1) Iran suffers from a severe dual narcotic abuse!

Substance abuse as an economic issue

5,000,000,000 $ are spent annually on narcotics

 

 Results: Heroin vs. Opium Abusers

 Results: Heroin vs. Opium Abusers

 Results: Heroin vs. Opium Abusers

We know (or think we know) 2 other facts about opium versus heroin enigma;

n    Heroin and opium users show similar relapse rates after detoxification

n    Opium dependence can be pharmacologically as severe as heroin dependence!

Detoxification of opium versus heroin abusers

 

2) HIV is highly associated with narcotic abuse in the nation

n    >65% of HIV cases is due to needle sharing among drug users!

n    But most cases are either imprisoned narcotic users or drug users coming from very underprivileged areas!

Drug abuse is a crime and drug abusers are arrested!

 

3) Treatment coverage is low:

People, authorities and professionals are highly persuaded that addiction has a medical solution but;

The washing machine concept is ruling;

 

Naltrexone maintenance in different cities

Similar findings;

n    13 deaths after 130 successful inpatient detoxifications.

n    Almost 100% relapse after release from prison and concentration camps!

n    …

In 2002 MMT was implemented in Iran

 

Comparison of low dose (A) versus high dose  (B) MMT

Results of high dose versus low dose MMT

Profile of MMT Clients in 3 centers

Basic features and facilities of the clinics

Main outcome results

And retention rates were high

Methadone

Abstinence-based

And retention rates were high

Methadone

Abstinence-based

And retention rates were high

Methadone

Abstinence-based

And retention rates were high

Methadone

Abstinence-based

And retention rates were high

Methadone

Abstinence-based

How many people should go on MMT?

Who should go to MMT?

The Utmost Critical Question

Should opium dependent individuals receive substitution treatment?

MMT should go to individuals with IV drug use/high risk behavior (injection and sex) !!

According to AMU (agonist maintenance units) legislations 90% of allocated methadone should go to the above!

 

Patients in MMT and methadone consumption

Patients in MMT and methadone consumption

Patients in MMT and methadone consumption

To reach high-risk clients;

n    Promote MMT with maximum pace

n   Privatize MMT!

Private AMU

Currently 400-600 private AMUs to be raised to 1,200 (1/50,000 population)

 

To reach high-risk clients;

n    Promote MMT with maximum pace

n   Privatize MMT!

n    Offer more feasible forms of methadone

 

To reach high-risk clients;

n    Promote MMT with maximum pace

n   Privatize MMT!

n   Offer more feasible forms of methadone

n    Use other agonists

n   Buprenorphine

 

 

To reach high-risk clients;

n    Promote MMT with maximum pace

n   Privatize MMT!

n   Offer more feasible forms of methadone

n    Use other agonists

n   Buprenorphine

n   Even tincture of opium

 

 

To reach high-risk clients;

n     Promote MMT with maximum pace

n    Privatize MMT!

n    Offer more feasible forms of methadone

n     Use other agonists

n    Buprenorphine

n    Even tincture of opium

n     Offer MMT to very high risk neighborhoods

n    DICs

 

 

Joint NGO-Governmental DICs

To reach high-risk clients;

n     Promote MMT with maximum pace

n    Privatize MMT!

n    Offer more feasible forms of methadone

n     Use other agonists

n    Buprenorphine

n    Even tincture of opium

n     Offer MMT to very high risk neighborhoods

n    DICs

n    Prisons

 

Large maintenance treatment & harm reduction industry

n    DICs, MMT clinics, agonist maintenance association?, pharmaceuticals, NGOs,

n    Patients

n    Public opinion and mass media

n    Politicians