through "snowball sampling" (i.e., using peers to refer participants to the study). We first examined associations between individual-level variables and HIV risk behaviors in bivariate analysis using the chi-square or Fisher's exact tests, as appropriate. Next, multi-level models were constructed to determine the amount of variability in HIV risk behavior that could be accounted for by individual- and community-level characteristics. Variables with p value < 0.2 were included in the multiple logistic regression model. RESULTS The results of the multilevel modeling showed that 32% of the variability in HIV risk behaviors among PWID could be explained by factors that differed between the two cities. When individual factors including higher HIV knowledge, access to NSP, higher HIV risk perception, and methamphetamine use were all included in the final model, 22% of the variability in HIV risk behaviors could be explained to city-level variables. CONCLUSION Findings suggest that expanding the accessibility (i.e., hours and venues) and community-level coverage of NSP services by establishing programs where PWID congregate might reduce HIV risk behavior among PWID.
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Affiliation(s)
- Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Alireza Noroozi
- Department of Neuroscience and Addiction, School of Advanced Technologies in Medicine, University of Medical Sciences, Tehran, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Hesam Ghisvand
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran. .,School of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Iran. .,, Tehran-Saveh freeway, Kaveh Industrial Estate company, Saveh, 3914334911, Iran.
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Bayesian Zero- Inflated Poisson model for prognosis of demographic factors associated with using crystal meth in Tehran population. Med J Islam Repub Iran 2018; 32:24. [PMID: 30159275 PMCID: PMC6108249 DOI: 10.14196/mjiri.32.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Indexed: 11/26/2022] Open
Abstract
Background: Use of methamphetamine (MA) and other stimulants has increased steadily over the past 10 years. Risk factor evaluation to reduce the problem in the community is one solution to protect people from addiction. This study aimed at using Bayesian zeroinflated Poisson (ZIP) model to investigate the relationship between the number of using crystal meth and some demographic factors in Tehran population.
Methods: A cross-sectional study was conducted to investigate crystal meth abuse in Tehran, the capital of Iran, in 2012. Stratified sampling method was used to select samples from 22 urban areas of Tehran. Trained researchers referred to the public places, such as streets, parks, squares, and libraries, to perform face-to-face interviews with the randomly selected samples. Bayesian ZIP model was used to perform the analysis, and SAS 9.3 program was used for data analysis.
Results: A total of 993 individuals were studied. According to Bayesian ZIP model, sex (mean= -0.27, 95%CI (-0.485, -0.061)), age (mean= 0.03, 95%CI (0.018, 0.043)), high school level education (mean= 1.276, 95%CI (0.699, 01.9)), diploma level education (mean= 10.4, 95%CI (0.511, 1.69)), and university level education (mean= 0.69, 95%CI (0.142, 1.33)) were all found to have significant associations with crystal meth usage, being the dependent variable.
Conclusion: Males, those with higher education levels, and older people in Tehran population are more likely to use crystal meth. This demographic information may be useful in designing preventive programs. Moreover, it is better to analyze count data with excessive zeroes using Bayesian zero- inflated model instead of the usual count models.
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Amirabadizadeh A, Nezami H, Vaughn MG, Nakhaee S, Mehrpour O. Identifying Risk Factors for Drug Use in an Iranian Treatment Sample: A Prediction Approach Using Decision Trees. Subst Use Misuse 2018; 53:1030-1040. [PMID: 29172870 DOI: 10.1080/10826084.2017.1392981] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND AIM Substance abuse exacts considerable social and health care burdens throughout the world. The aim of this study was to create a prediction model to better identify risk factors for drug use. DESIGN AND METHODS A prospective cross-sectional study was conducted in South Khorasan Province, Iran. Of the total of 678 eligible subjects, 70% (n: 474) were randomly selected to provide a training set for constructing decision tree and multiple logistic regression (MLR) models. The remaining 30% (n: 204) were employed in a holdout sample to test the performance of the decision tree and MLR models. Predictive performance of different models was analyzed by the receiver operating characteristic (ROC) curve using the testing set. Independent variables were selected from demographic characteristics and history of drug use. RESULTS For the decision tree model, the sensitivity and specificity for identifying people at risk for drug abuse were 66% and 75%, respectively, while the MLR model was somewhat less effective at 60% and 73%. Key independent variables in the analyses included first substance experience, age at first drug use, age, place of residence, history of cigarette use, and occupational and marital status. DISCUSSION AND CONCLUSION While study findings are exploratory and lack generalizability they do suggest that the decision tree model holds promise as an effective classification approach for identifying risk factors for drug use. Convergent with prior research in Western contexts is that age of drug use initiation was a critical factor predicting a substance use disorder.
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Affiliation(s)
- Alireza Amirabadizadeh
- a Medical Toxicology and Drug Abuse Research Center (MTDRC) , Birjand University of Medical Sciences , Moallem Avenue , Birjand , Iran
| | - Hossein Nezami
- b Department of Basic Sciences , Faculty of Medicine, Gonabad University of Medical Sciences , Gonabad , Iran
| | - Michael G Vaughn
- c School of Social Work , Saint Louis University , St. Louis , Missouri , USA
| | - Samaneh Nakhaee
- a Medical Toxicology and Drug Abuse Research Center (MTDRC) , Birjand University of Medical Sciences , Moallem Avenue , Birjand , Iran.,d Cardiovascular Diseases Research Center , Birjand University of Medical Sciences , Birjand , Iran
| | - Omid Mehrpour
- a Medical Toxicology and Drug Abuse Research Center (MTDRC) , Birjand University of Medical Sciences , Moallem Avenue , Birjand , Iran
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Shahbazi F, Mirtorabi SD, Ghadirzadeh MR, Hashemi-Nazari SS, Barzegar A. Characterizing Mortality from Substance Abuse in Iran: An Epidemiological Study during March 2014 to February 2015. ADDICTION & HEALTH 2017; 9:166-174. [PMID: 29657697 PMCID: PMC5894796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Drug abuse is a severe and chronic disorder that leaves morbidity, disability and premature mortality in the society. The study of death due to substance abuse provides useful information for local, national and international administrators. Thus, by identifying the factors that have an impact on overdose-related mortality we can provide suitable intervention for vulnerable groups. The aim of this study was an investigation of mortality rate caused by consumption of narcotic and psychoactive substances in Iran. METHODS In this cross-sectional study, demographic and epidemiological data about all people whose cause of death was substance abuse in March 2014 to February 2015 were collected from Legal Medicine Organization (LMO). Finally, the information that was extracted from two checklists was analyzed by descriptive statistics. FINDINGS In this study, 2986 cases died from substances abuse were evaluated. Most deaths have befallen in unmarried young men with mean age of 36.9 ± 12.3, in the private locations. The mortality rate of drug abuse in the whole country was 38.4 per 1000000 population. The proportion of mortality was higher in Iranian nationality and in people who had a diploma and less education. History of overdose, suicide, hospitalization in a psychiatric hospital, staying in prison and substance abuse in the family were investigated in the study population. CONCLUSION The present study revealed that mortality rate from substance abuse is more among unmarried young men aged 30-39 years with low education level and also in the self-employed group. We suggest that policies should be taken to prevent these people from accessing and using the drug.
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Affiliation(s)
- Fatemeh Shahbazi
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Davood Mirtorabi
- General Practitioner, Department of Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Ghadirzadeh
- Forensic Medicine Specialist, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Seyed Saeed Hashemi-Nazari
- Assistant Professor, Safety Promotion and Injury Prevention Research Center AND Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Correspondence to: Saeed Hashemi-Nazari MD, MPH, PhD,
| | - Abdolrazagh Barzegar
- Forensic Medicine Specialist, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
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Hojjat SK, Hatami SE, Rezaei M, Hamidi M, Norozi Khalili M. Women in opioid maintenance treatment in Iran: Background characteristics and history of substance use and risk behaviors. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.1080/14659891.2016.1227381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Seyed Kaveh Hojjat
- Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Seyed Esmaeil Hatami
- Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Mahdi Rezaei
- Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Mahin Hamidi
- Clinical Psychology, Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Mina Norozi Khalili
- Department of Community Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
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Samiei M, Moradi A, Noori R, Aryanfard S, Rafiey H, Naranjiha H. Persian At-Risk Women and Barriers to Receiving HIV Services in Drug Treatment: First Report From Iran. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2016; 5:e27488. [PMID: 27622170 PMCID: PMC5002316 DOI: 10.5812/ijhrba.27488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/26/2015] [Accepted: 04/14/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND As the most populated Persian Gulf country, in Iran, engagement with drug injection and unsafe sex are the main routes of HIV transmission among some drug-dependent women. OBJECTIVES The current study explored the barriers that a group of drug-dependent women reported in accessing and adhering to HIV services in drug use treatment. PATIENTS AND METHODS Qualitative interviews were conducted with 47 Persian women at five outpatient drug treatment centers between January and December 2011. Five focus group interviews were conducted with ten key informants (KI). The interviews made use of a semi-structured interview guide, which facilitated discussion regarding the barriers. The interview transcripts were analyzed thematically using Atlas-ti software. RESULTS The interview accounts highlighted a number of barriers, including stigmatization, a considerable lack of knowledge about free HIV centers in the community, previous traumatic events, misconceptions about the quality of HIV services, and a poor supportive referral system among drug treatment and HIV centers. CONCLUSIONS The findings highlight a need for removing stigma and providing high quality women-only HIV services. Increasing trust and knowledge of available HIV services are needed for this group of women. Increasing staff knowledge is a priority. An integrated supportive network among drug treatment and HIV centers is suggested in Iran.
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Affiliation(s)
- Mercedeh Samiei
- Division of Psychiatry, Razi Psychiatric Hospital, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
| | - Afsaneh Moradi
- Department of Psychology, Faculty of Psychology and Educational Sciences, Al-Zahra University, Tehran, IR Iran
| | - Roya Noori
- Substance Abuse and Dependence Research Centre, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
- Corresponding author: Roya Noori, Substance Abuse and Dependence Research Centre, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran. Tel/Fax: +98-2122180095, E-mail:
| | - Sepideh Aryanfard
- Department of Social Welfare, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
| | - Hassan Rafiey
- Department of Social Welfare, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
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Akbari M, Akbari M, Naghibzadeh-Tahami A, Joulaei H, Nasiriyan M, Hesampour M, Bagheri-Lankarani K. Prevalence of HIV/AIDS among Iranian Prisoners: A Review Article. ADDICTION & HEALTH 2016; 8:195-206. [PMID: 28496958 PMCID: PMC5422016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/21/2016] [Indexed: 10/31/2022]
Abstract
BACKGROUND Worldwide, prisoners are more at risk of being infected by human immunodeficiency virus (HIV) as well as hepatitis C and B in comparison with other risk groups. The combination of acquired immune deficiency syndrome (AIDS), addiction and prison are factors that threaten the health of our society. Influence of risky behaviors is so common on transmission of AIDS into prisoners' bodies. This study used available information and reports to investigate the prevalence of HIV in Iranian prisons. METHODS The following review of documents available in national and foreign databases, a total of 26 studies were investigated and required information was extracted from both the full papers and abstracts. FINDINGS The selected studies differed methodologically in their sampling method and data collection tools. Within the 26 studies analyzed, there was a combined study cohort of 39707 people in whom HIV prevalence varied between 0% and 24.40%. CONCLUSION In this study, HIV prevalence ranged widely among the prisoners, and in most of these studies, the rate in Iran was higher than that of other countries. The prevalence of disease was highest among intravenous drug users. Unless proper preventive and control plans among risk groups such as prisoners are not implemented in a timely and suitable manner, the risk of infection in the broader society will increase.
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Affiliation(s)
- Morteza Akbari
- Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Akbari
- PhD Student, Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Naghibzadeh-Tahami
- PhD Student, Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hassan Joulaei
- Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Nasiriyan
- Assistant Professor, Department of Biostatistic and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Hesampour
- Department of Health Education and Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Bagheri-Lankarani
- Professor, Health Policy Research Center AND Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Heijnen M, Mumtaz GR, Abu-Raddad LJ. Status of HIV and hepatitis C virus infections among prisoners in the Middle East and North Africa: review and synthesis. J Int AIDS Soc 2016; 19:20873. [PMID: 27237131 PMCID: PMC4884676 DOI: 10.7448/ias.19.1.20873] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/05/2016] [Accepted: 04/26/2016] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION The status of HIV and hepatitis C virus (HCV) infections among incarcerated populations in the Middle East and North Africa (MENA) and the links between prisons and the HIV epidemic are poorly understood. This review synthesized available HIV and HCV data in prisons in MENA and highlighted opportunities for action. METHODS The review was based on data generated through the systematic searches of the MENA HIV/AIDS Epidemiology Synthesis Project (2003 to December 15, 2015) and the MENA HCV Epidemiology Synthesis Project (2011 to December 15, 2015). Sources of data included peer-reviewed publications and country-level reports and databases. RESULTS AND DISCUSSION We estimated a population of 496,000 prisoners in MENA, with drug-related offences being a major cause for incarceration. Twenty countries had data on HIV among incarcerated populations with a median prevalence of 0.6% in Afghanistan, 6.1% in Djibouti, 0.01% in Egypt, 2.5% in Iran, 0% in Iraq, 0.1% in Jordan, 0.05% in Kuwait, 0.7% in Lebanon, 18.0% in Libya, 0.7% in Morocco, 0.3% in Oman, 1.1% in Pakistan, 0% in Palestine, 1.2% in Saudi Arabia, 0% in Somalia, 5.3% in Sudan and South Sudan, 0.04% in Syria, 0.05% in Tunisia, and 3.5% in Yemen. Seven countries had data on HCV, with a median prevalence of 1.7% in Afghanistan, 23.6% in Egypt, 28.1% in Lebanon, 15.6% in Pakistan, and 37.8% in Iran. Syria and Libya had only one HCV prevalence measure each at 1.5% and 23.7%, respectively. There was strong evidence for injecting drug use and the use of non-sterile injecting-equipment in prisons. Incarceration and injecting drugs, use of non-sterile injecting-equipment, and tattooing in prisons were found to be independent risk factors for HIV or HCV infections. High levels of sexual risk behaviour, tattooing and use of non-sterile razors among prisoners were documented. CONCLUSIONS Prisons play an important role in HIV and HCV dynamics in MENA and have facilitated the emergence of large HIV epidemics in at least two countries, Iran and Pakistan. There is evidence for substantial but variable HIV and HCV prevalence, as well as risk behaviour including injecting drug use and unprotected sex among prisoners across countries. These findings highlight the need for comprehensive harm-reduction strategies in prisons.
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Affiliation(s)
- Marieke Heijnen
- Infectious Disease Epidemiology Group, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, NY, USA; ;
| | - Ghina R Mumtaz
- Infectious Disease Epidemiology Group, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, NY, USA
- College of Public Health, Hamad bin Khalifa University, Doha, Qatar
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Norouzian H, Gholami M, Shakib P, Goudarzi G, Ghobadian Diali H, Rezvani A. Prevalence of HCV Infections and Co-Infection With HBV and HIV and Associated Risk Factors Among Addicts in Drug Treatment Centers, Lorestan Province, Iran. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2016; 5:e25028. [PMID: 27162762 PMCID: PMC4859996 DOI: 10.5812/ijhrba.25028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 03/01/2015] [Accepted: 03/09/2015] [Indexed: 01/27/2023]
Abstract
Background: Hepatitis C is an infectious disease caused by blood-borne pathogen, hepatitis C virus (HCV). Objectives: The purpose of this study was to investigate the prevalence of HCV infection and associated risk factors among addicts in drug treatment centers in Lorestan Province, Iran. Patients and Methods: A cross-sectional sero-behavioral survey was given to drug addicts in the drug treatment centers of Khorramabad, Lorestan Province, Iran during June 2012 - March 2013. Drug addicts were interviewed using a standard questionnaire including demographic, imprisonment history, and HCV-related risk behavior items. Thereafter, the sera drawn from the participants were tested for anti-HCV antibody (Ab), anti-human immunodeficiency virus (HIV) Ab, and hepatitis B surface antigen (HBsAg). Results: The mean age of the cohorts was 31.7. Up to 60.2% of drug users had educational levels less than high school, 67.5% were self-employed, and 32.5% were office workers. The mean duration of drug injection was 6.8 years. Statistical analyses indicated that the prevalence of HCV among drug addicts was positively associated with age, past incarceration, drug injection history, the duration of drug use, and tattooing. In addition, 16.23% of volunteers were HCV-positive. Of those infected with HCV, 1.10% was co-infected with HBV, 2.95% were positive for HIV, and 0.36% of HCV-positive cases were infected with all three viruses. Conclusions: The high prevalence of HCV infection among this group implies a high rate of transmission and exposure to the risk of serious diseases. It is important that the high prevalence of HCV infection be taken into consideration to control further transmission of this infection.
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Affiliation(s)
- Hossein Norouzian
- Hepatitis Research Center, Lorestan University of Medical Sciences, Khorramabad, IR Iran
| | - Mohammadreza Gholami
- Hepatitis Research Center, Lorestan University of Medical Sciences, Khorramabad, IR Iran
| | - Pegah Shakib
- Hepatitis Research Center, Lorestan University of Medical Sciences, Khorramabad, IR Iran
| | - Gholamreza Goudarzi
- Hepatitis Research Center, Lorestan University of Medical Sciences, Khorramabad, IR Iran
- Corresponding author: Gholamreza Goudarzi, Hepatitis Research Center, Lorestan University of Medical Sciences, Khorramabad, IR Iran. Tel/Fax: +98-6633120133, E-mail:
| | | | - Azam Rezvani
- Deputy of Health Services, Lorestan University of Medical Sciences, Khorramabad, IR Iran
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White WL. Congress 60: An Addiction Recovery Community within the Islamic Republic of Iran. ALCOHOLISM TREATMENT QUARTERLY 2015. [DOI: 10.1080/07347324.2015.1050929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Azimaraghi O, Marashi SM, Khazaei N, Pourhassan S, Movafegh A. The Effect of Adding Sufentanil to 0.5% Hyperbaric Bupivacaine on Duration of Brachial Plexus Blockade in Chronic Opium Abusers: a Randomized Clinical Trial. Anesth Pain Med 2015; 5:e21960. [PMID: 26161314 PMCID: PMC4493736 DOI: 10.5812/aapm.21960v2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 10/04/2014] [Accepted: 11/11/2014] [Indexed: 01/19/2023] Open
Abstract
Background: Anesthesia induction in patients with current substance abuse can be a challenge for anesthesiologists. Objectives: This study aimed to evaluate the effect of adding Sufentanil to Bupivacaine on duration of brachial plexus nerve block. Patients and Methods: One hundred and twenty patients with (Groups C and D) and without (Groups A and B) a history of opium abuse (60 in each group) scheduled for elective upper extremity procedures were randomly assigned to either receive 30 mL bupivacaine alone (Groups A and C) or in combination with additional 10 µg sufentanil (Groups B and D). An ultrasound-guided technique was applied to perform upper extremity brachial plexus blockade. The onset and duration of sensory and motor blocks were recorded and compared between the four groups. Results: The duration of sensory and motor block were significantly less in Group C (537.0 ± 40.1 minutes, 479.0 ± 34.8 minutes) and the longest duration of sensory and motor block was observed in group B (705.0 ± 43.8 minutes, 640.0 ± 32.5 minutes). The duration of sensory and motor block in Group B (705.0 ± 43.8 minutes, 640.0 ± 32.5 minutes) was longer and statistically higher than group A (619.5 ± 48.0 minutes, 573.2 ± 31.5 minutes), the same trend was observed in group D (598.6 ± 53.2 minutes, 569.3 ± 39.9 minutes) over group C (537.0 ± 40.1 minutes, 479.0 ± 34.8 minutes) (P < 0.001, one-way ANOVA). Conclusions: The length of sensory and motor blockade is shorter in chronic opioid abusers. Adding 10 µg sufentanil to hyperbaric bupivacaine in opium abusers lengthened the sensory and motor block duration.
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Affiliation(s)
- Omid Azimaraghi
- Department of Anesthesiology, Pain and Critical Care, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mojtaba Marashi
- Department of Anesthesiology, Pain and Critical Care, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Khazaei
- Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sarah Pourhassan
- Department of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Movafegh
- Department of Anesthesiology, Pain and Critical Care, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Ali Movafegh, Department of Anesthesiology, Pain and Critical Care, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-9123021389, Fax: +98-88220032, E-mail:
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Shahbazi M, Farnia M, Moradi G, Karamati M, Paknazar F, Mirmohammad Khani M. Injecting Drug Users Retention in Needle-Exchange Program and its Determinants in Iran Prisons. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2015; 4:e23751. [PMID: 26405681 PMCID: PMC4579801 DOI: 10.5812/ijhrba.23751v2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 12/15/2014] [Accepted: 12/17/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Participation and to stay in a health program depends on many factors. One of these programs is Needle Exchange Program (NEP) in prisons. OBJECTIVES The current study aimed to evaluate the retention of injecting drug prisoners and find the related factors in Iran. PATIENTS AND METHODS This cohort study analyzed data about injecting drug male prisoners who were participated in NEP in three Iranian prisons. Data was collected from October 2009 to June 2010. A proper approach of survival analyses including Kaplan-Meier method, Log-Rank test, and Cox Proportional Hazard Model were used to evaluate Injecting Drug Users (IDUs) retention in NEP and its determinants. RESULTS Out of 320 prisoners, 167 were from Isfahan Central Prison, 82 from Tehran-Ghezel-Hesar Prison, and 71 from Hamadan Central Prison. Two-hundred and fifty prisoners (78.4%) had history of drug injection; and drug injection was the most common choice for 115 persons (35.9%). Participants were followed up for 29 weeks, the mean (SD) time of retention in the program was 24.1 (0.6) weeks. There was a significant relationship between age, number of used needles per week, duration of addiction, age of addiction onset, as well as imprisonment age, main method of drug use, type of main using drug, Hepatitis B Virus (HBV) infection, job status, reason of arrestment, history of involvement in harm reduction programs, and the length of retention (P < 0.05). There was also significant relationship between the history of using harm reduction services (P = 0.007), tattooing (P = 0.01), longer durations of addiction (P = 0.048), and retention. CONCLUSIONS Tattooing and longer duration of addiction were two important factors that significantly increased retention in the program. In contrast, history of using harm reduction services was the factor that decreased persistence. The risk of quitting the program may decrease about 68% in those who did not involve in harm reduction programs.
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Affiliation(s)
- Mohammad Shahbazi
- United Nations Development Program, Prisons Organization, Tehran, IR Iran
| | - Marzieh Farnia
- Health and Treatment Office of Iranian Prisons Organization, Tehran, IR Iran
| | - Ghobad Moradi
- Social Determinant of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, IR Iran
- Epidemiology and Biostatistics Department, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, IR Iran
| | | | - Fatemeh Paknazar
- Department of Epidemiology and Biostatistics, School of Public Health , International Campus, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Majid Mirmohammad Khani
- Research Center for Social Determinants of Health, Semnan University of Medical Sciences, Semnan, IR Iran
- Community Medicine Department, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, IR Iran
- Corresponding author: Majid Mirmohammad Khani, Community Medicine Department, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, IR Iran. Tel: +98-2313354183, E-mail: ,
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Alinejad S, Kazemi T, Zamani N, Hoffman RS, Mehrpour O. A systematic review of the cardiotoxicity of methadone. EXCLI JOURNAL 2015; 14:577-600. [PMID: 26869865 PMCID: PMC4747000 DOI: 10.17179/excli2015-553] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/14/2015] [Indexed: 01/07/2023]
Abstract
UNLABELLED Methadone is one of the most popular synthetic opioids in the world with some favorable properties making it useful both in the treatment of moderate to severe pain and for opioid addiction. Increased use of methadone has resulted in an increased prevalence of its toxicity, one aspect of which is cardiotoxicity. In this paper, we review the effects of methadone on the heart as well as cardiac concerns in some special situations such as pregnancy and childhood. METHODS We searched for the terms methadone, toxicity, poisoning, cardiotoxicity, heart, dysrhythmia, arrhythmia, QT interval prolongation, torsade de pointes, and Electrocardiogram (ECG) in bibliographical databases including TUMS digital library, PubMed, Scopus, and Google Scholar. This review includes relevant articles published between 2000 and 2013. The main cardiac effects of methadone include prolongation of QT interval and torsade de pointes. Other effects include changes in QT dispersion, pathological U waves, Taku-Tsubo syndrome (stress cardiomyopathy), Brugada-like syndrome, and coronary artery diseases. The aim of this paper is to inform physicians and health care staff about these adverse effects. Effectiveness of methadone in the treatment of pain and addiction should be weighed against these adverse effects and physicians should consider the ways to lessen such undesirable effects. This article presents some recommendations to prevent heart toxicity in methadone users.
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Affiliation(s)
- Samira Alinejad
- Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences,Birjand, Iran
| | - Toba Kazemi
- Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences,Birjand, Iran
| | - Nasim Zamani
- Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Robert S. Hoffman
- Division of Medical Toxicology, Ronald O. Pereleman Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Pasdaran Avenue, Birjand, 9713643138 Iran
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Assari S, Moghani Lankarani M, Dejman M, Farnia M, Alasvand R, Sehat M, Roshanpazooh M, Tavakoli M, Jafari F, Ahmadi K. Drug Use among Iranian Drivers Involved in Fatal Car Accidents. Front Psychiatry 2014; 5:69. [PMID: 25221521 PMCID: PMC4148638 DOI: 10.3389/fpsyt.2014.00069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 05/31/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although the problem of substance use among drivers is not limited to certain parts of the world, most epidemiological reports on this topic have been published from industrial world. AIM To investigate pattern of drug use among Iranian drivers who were involved in fatal road accidents. METHODS This study enrolled 51 Iranian adults who were involved in fatal vehicle accidents and were imprisoned thereafter. Data came from a national survey of drug abuse that was done among Iranian prisoners. The survey collected data at the entry to seven prisons in different regions of the country during a 4-month period in 2008. Self-reported lifetime, last year, and last month drug use was measured. Commercial substance screening tests were applied to detect recent substance use (opioids, cannabinoids, methamphetamines, and benzodiazepines). RESULTS The commercial substance screening test showed three distinct patterns of recent illicit drug use: opioids (37.3%), cannabinoids (2.0%), opioids and cannabinoids (13.7%). 29.4% were also positive for benzodiazepines. The substance use screening test detected 23.5% of participants who had used drugs but did not disclose any substance use. CONCLUSION Opioids are the most common illicit drugs being used by Iranian drivers who are involved in fatal car accidents. The high rate of substance use prior to fatal car accidents in Iran advocates for the need for drug use control policies and programs as major strategies for injury prevention in Iran. There is also a need for substance screening among all drivers involved in fatal car accidents in Iran, as more than 20% of users may not disclose substance use.
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Affiliation(s)
- Shervin Assari
- Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Social Determinants of Health Research Centre, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Maryam Moghani Lankarani
- Universal Network for Health Information Dissemination and Exchange (UNHIDE), Tehran, Iran
- Medicine and Health Promotion Institute, Tehran, Iran
| | - Masoumeh Dejman
- Social Determinants of Health Research Centre, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Marzieh Farnia
- Health and Treatment Bureau of Iran Prisons Organization, Tehran, Iran
| | - Ramin Alasvand
- Health and Treatment Bureau of Iran Prisons Organization, Tehran, Iran
| | - Mahmood Sehat
- Universal Network for Health Information Dissemination and Exchange (UNHIDE), Tehran, Iran
- Medicine and Health Promotion Institute, Tehran, Iran
| | - Mohsen Roshanpazooh
- Universal Network for Health Information Dissemination and Exchange (UNHIDE), Tehran, Iran
| | - Mahmood Tavakoli
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Firoozeh Jafari
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Khodabakhsh Ahmadi
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Assari S, Ahmadi K, Rezazade M. Socio-Economic Status Determines Risk of Receptive Syringe Sharing Behaviors among Iranian Drug Injectors; A National Study. Front Psychiatry 2014; 5:194. [PMID: 25852577 PMCID: PMC4369970 DOI: 10.3389/fpsyt.2014.00194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 12/16/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although needle and syringe sharing is one of the main routs of transmission of HIV in several countries in the middle east, very little is known about how socio-economic status of injecting drug users (IDUs) is linked to the receptive syringe sharing behaviors in these countries. AIM To study socio-economic correlates of receptive needle and syringe sharing among IDUs in Iran. METHODS The study used data from the Unhide Risk Study, a national survey of IDUs. This study sampled 636 IDUs (91% male) via snowball sampling from eight provinces in Iran in 2009. Socio-demographic and drug use characteristics were collected. We used a logistic regression to determine factors associated with receptive needle and syringe sharing during the past 6 months. RESULTS From 636 IDUs enrolled in this study, 68% (n = 434) reported receptive needle and syringe sharing behaviors in the past 6 months. Odds of receptive needle and syringe sharing in the past 6 months was lower among IDUs who were male [odds ratios (OR) = 0.29, 95% confidence interval (CI) = 0.12-0.70], had higher education (OR = 0.74, 95% CI = 0.64-0.86) but higher among those who were unemployed (OR = 4.05, 95% CI = 1.50-10.94), and were single (OR = 1.47, 95% CI = 1.02-2.11). CONCLUSION This study presented factors associated with risk of receptive needle and syringe sharing among Iranian IDUs. This information may be used for HIV prevention and harm reduction purposes. Socio-economic status of Iranian IDUs may be closely linked to high-risk injecting behaviors among them.
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Affiliation(s)
- Shervin Assari
- Department of Psychiatry, School of Medicine, University of Michigan , Ann Arbor, MI , USA ; Center for Research on Ethnicity, Culture, and Health (CRECH), School of Public Health, University of Michigan , Ann Arbor, MI , USA ; Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation , Tehran , Iran
| | - Khodabakhsh Ahmadi
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences , Tehran , Iran
| | - Majid Rezazade
- AIDS Prevention and Control Committee of Welfare Organization State , Tehran , Iran
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Haji-Maghsoudi S, Haghdoost AA, Baneshi MR. Selection of Variables that Influence Drug Injection in Prison: Comparison of Methods with Multiple Imputed Data Sets. ADDICTION & HEALTH 2014; 6:36-44. [PMID: 25140216 PMCID: PMC4137438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 10/09/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prisoners, compared to the general population, are at greater risk of infection. Drug injection is the main route of human immunodeficiency virus ý(HIV) transmission, in particular in Iran. What would be of interest is to determine variables that govern drug injection among prisoners. However, one of the issues that challenge model building is incomplete national data sets. In this paper, we addressed the process of model development when missing data exist. METHODS Complete data on 2720 prisoners was available. A logistic regression model was fitted and served as gold standard. We then randomly omitted 20%, and 50% of data. Missing date were imputed 10 times, applying multiple imputation by chained equations (MICE). Rubin's rule (RR) was applied to select candidate variables and to combine the results across imputed data sets. In S1, S2, and S3 methods, variables retained significant in one, five, and ten imputed data sets and were candidate for the multifactorial model. Two weighting approaches were also applied. FINDINGS Age of onset of drug use, recent use of drug before imprisonment, being single, and length of imprisonment were significantly associated with drug injection among prisoners. All variable selection schemes were able to detect significance of these variables. CONCLUSION We have seen that the performances of easier variable selection methods were comparable with RR. This indicates that the screening step can be used to select candidate variables for the multifactorial model.
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Affiliation(s)
- Saiedeh Haji-Maghsoudi
- PhD Student, Regional Knowledge Hub and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoost
- Professor, Regional Knowledge Hub and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Reza Baneshi
- Associate Professor, Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Mehrjerdi ZA, Abarashi Z, Noroozi A, Arshad L, Zarghami M. Correlates of shared methamphetamine injection among methamphetamine-injecting treatment seekers: the first report from Iran. Int J STD AIDS 2013; 25:420-7. [PMID: 24287028 DOI: 10.1177/0956462413512806] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Shared methamphetamine injection is an emerging route of drug use among Iranian methamphetamine injectors. It is a primary vector for blood-borne infections. The aim of the current study is to determine the prevalence and correlates of shared methamphetamine injection in a sample of Iranian methamphetamine injecting treatment seekers in the south of Tehran. We surveyed male and female methamphetamine injectors at three drop-in centres and 18 drug-use community treatment programmes. Participants reported socio-demographic characteristics, drug use, high-risk behaviours, current status of viral infections and service use for drug treatment. Bivariate and multivariate logistic regression models were used to test associations between participants' characteristics and shared methamphetamine injection. Overall, 209 clients were recruited; 90.9% were male; 52.6% reported current methamphetamine injection without any shared injection behaviour and 47.4% reported current shared methamphetamine injection. Shared methamphetamine injection was found to be primarily associated with living with sex partners (AOR 1.25, 95% CI 1.13-1.98), reporting ≥3 years of dependence on methamphetamine injection (AOR 1.61, 95% CI 1.27-2.12), injection with pre-filled syringes in the past 12 months (AOR 1.96, 95% CI 1.47-2.42), homosexual sex without condom use in the past 12 months (AOR 1.85, 95% CI 1.21-2.25), the paucity of NA group participation in the past 12 months (AOR 0.67, 95% CI 0.41-0.99), the paucity of attending psychotherapeutic sessions in the past 12 months (AOR 0.44, 95% CI 0.28-0.96) and positive hepatitis C status (AOR 1.98, 95% CI 1.67-2.83). Deeper exploration of the relationship between shared methamphetamine injection and sexual risk among Iranian methamphetamine injectors would benefit HIV/sexually transmitted infection prevention efforts. In addition, existing psychosocial interventions for methamphetamine-injecting population may need to be adapted to better meet the risks of shared methamphetamine injectors.
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Affiliation(s)
- Zahra Alam Mehrjerdi
- Program of International Research and Training, National Drug and Alcohol Research Centre, Faculty of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
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Mehrpour O, Karrari P, Sheikhazadi A. Survey of factors related to criminal behavior in a sample of Iranian substance abusers. J Forensic Leg Med 2013; 20:1078-81. [PMID: 24237824 DOI: 10.1016/j.jflm.2013.09.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 09/26/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Many countries including Iran have a high rate of substance abuse. It is essential for public health and law enforcement strategies to know the causes and consequences of substance abuse and its relation to crimes. METHODS In a prospective case-control study, covering a period of one year starting from March 21, 2010, 125 cases with criminal behavior and 125 cases with no history of criminal behavior were studied. RESULTS Eight percent of our studied population had a previous history of psychological disorder. Most of our cases were cigarette users (78.4%). Forty-two cases had a history of alcohol abuse (16.8%). Modern drugs were the most common type of drugs (56%) being used. Multivariate analysis using logistic regression revealed that criminal behavior was correlated with divorce (RR = 5.35; 95% CI = 1.59-16.01; P = 0.023), history of alcohol use (RR = 2.63; 95% CI = 1.11-6.22; P = 0.027), history of psychological disorder (RR = 4.97; 95% CI = 1.44-17.20; P = 0.011), Modern drug use (RR = 4.86; 95% CI = 2.01-11.76; P = 0.001) and starting drug abuse at an early age (RR = 0.94; 95% CI = 0.88-0.99; P = 0.03). CONCLUSIONS Risk factors for criminal behavior among substance abusers include being divorced, history of alcohol abuse, history of psychological disorder, modern drug abuse and starting drug abuse at an early age.
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Affiliation(s)
- Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Group, Birjand University of Medical Sciences, Birjand, Iran; Department of Clinical Toxicology and Forensic Medicine, Faculty of Medicine, Birjand University of Medical Sciences, Ghaffari Avenue, Birjand 97175-379, Iran
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Alam Mehrjerdi Z, Abarashi Z, Mansoori S, Deylamizadeh A, Salehi Fadardi J, Noroozi A, Zarghami M. Methamphetamine use among Iranian heroin kerack-dependent women: implications for treatment. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2013; 2:15-21. [PMID: 24971266 PMCID: PMC4070142 DOI: 10.5812/ijhrba.10216] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/02/2013] [Accepted: 03/11/2013] [Indexed: 11/24/2022]
Abstract
Background Co-use of heroin kerack with methamphetamine (MA) is a new epidemic health concern among Iranian female drug users. Yet, little is known about this issue because of stigma. Objectives The current study aimed to investigate the reasons associated with initial and continued co-use of heroin kerack with MA among two groups of regular and recreational female co-users, their motivations associated with treatment entry and to compare their general characteristics at a drop in center (DIC) in Tehran. Materials and Methods 82 clients were randomly recruited. A researcher-designed questionnaire was used to collect data. Data was analyzed by performing descriptive statistics, the Chi-square test and t-test. Results The mean age of the participants were 31 (SD = 8) years. Reducing negative affect (55%), addicted family and social networks (50%), curiosity (48%), and the lack of knowledge on addictive effects of co-use of heroin kerack with MA (32%) were the most frequently reported reasons at initiation. Drug dependence (71%) and drug availability (56%) were reasons of continued co-use. Restoring health (61%), fear from becoming MA abuser only (33%), and fear from making a transition from heroin kerack and MA smoking to injection (15%) were important motivations for treatment entry. Regular co-users were more likely to be single (41.7% vs. 14.7%, P < 0.001), jobless (45.8% vs. 38.2, P < 0.05), homemaker (50% vs. 35.3%, P < 0.01), recently incarcerated (16.7% vs. 11.7%, P < 0.01), and were less likely to be enrolled in opioid replacement programs (33.5% vs. 41%, P < 0.01). Regular co-users were younger (30.6 vs. 32.1 years, P < 0.05), less educated (9.6 vs. 10.8 years, P < 0.05) and had a longer duration of drug dependence (9.6 vs. 8 years, P < 0.05). Conclusions Reasons associated with initial and continued co-use of heroin kerack with MA, factors associated with treatment entry and the differences between regular and recreational co-users should be specifically considered in designing and tailoring drug use treatment programs for this group.
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Affiliation(s)
- Zahra Alam Mehrjerdi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Zahra Alam Mehrjerdi, Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, IR Iran, Tel.: +98-2155421177, Fax: +98-2155421177, E-mail:
| | - Zohreh Abarashi
- Center of Psychological Counseling Services, Ferdowsi University, Mashhad, IR Iran
| | - Sahar Mansoori
- Division of Research on Drug Use and Dependence, Rebirth Society (NGO), Tehran, IR Iran
| | - Abbas Deylamizadeh
- Division of Research on Drug Use and Dependence, Rebirth Society (NGO), Tehran, IR Iran
| | - Javad Salehi Fadardi
- Department of Psychology, Faculty of Psychology and Educational Sciences, Ferdowsi University, Mashhad, IR Iran
| | - Alireza Noroozi
- School of Advanced Technologies in Medicine (SATM), Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mehran Zarghami
- Department of Psychiatry, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
- Psychiatry and Behavioral Sciences Research Center, Mazandaran University of Medical Sciences, Sari, IR Iran
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Askarian M, Mansour Ghanaie R, Karimi A, Habibzadeh F. Infectious diseases in Iran: a bird's eye view. Clin Microbiol Infect 2012; 18:1081-8. [PMID: 23033964 DOI: 10.1111/1469-0691.12021] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Thanks to improved health standards in Iran over the past three decades, we have witnessed a shift in the causes of death in Iran from infectious causes to non-communicable diseases-mainly cardiovascular disorders, cancers, and road traffic injuries. The incidence and prevalence of many infectious diseases, such as many parasitic infections, have fallen significantly; there have been no reported cases of dracunculiasis in Iran since the mid-1970s. Great strides have also been made towards the elimination of schistosomiasis in Iran. However, we still have some problems with cutaneous leishmaniasis, hepatitis C, human immunodeficiency virus, tuberculosis, infections among immunocompromised hosts, hospital-acquired infections, and antibiotic-resistant bacterial strains. We need to emphasize improvements in sanitation, good clinical practice, and education about the rational administration of antibiotics.
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Affiliation(s)
- M Askarian
- Department of Community Medicine, School of Medicine, Medicinal & Natural Products Chemistry Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran.
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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. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 23:271-8. [DOI: 10.1016/j.drugpo.2011.09.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 07/25/2011] [Accepted: 09/06/2011] [Indexed: 11/27/2022]
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Shekarchizadeh H, Ekhtiari H, Khami MR, Virtanen JI. Patterns of pre-treatment drug abuse, drug treatment history and characteristics of addicts in methadone maintenance treatment in Iran. Harm Reduct J 2012; 9:18. [PMID: 22676557 PMCID: PMC3405442 DOI: 10.1186/1477-7517-9-18] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 06/07/2012] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Opiates are the main drugs of abuse, and Methadone Maintenance Treatment (MMT) is the most widely administered drug addiction treatment program in Iran. Our study aimed to investigate patterns of pre-treatment drug abuse, addiction treatment history and characteristics of patients in MMT in Tehran. METHODS We applied a stratified cluster random sampling technique and conducted a cross-sectional survey utilizing a standard patient characteristic and addiction history form with patients (n = 810) in MMT. The Chi-square test and t-test served for statistical analyses. RESULTS A clear majority of the participants were men (96%), more than 60% of whom were between 25 and 44 years of age, educated (89% had more than elementary education), and employed (>70%). The most commonly reported main drugs of abuse prior to MMT entry were opium (69%) and crystalline heroin (24%). The patients' lifetime drug experience included opium (92%), crystalline heroin (28%), cannabis (16%), amphetamines (15%), and other drugs (33%). Crystalline heroin abusers were younger than opium users, had begun abusing drugs earlier, and reported a shorter history of opiate addiction. CONCLUSION Opium and crystalline heroin were the main drugs of abuse. A high rate of addiction using more dangerous opiate drugs such as crystalline heroin calls for more preventive efforts, especially among young men.
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Affiliation(s)
- Hajar Shekarchizadeh
- Community Oral Health Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
- Department of Oral Public Health, University of Helsinki, Helsinki, Finland
| | - Hamed Ekhtiari
- Translational Neuroscience Program, Institute for Cognitive Science Studies, Tehran, Iran
- Neurocognitive Laboratory, Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad R Khami
- Community Oral Health Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Jorma I Virtanen
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Department of Community Dentistry, University of Oulu, P.O.Box 5281, FI-90014, Oulu, Finland
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Hassannejad R, Kassaian N, Ataei B, Adibi P. High risky behaviors among intravenous drug users in Isfahan, Iran: A study for hepatitis C harm reduction programs. Int J Prev Med 2012; 3:S73-8. [PMID: 22826773 PMCID: PMC3399296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 08/01/2011] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Intravenous drug users (IVDUs) who share needles/syringes and practice sexual behaviors, are the most important group in the transmission of blood-borne infection diseases such as hepatitis C virus (HCV). Therefore identification of prevalent high-risky behaviors among IVDUs to detect the most route of transmission among them is essential to develop harm reduction programs among IVDUs and decrease HCV transmission from them to community. METHODS The cross-sectional study was carried out on 1510 intravenous drug users from November 2008 to February 2009 in Isfahan province, Iran. After obtaining consent form from participants, information was collected by interviewer-administered validated questionnaire. The data was analyzed with descriptive statistical methods by SPSS software, version 15. RESULTS 1510 IVDUs participated in the study with the mean age 32.16 ± 8.26. 66.4% of participants had a history of illegal sexual activity. Among male IVDUs who had illegal sexual contact, 40.6% reported having homosexual contact and 36.2% of them have used condom in their contact. Also 57.7% had sexual contact with female sex workers. 83.5% of IVDUs reported having multiple sexual partners, and 30.9% had IVDUs sexual partners. The mean number of injection and duration of injection among IVDUs were 75.12 ± 95.51 times per month and 12.34 ± 7.53 years respectively. 36.9% of subjects have reported sharing needles/syringes. CONCLUSIONS According to the high prevalence of unprotected sexual contacts and unsafe injection among IVDUs, effectiveness interventions and harm reduction programs are necessary to prevent spread of blood-borne infection diseases particularly HCV. With reduction of risky behaviors and consequently decrease of spread of HCV, these programs benefit both drug users and society.
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Affiliation(s)
- Razieh Hassannejad
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nazila Kassaian
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Correspondence to: Nazila Kassaian, Infectious Diseases and Tropical Medicine Research center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Behrooz Ataei
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Department of Gastroenterology, Integrative Functional Gastroenterology Research center, Isfahan University of Medical Sciences, Isfahan, Iran
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Karrari P, Mehrpour O, Balali-Mood M. Iranian Crystal: A misunderstanding of the crystal-meth. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2012; 17:203-4. [PMID: 23264800 PMCID: PMC3525044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 01/28/2012] [Accepted: 02/10/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Parissa Karrari
- Department of Clinical Toxicology and Forensic Medicine, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran,Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Omid Mehrpour
- Department of Clinical Toxicology and Forensic Medicine, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran,Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran,Address for correspondence: Omid Mehrpour, Department of Clinical Toxicology and Forensic Medicine, Faculty of Medicine, Birjand University of Medical Sciences, Ghaffari Avenue, Birjand, Iran. E-mail:
| | - Mahdi Balali-Mood
- Medical Toxicology Research Centre, (MTRC) and Department of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Dolan K, Salimi S, Nassirimanesh B, Mohsenifar S, Allsop D, Mokri A. Six-month follow-up of Iranian women in methadone treatment: drug use, social functioning, crime, and HIV and HCV seroincidence. Subst Abuse Rehabil 2012; 3:37-43. [PMID: 24474875 PMCID: PMC3889184 DOI: 10.2147/sar.s21349] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background In general, information about women who use drugs comes from studies performed in the West. Whether women in countries such as Iran are likely to enter drug treatment or how they will respond is not known. Purpose To examine the short-term impact of methadone maintenance treatment (MMT) on drug use, dependence, social functioning, crime, and human immunodeficiency virus (HIV) and hepatitis C virus (HCV) risk behavior and seroincidence in female drug users in Iran. Methods Women were eligible for inclusion in the study if they were assessed as dependent on opiates according to the International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10). The sample comprised 78 female heroin or opium users who attended the Persepolis women’s drug treatment clinic in Tehran between 2007 and 2008. Participants were followed up in 2009/2010. Heroin and the use of other drugs, social functioning, involvement in crime, and involvement in HIV and HCV risk behavior were measured by self-report. The prevalence and incidence of HIV and HCV were measured by serology and self-report. Findings Of the 78 women recruited, 40 were followed up, and this occurred approximately 7 months later. One in four women reported a history of drug injection. At follow-up there were significant reductions in self-reported heroin use on ICD-10 dependence scores. Subjects with more severe drug dependence at baseline were significantly more likely to be criminally active than less severely dependent subjects. Baseline prevalence for HIV and HCV was 5% and 24%, respectively. At follow-up, no one had acquired HIV infection, but one participant had acquired HCV, giving an incidence rate of 7.1 per 100 person-years. Conclusion This research provides the first evidence that Iranian female drug users can enter MMT and respond well. Within a few months of entering MMT, improvements occurred in heroin use, levels of dependence, social functioning, and HIV risk behavior. While the incidence of blood-borne viral infections was low, there was a serious risk of HIV transmission among this cohort and also to participants’ needle and sexual contacts. In a country with high levels of drug use, the high levels of HCV among female drug users require more women to enter drug treatment if an HIV epidemic is to be avoided. Many participants had a chronic drug problem and had had little or no previous exposure to MMT. The introduction or expansion of women-only drug treatment services is urgently needed in order to engage more women in treatment.
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Affiliation(s)
- Kate Dolan
- Program of International Research and Training, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Shabnam Salimi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Setareh Mohsenifar
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - David Allsop
- Program of International Research and Training, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Azarakhsh Mokri
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
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Hajia M, Amirzargar A, Ghoreishi M, Sam S. Estimation the Frequency of Human Immunodeficiency Virus among Male and Female Patients, Iran. CELL JOURNAL 2012; 13:237-42. [PMID: 23508353 PMCID: PMC3584483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 09/22/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A reduction in new human immunodeficiency virus(HIV) cases is one of the ten areas prioritized by the United Nations Program on HIV. However, recent official reports confirm the HIV rate is increasing and predicted a huge incidence in the near future in Iran, despite the preventative program by Iran's Health Ministry. In this descriptive study, we evaluate the frequency of HIV positive cases among referral patients to a private clinic laboratory for its diagnosis in addition to specimens from other laboratories. An epidemiological analysis is also performed. MATERIALS AND METHODS In this descriptive study, the total number of patients was 138 cases that referred for the diagnosis of HIV to the private Laboratory. Of these, 93 males (67.4%) and 45 females (32.6%) voluntarily requested to be examined for specific increases in specific antibody titer, western blot assays and RNA quantitation polymerase chain reaction. We collected two separate tubes of whole blood, one for reverse transcriptasepolymerase chain reaction analysis and the second one for the remaining two tests. Those patients who were antibody positive by western blot and/or reverse transcriptase-polymerase chain reaction(RT-PCR) analyses were considered as HIV positive cases. RESULTS There were 18.84% confirmed HIVcases (17.39% males; 1.45% females). Analysis of the results confirmed that the ratio of male to female patients in the infected group was not comparable to those in the suspect group. The majority of HIV positive cases were either infected by their partner via sexual intercourse (84.61%) or needle sticks (11.53%) among the drug addicted group. The infection routes of the remainder were unknown. CONCLUSION Analysis of the data revealed a higher frequency of HIVin males than females among the tested group. There was a shift in to unsafe sexual intercourse as seen in the present study. The higher rate of infected male patients shows a shift in transmission route to unsafe intercourse. Therefore, it is necessary to design new supportive programs by actively identifying and contacting at-risk groups, particularly infected females who are uninterested in being and monitored.
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Affiliation(s)
- Masoud Hajia
- Department of Medical Microbiology, Health Reference Laboratory of Iran, Ministry of Health and
Medical Education Tehran, Iran,* Corresponding Address:
Department of Medical MicrobiologyHealth Reference LaboratoryMinistry of Health and Medical EducationTehranIran
| | - Ali Amirzargar
- 2. Department of Immunology, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sohrab Sam
- 4. Noor Clinical Laboratory, Tehran, Iran
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Dolan K, Salimi S, Nassirimanesh B, Mohsenifar S, Allsop D, Mokri A. Characteristics of Iranian Women Seeking Drug Treatment. J Womens Health (Larchmt) 2011; 20:1687-91. [DOI: 10.1089/jwh.2010.2694] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Kate Dolan
- Program of International Research and Training, National Drug and Alcohol Research Centre, University of NSW, Sydney, Australia
| | - Shabnam Salimi
- The Iranian National Center for Addiction Studies, Tehran, Iran
| | | | | | - David Allsop
- Program of International Research and Training, National Drug and Alcohol Research Centre, University of NSW, Sydney, Australia
| | - Azarakhsh Mokri
- The Iranian National Center for Addiction Studies, Tehran, Iran
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The establishment of a methadone treatment clinic for women in Tehran, Iran. J Public Health Policy 2011; 32:219-30. [PMID: 21390074 DOI: 10.1057/jphp.2011.10] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In Iran women are less likely than men to use drugs, but suffer greater morbidity, are stigmatised, and are less likely to seek treatment. In 2007, we established a clinic in Tehran for drug using women. We report here on our study of the 97 women who registered in the first year of operation. We profiled these women: demographics, drug use, risk behaviour, and use of services. The clinic's services were heavily used. We interviewed clients and staff about the clinic and learned that intensive help is needed for women trying to recover from years of drug use. We conclude that female drug users will make use of harm reduction services if they are provided in a setting designed and operated for women.
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Prevalence and Correlates of HIV Infection Among Male Injection Drug Users in Detention in Tehran, Iran. J Acquir Immune Defic Syndr 2010; 53:273-5. [PMID: 20104123 DOI: 10.1097/qai.0b013e3181be6dde] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Surveillance of HIV drug resistance transmission in Iran: experience gained from a pilot study. Arch Virol 2010; 155:329-34. [PMID: 20052598 DOI: 10.1007/s00705-009-0583-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Accepted: 12/02/2009] [Indexed: 10/20/2022]
Abstract
We performed a pilot surveillance study on transmitted HIV drug resistance (TDR) in Iran, with specimens collected and stored as dried blood spots (DBS). The protease region and relevant positions in the reverse transcriptase region of the pol gene were sequenced to detect mutations known to be associated with resistance to drugs in standard first-line regimens. Seventy-three specimens were collected, with 39 (53%) specimens yielding sequence from both protease and at least part of RT. Specimens were almost exclusively HIV-1 subtype CRF 35_A1D based on pol sequencing. Mutations were restricted to RT, with D67DG and V75AV each seen in a single specimen. An atypical protease inhibitor mutation, I47M, appeared at a resistance-associated position in protease from a single specimen. These preliminary data showed that the rate of transmitted drug resistance in Iran, within the areas sampled, was 5.1% (2/39). However, the small sample size makes this figure only an approximation. Due to the sampling strategy and resulting small sample size, we were unable to accurately calculate TDR rates for individual areas using the WHO HIV drug resistance threshold survey method. Increasing the sample size and improving the yield from DBS would improve the accuracy of drug resistance surveillance and facilitate wider application of this methodology in Iran.
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Kheirandish P, SeyedAlinaghi S, Jahani M, Shirzad H, Seyed Ahmadian M, Majidi A, Sharifi A, Hosseini M, Mohraz M, McFarland W. Prevalence and correlates of hepatitis C infection among male injection drug users in detention, Tehran, Iran. J Urban Health 2009; 86:902-8. [PMID: 19844670 PMCID: PMC2791818 DOI: 10.1007/s11524-009-9393-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
For the benefit of planning for the future care and treatment of people infected with hepatitis C virus (HCV) and to help guide prevention and control programs, data are needed on HCV seroprevalence and associated risk factors. We conducted a cross-sectional sero-behavioral survey of injection drug users (IDU) detained for mandatory rehabilitation during a police sweep of Tehran, Iran, in early 2006. During the study period, a consecutive sample comprising 454 of 499 (91.0%) men arrested and determined to be IDU by urine test and physical examination consented to a face-to-face interview and blood collection for HCV antibody testing. Overall, HCV prevalence was 80.0% (95% confidence interval (CI) 76.2-83.6). Factors independently associated with HCV infection included history of incarceration (adjusted OR 4.35, 95% CI 1.88-10.08), age of first injection < or =25 years (OR 2.72, 95% CI 1.09-6.82), and history of tattooing (OR 2.33, 95% CI 1.05-5.17). HCV prevalence in this population of IDU upon intake to jail was extremely high and possibly approaching saturation. Findings support that incarceration is contributing to the increased spread of HCV infection in Iran and calls for urgent increased availability of HCV treatment, long-term preparation for the care of complications of chronic infection, and rapid scale-up of programs for the primary prevention of parenterally transmitted infections among drug users.
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Affiliation(s)
- Parastoo Kheirandish
- Iranian Research Center for HIV/AIDS (IRCHA), Department of Infectious and Tropical Diseases, Tehran University of Medical Sciences, Tehran, Iran
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Rafiey H, Narenjiha H, Shirinbayan P, Noori R, Javadipour M, Roshanpajouh M, Samiei M, Assari S. Needle and syringe sharing among Iranian drug injectors. Harm Reduct J 2009; 6:21. [PMID: 19643014 PMCID: PMC2731095 DOI: 10.1186/1477-7517-6-21] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 07/30/2009] [Indexed: 11/30/2022] Open
Abstract
Objective The role of needle and syringe sharing behavior of injection drug users (IDUs) in spreading of blood-borne infections – specially HIV/AIDS – is well known. However, very little is known in this regard from Iran. The aim of our study was to determine the prevalence and associates of needle and syringe sharing among Iranian IDUs. Methods In a secondary analysis of a sample of drug dependents who were sampled from medical centers, prisons and streets of the capitals of 29 provinces in the Iran in 2007, 2091 male IDUs entered. Socio-demographic data, drug use data and high risk behaviors entered to a logistic regression to determine independent predictors of lifetime needle and syringe sharing. Results 749(35.8%) reported lifetime experience of needle and syringe sharing. The likelihood of lifetime needle and syringe sharing was increased by female gender, being jobless, having illegal income, drug use by family members, pleasure/enjoyment as causes of first injection, first injection in roofless and roofed public places, usual injection at groin, usual injection at scrotum, lifetime experience of nonfatal overdose, and history of arrest in past year and was decreased by being alone at most injections. Conclusion However this data has been extracted from cross-sectional design and we can not conclude causation, some of the introduced variables with association with needle and syringe sharing may be used in HIV prevention programs which target reducing syringe sharing among IDUs.
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Affiliation(s)
- Hassan Rafiey
- Iranian Research Center for Substance Abuse and Dependence (IRCSAD), University of Social Welfare and Rehabilitation Science, Tehran, Iran.
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Narenjiha H, Rafiey H, Jahani MR, Assari S, Moharamzad Y, Roshanpazooh M. Substance-dependent professional drivers in Iran: a descriptive study. TRAFFIC INJURY PREVENTION 2009; 10:227-230. [PMID: 19452363 DOI: 10.1080/15389580902849017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To determine characteristics of a nationwide sample of Iranian dependent drug users whose main profession is driving. METHODS Data were derived from a larger study, which aimed to describe pattern of drug dependency in Iran. A "driver" was defined as a person whose main profession was driving a motor vehicle to earn a living. Nine hundred twenty individuals were interviewed by a trained drug abuse team in all provinces of Iran during a 5-month period, from April to August 2007. Socioeconomic characteristics, substance abused, and high-risk behaviors were collected by a checklist. RESULTS All drivers were male and their mean (+/- standard deviation) age was 35.1 (+/- 8.6) years. Opioids (434 cases, 46.8%) and kerack (256 cases, 27.6%) were the two most common drugs used. Except for buprenorphine, which was used via intravenous injection, inhalation was the dominant method of us in other substances including opioids (56%), heroin (51.4%), kerack (80.1%), methamphetamine (73.9%), and cannabis (77.8%). Extramarital sexual relationships (414 cases, 45%) and nonfatal intoxication (362 cases, 39.3%) were the two most frequent high-risk behaviors. CONCLUSIONS There are people with drug dependencies who drive for living in Iran. Deterrence programs through screening and random drug testing at police stations and legislation regarding charges of drugged drivers and prohibition from driving for long time periods are essential priorities in traffic safety.
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Affiliation(s)
- Hooman Narenjiha
- Iranian Research Center for Substance Abuse and Dependence, University of Social Welfare and Rehabilitation Science, Kudakyaar Av., Danish Blvd., Evin, Tehran, Iran.
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Abstract
Jails may foster the spread of HIV, particularly among drug users. In 2006, male injection drug users (n = 499) detained in Tehran consented to HIV testing at intake and discharge. HIV prevalence at intake was 24.4%. Nine of those who were HIV negative at intake were positive at discharge (annualized incidence rate 16.8%), including one p24 antigen positive. Jails may be contributing to the rapid spread of HIV in Iran and should be major points for prevention interventions.
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Kalkhoran S, Hale L. AIDS education in an Islamic nation: content analysis of Farsi-language AIDS-education materials in Iran. ACTA ACUST UNITED AC 2008; 15:21-5. [DOI: 10.1177/1025382308095651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Inconsistent statistics about the number of HIV/AIDS cases in Iran and misinformation about HIV/AIDS among Iranian adolescents necessitate proper understanding and knowledge of HIV/AIDS transmission and prevention. This is particularly important since many issues related to HIV/AIDS, such as sex, homosexuality, and drug use, are taboo topics in the Islamic world. We analyzed Farsi-language educational and informational small media items to ascertain the nature of HIV/AIDS-related material available in society. While all of the documents mentioned sexual contact as a means of transmitting the virus, and the majority (87%) mentioned condom use as a preventive means, mention of homosexuality (43%) and prostitution (17%) was lacking in most. Thus, mention of “safe sex” strategies was not avoided due to fear of promoting sex outside of marriage, as has been noted in other Islamic nations. Mention of intravenous drug use in 90% of the documents shows an acknowledgment of the drug problem in the nation, and an effort to curb its harmful sequelae. Therefore, while certain issues such as sex, condoms, and drug use were well represented in the documents analyzed, additional inclusion of topics such as homosexuality and prostitution, issues already discussed infrequently in society, can help to better educate the population and curb the spread of this life-threatening disease. (Promot Educ 2008;15(3): 21-25)
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Affiliation(s)
| | - Lauren Hale
- HSC Level 3, Room 071, Graduate Program in Public Health, Department of Preventive Medicine, Stony Brook University, NY 11794-8338, USA
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Razani N, Mohraz M, Kheirandish P, Malekinejad M, Malekafzali H, Mokri A, McFarland W, Rutherford G. HIV risk behavior among injection drug users in Tehran, Iran. Addiction 2007; 102:1472-82. [PMID: 17645427 DOI: 10.1111/j.1360-0443.2007.01914.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Iran faces parallel human immunodeficiency virus (HIV) and injection drug use epidemics; more than 62% of known HIV cases occur among injection drug users (IDU). We conducted a formative study of IDU in Tehran to explore risk behavior in the wake of the recent harm reduction efforts. PARTICIPANTS AND DESIGN Key informant interviews (n = 40), focus group discussions (nine groups of IDU, n = 66) and a review of existing published and unpublished literature were conducted. Participants included IDU, physicians, policy makers, police, IDU advocates and their families. IDU were diverse in gender, education, income and neighborhood of residence. Interviews were transcribed and analyzed using grounded theory. A typology of IDUs in Tehran, categorized according to self-defined networks as well as HIV risks, is presented. This categorization is based on the groups identified by IDUs, compared to those identified by other key informants, and on a secondary data review. FINDINGS Homeless, female, young IDU and users of a more potent form of heroin were identified as having increased risks for HIV. Participants described shortening transitions from smoked opium to injected opiates. Whereas a majority of participants considered needle sharing less common than previously, sharing continues in locations of group injection, and in states of withdrawal or severe addiction. System-wise barriers to harm reduction were discussed, and include the cost or stigma of purchasing needles from pharmacies, over-burdened clinics, irregular enforcement of laws protecting IDU and lack of efforts to address the sexual risks of IDU. CONCLUSIONS This research is one of the first to describe a diversity of IDU, including women and higher socio-economic class individuals, in Tehran. While efforts in harm reduction in Iran to date have been notable, ongoing risks point to an urgent need for targeted, culturally acceptable interventions.
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Affiliation(s)
- Nooshin Razani
- University of California, San Francisco, Center for AIDS Prevention Studies, San Francisco, CA 94105, USA.
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Razzaghi EM, Movaghar AR, Green TC, Khoshnood K. Profiles of risk: a qualitative study of injecting drug users in Tehran, Iran. Harm Reduct J 2006; 3:12. [PMID: 16545137 PMCID: PMC1431517 DOI: 10.1186/1477-7517-3-12] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Accepted: 03/18/2006] [Indexed: 11/12/2022] Open
Abstract
Background In Iran, there are an estimated 200,000 injecting drug users (IDUs). Injecting drug use is a relatively new phenomenon for this country, where opium smoking was the predominant form of drug use for hundreds of years. As in many countries experiencing a rise in injecting drug use, HIV/AIDS in Iran is associated with the injection of drugs, accounting for transmission of more than two-thirds of HIV infections. This study aimed to: describe the range of characteristics of IDUs in Tehran, Iran's capital city; 2) examine the injecting-related HIV risk behaviors of IDUs, and 3) suggest necessary interventions to prevent HIV transmission among IDUs and their families and sex partners. Methods Using rapid assessment and response methods with a qualitative focus, six districts of Tehran were selected for study. A total of 81 key informants from different sectors and 154 IDUs were selected by purposeful, opportunistic and snowball sampling, then interviewed. Ethnographic observations were done for mapping and studying injecting-related HIV risk settings and behaviors. Modified content analysis methods were used to analyze the data and extract typologies of injecting drug users in Tehran. Results Evidence of injecting drug use and drug-related harm was found in 5 of 6 study districts. Several profiles of IDUs were identified: depending on their socioeconomic status and degree of stability, IDUs employed different injecting behaviors and syringe hygiene practices. The prevalence of sharing injection instruments ranged from 30–100%. Varied magnitudes of risk were evident among the identified IDU typologies in terms of syringe disinfection methods, level of HIV awareness, and personal hygiene exhibited. At the time of research, there were no active HIV prevention programs in existence in Tehran. Conclusion The recent rise of heroin injection in Iran is strongly associated with HIV risk. Sharing injection instruments is a common and complex behavior among Iranian IDUs. For each profile of IDU we identified, diverse and targeted interventions for decreasing sharing behavior and/or its harms are suggested. Some notable efforts to reduce the harm of injecting drug use in Iran have recently been accomplished, but further policies and action-oriented research for identification of effective preventive interventions are urgently needed.
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Affiliation(s)
- Emran M Razzaghi
- Psychiatry, Tehran University of Medical Sciences, South Karegar Ave., Rouzbeh Hospital, Tehran, Iran
| | - Afarin Rahimia Movaghar
- Psychiatry, Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, No. 669, South Karegar Ave., Tehran, 13366–16357, Iran
| | - Traci Craig Green
- Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, 60 College St., CT 06520–8034, USA
- Yale Center for Interdisciplinary Research on AIDS, Yale University, 40 Temple St. Suite 1B New Haven, CT 06510, USA
| | - Kaveh Khoshnood
- Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, 60 College St., CT 06520–8034, USA
- Yale Center for Interdisciplinary Research on AIDS, Yale University, 40 Temple St. Suite 1B New Haven, CT 06510, USA
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