History of Addiction and Related Strategies in Iran

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(No Transcript)
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Policies and Changes in Policies During Last 5o
Years Regarding Regulation and Scheduling of
Controlled Substances in Iran.

• Conference on Drug Dependence and Harm Reduction,
  National Bureau of Controlled Drugs, Department
  of Health, Executive Yuan
• Monday 15/10/2007
• Dr.S.Ramin Radfar MD,MPH
• Raminradfar_at_iuwrs.ac.ir

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Appreciation

• First of all ,I shall to express my great thanks
  and respects for
• Chun-Sheng Chien, Ph.D(Director General)
• Steve Chiou, Ph.D.(Director, Licensing and
  Registration Division)
• Jih-Chiao Chu(Section Chief of Licensing and
  Registration Division)
• Shiau-Ping Guo(Officer)
• Because of providing this opportunity for sharing
  Ideas and experiences

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• All of the topics and data that will be present
  at this presentation , has been selected from
  valid documents and latest data that were
  available , but non of them is formal view of
  Iran Government and Is only my perception from
  the documents as an expert
• The main References for this presentation are

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• World Drug Report 2007
• Islamic Republic of Iran HIV/AIDS Situation and
  Response Analysis
• Iran As Reflected by Statistics 2004. Iranian
  Statistics Center 2005
• A Study of Human Resources and their
  Characteristics in the Iranian Economy
• Reported by SAPTO and Iranian Family Planning
  Association 2006
• Population and health in the Islamic Republic of
  Iran. Ministry of Health and Medical
• Education.2000
• Dr. Omran Mohammad Razzaghi et al, Rapid
  Assessment of Substance Abuse in Iran, Welfare
• Organization Deputyship for Prevention UNDCP
  2000
• Narenjiha H, Rafiey H, Baghestani AH et al.
  (2005) Rapid Situation Assessment of Drug
• Abuse and Drug Dependence in Iran, DARIUS
  Institute (Draft Version, in Farsi).
• First National Strategic Plan of Islamic Republic
  of Iran for HIV/AIDS
• I.R Iran report to Coverage of selected services
  for .HIV/AIDS prevention ,care and support in low
  and middle income countries in 2005. USAID,
  UNAIDS, WHO , UNICEF,and the POLICY PRIJECT
  (unpublished ).
• Reported by Prisons Organization Office for
  Health Treatment 2006
• Official website of UNDCP office in Iran

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1. History of Opium
2. History of Addiction and Activities against drug
   before Islamic Revolution in Iran
3. Review of Iran and Iran governmental system
4. Current Epidemiology of Drugs in Iran
5. Afghanistan situation and Trafficking
6. Supply Reduction in Iran
7. Laws about drugs after Islamic Revolution
8. Prevention approaches in Iran
9. Treatment methods in Iran

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History of Opium
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History

• We can not speak about history of addiction
  without speaking about history opium , because in
  the most of ancient Asia and Europe opium were
  the oldest psychoactive drug that human kind had
  been used . So we first review a little about
  history of opium and especially , highlight every
  where we can see issues related to Iran

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History (continue)

• c.3400 B.C. The opium poppy is cultivated in
  lower Mesopotamia. The Sumerians refer to it as
  Hul Gil, the 'joy plant.' The Sumerians would
  soon pass along the plant and its euphoric
  effects to the Assyrians. The art of opium poppy-
  culling would continue from the Assyrians to the
  Babylonians who in turn would pass their
  knowledge onto the Egyptians

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History (continue)

• c.1300 B.C. In the capital city of Thebes,
  Egyptians begin cultivation of opium thebaicum,
  grown in their famous poppy fields. The opium
  trade flourishes during the reign of Thutmose IV,
  Akhenaton and King Tutankhamen. The trade route
  included the Phoenicians and Minoans who move the
  profitable item across the Mediterranean Sea into
  Greece, Carthage, and Europe.

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History (continue)

• c.1100 B.C. On the island of Cyprus, the
  "Peoples of the Sea" craft surgical-quality
  culling knives to harvest opium, which they would
  cultivate, trade and smoke before the fall of
  Troy.
• c. 460 B.C. Hippocrates, "the father of
  medicine", dismisses the magical attributes of
  opium but acknowledges its usefulness as a
  narcotic and styptic in treating internal
  diseases, diseases of women and epidemics.

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History (continue)

• 330 B.C. Alexander the Great introduces opium to
  the people of Persia and India.
• A.D. 400 Opium thebaicum, from the Egyptian
  fields at Thebes, is first introduced to China by
  Arab traders.
• 1020Avicenna of Persia teaches that opium is
  "the most powerful of stupefacients."

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History (continue)

• A.D. 1200Ancient Indian medical treatises The
  Shodal Gadanigrah and Sharangdhar Samahita
  describe the use of opium for diarrhea and sexual
  debility. The Dhanvantri Nighantu also describes
  the medical properties of opium.

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History (continue)

• 1300s Opium disappears for two hundred years
  from European historical record. Opium had become
  a taboo subject for those in circles of learning
  during the Holy Inquisition. In the eyes of the
  Inquisition, anything from the East was linked to
  the Devil.
• 1500 The Portuguese, while trading along the
  East China Sea, initiate the smoking of opium.
• 1527 During the height of the Reformation, opium
  is reintroduced into European medical literature
  by Paracelsus as laudanum. These black pills or
  "Stones of Immortality" were made of opium
  thebaicum, citrus juice and quintessence of gold
  and prescribed as painkillers.

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History (continue)

• 1600s Residents of Persia and India begin eating
  and drinking opium mixtures for recreational use.

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History (continue)

• 1680 English apothecary, Thomas Sydenham,
  introduces Sydenham's Laudanum, a compound of
  opium, sherry wine and herbs. His pills along
  with others of the time become popular remedies
  for numerous ailments.
• 1700 The Dutch export shipments of Indian opium
  to China and the islands of Southeast Asia the
  Dutch introduce the practice of smoking opium in
  a tobacco pipe to the Chinese.

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• History of Addiction and Activities against drug
  before Islamic Revolution in Iran

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• After that , Opium and Tobacco showed another
  faces in Iran when Britannia and East Indian
  Company entered Iran in more than 200 years ago
  while the Qajarie kings were kings of Iran. They
  were the weakest kingdoms in Iran that Iran had
  been ever seen.

• History of Addiction and Activities against drug
  before Islamic Revolution in Iran (Continue)

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History of Addiction and Activities against drug
before Islamic Revolution in Iran (Continue)

• As mentioned in documented history of Iran,
  Tobacco and shisha had been used and introduced
  to Iranian in British embassy at Tehran.

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History of Addiction and Activities against drug
before Islamic Revolution in Iran (Continue)

• For many years from more that 200 years ago until
  the victory of Islamic revolution ,cultivation of
  poppies were very common in Iran.
• Also in Pahlavi regime we had laws for
  prohibition of poppy cultivation in Iran but
  every body on that years could see poppy farms in
  most of the areas in Iran

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History of Addiction and Activities against drug
before Islamic Revolution in Iran (Continue)

• But it is clear that before years 1960 ,we had
  not heroin user in Iran and in years of 1960s
  ,Iranian drug users experienced Heroin for the
  first time.
• Before these years , Iranian drug users used
  opium in traditional route and usually were in
  upper percentiles of the community with good
  economical , cultural and political situations

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History of Addiction and Activities against drug
before Islamic Revolution in Iran (Continue)

• We also had some rules before Islamic Revolution
  that I mentioned briefly in next few slides

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History of Addiction and Activities against drug
before Islamic Revolution in Iran (Continue)

• The first documented rule that we can see about
  Drug in Iran , had been approved at 1911
• The law of Prohibition of using opium and opium
  juice
• This law shows us that we have had a very bad
  situation about drugs in Iran on that years

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History of Addiction and Activities against drug
before Islamic Revolution in Iran (Continue)

• The second law approved in 17 years later at
  1928, the law expressed that
• The Government of Iran should provide facilities
  for treatment of drug addicts

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History of Addiction and Activities against drug
before Islamic Revolution in Iran (Continue)

• After this rule , the parliament of Iran is
  silent about drugs for 40 years! And it was in
  1969 that 2 another laws approved by Iran
  parliament , the laws were
• 1)Every employee of the government with addiction
  should be retire or quit his work.
• 2)The government should provide opium for old age
  drug users that can not rehabilitated!
• (It seems that the first step for legalization of
  drug are going to be done!!)

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After Islamic Revolution

• Before that we start about drug situation in Iran
  in last 29 years ,I will explain a little about
  Iran and Iran governmental system and its
  component that could be useful for having a
  better view of Iran

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• Review of Iran and Iran
• governmental system

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Socio-Demographic

• With a total area of 1,648,000 square kilometers
  , the Islamic Republic of Iran lies in the
  expanse between the Persian Gulf and the Caspian
  Sea in southwest Asia. To the north,Iran borders
  the Caspian Sea, Turkmenistan, Azerbaijan and
  Armenia to the east, Afghanistan and Pakistan
  to the south, the Persian Gulf and the Sea of
  Oman and to the west, Iraq and Turkey.

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• According to the Iranian Statistics Center, the
  country had a population of about 68,467,440 in
  2005. Over 65 of the population is urban. The
  population growth rate is 1.2. Over the 1991-
  1996 period population growth rates decreased
  both for the rural (from 1.2 to 0.7) and urban
  populations (from 3.5 to 2.9).

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• Though indicative of positive population increase
  in both populations, these figures also signify
  increased rural to urban migration. By 2004 the
  population of young people between ages of 15 and
  24 had reached 24.4 of the total. Some 38-40
  million persons were between 15 and 49 years of
  age.
• Unemployment rate which had peaked during the
  Iraqi-imposed war on Iran (1980-1988), began to
  decrease immediately afterwards. In 2005 the rate
  was estimated at 12.1. The figure amounted to
  25 for youth of 15 to 24 years of age. A study
  titled An Examination of Irans Labor Force and
  Its Characteristics in the Economy found that
• the majority (70) of the unemployed were young
  people under thirty.

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Political, Economic and Legislative Facts

• An overwhelming majority of Iranians is Muslim.
  Upon the 1979 Islamic Revolution, Islamic
  Republic became the countrys form of government.
  The Supreme Leader oversees the executive,
  legislative and judicial branches as well as
  certain key institutions such as the armed
  forces, law enforcement forces and the state-run
  radio and television. The Supreme Leader is
  appointed by the Assembly of Experts.
• The president is elected for four year terms
  through direct public ballots. A State Expediency
  Council sets the general policies of the state.
  Members of this council are appointed by the
  Supreme Leader.

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• The Council is also in charge of adjudicating
  deadlocks between the parliament (the Islamic
  Consultative Assembly) and its constitutional
  oversight body
• (the Guardian Council). The parliament is the
  sole source of legislature which becomes
• law upon confirmation by the Guardian Council.

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• Parliamentarians are elected through direct
  public ballots for four-year terms. The
  parliament also supervises the performance of
  government. One half of the members of the
  Guardian Council are appointed by the Supreme
  leader, while the other half are nominated by the
  Judiciary chief and approved by the parliament.
  The Judiciary chief is appointed by the Supreme
  Leader.

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• Per capita GND is USD 7219 health expenditure
  per capita is USD432 and the share of health
  expenditure in the GNP is 6. Irans budget bill
  is planned on an annual basis.
• The Bill is drafted by the government and
  presented to the parliament for approval.
  Specialized parliamentary sub-committees then
  deliberate on the bill and apply any
• intended modifications, whereupon it is presented
  to the floor for debate then approved by
  majority vote. If confirmed by the Guardian
  Council the bill becomes binding law to be
• implemented by the Executive.

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• The constitution has confirmed that
• All persons are equal before the law.
• The Government must eliminate any unfair
  discrimination in all material and spiritual
  spheres.
• Citizens are equally entitled to political,
  social, cultural and basic human rights.
• Citizens are entitled to health and treatment
  services.

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Drug Abuse Epidemiology In Iran
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Drug Abuse Epidemiology In Iran

• Using opium, both as a medicine and a
  recreational substance has a very long history in
  Iran first reports go back to the 17 th century. 
  the first official statistics on this issue dates
  back to 1943, where the Opium and Alcohol
  Enforcement Society estimated the number of opium
  addicts in Iran as to be one and half a million,
  from the total population of 14 million at that
  time . In 1949 it was estimated that 11 of
  Iranian adults were drug users corresponding to
  1.3 million opium addicts.

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• In 1955, Iran introduced its first laws against
  the cultivation and use of opium . Heroin was
  introduced in Iran in the 60s . In 1969 the
  government permitted limited and supervised
  cultivation of opium. At the same time nationwide
  opium maintenance program for people 60 years and
  older was initiated. By 1972, Iran's drug
  addicted population was estimated 400,000 with
  105,000 registered opium users. In 1975 it was
  reported there were 30,000 heroin users in the
  country, with some of them injecting

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• From 1974 to 1977 a major detoxification program
  operated throughout Iran. Its emphasis was on
  out-patient treatment and it served around 30,000
  out-patients To reduce a drug user's habit,
  coupons for opium tablets for two to three months
  were provided or methadone treatment was made
  available.In 1977, the prevalence of addiction
  was estimated to be 2.5, based on a general
  survey it should be noted that the number of
  those having opium coupons was far below this
  number.

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• The programme was also designated as opium
  maintenance . In 1978, a survey from the National
  Iranian Society for the rehabilitation of the
  Disabled showed 94 of registered addicts used
  opium while 50 of non-registered drug users
  mentioned heroin. By early 1980 following the
  revolution, a severe anti-drug campaign was
  introduced which involved the extensive use of
  the death penalty for drug trafficking and other
  punishments for drug addicts . Throughout the
  1980s and 1990s the courts were sending drug
  users to mandatory rehabilitation in prison-like
  settings.

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• In 1994, Iran developed out-patient treatment
  centers in all 28 provinces and supported the
  development of Narcotic Anonymous (NA) and other
  self-help groups. Since the late 1990s the law
  has allowed treatment-seeking drug users to be
  excluded from penal punishments

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In the past decade several major surveys on the
situation of drug abuse were carried out

1. The Rapid Situation Assessment (RSA) of Drug
   abuse in Iran (1998) was carried out by the
   State Welfare Organisation supported by the
   UNODC. Ten blocks with common cultural and social
   characteristics and roughly having the same
   population of 6 million for each region were
   defined encompassing the whole country. The major
   urban centre of each region was thereafter
   selected as the site for the study. The
   methodology included individual deep interviews
   with selected dug users and key informants, focus
   group discussions with drug users and service
   providers. Drug users from three different
   settings the prison, treatment centre and drug
   users from street were recruited. The total
   number of drug users was estimated through
   indirect methods and secondary data

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Brief Results

• The RSA 1998 estimated the total number of Drug
  users as 2,000,000 with 1,200,000 addicts and
  800,000 recreational users. It revealed that 16
  of the interviewees had injected in the month
  prior to interview and 21.9 were ever injectors.
  Injection behaviour had been more prevalent in
  prisons. Mean of onset of injecting any drug was
  26.3 ( 6.70) years with 80 of injection cases
  initiated before 35 years of age. Reasons
  mentioned for switch to injecting behaviour were
  'tolerance' and less costs. Almost all IDUs had a
  previous history of 5-15 years of opium use prior
  to injecting. Sharing behaviour was generally
  reported by 70 of IDUs. 37.5 of the samples
  from treatment centres and the community had a
  history of imprisonment

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In the past decade several major surveys on the
situation of drug abuse were carried out

• 2.The Epidemiology of Substance Abuse in the I.R
  of Iran (2001) conducted through the Ministry of
  Health and Medical Education together with the
  Drug Control Headquarters and supported by the
  UNODC. The survey was conducted in 53 emergency
  rooms among 5212 randomly selected individuals in
  this setting. Urine tests accompanied interviews,
  collected at the interview site and sent for
  examination to the Reference Laboratory of the
  MoHME to back-up and verify accuracy of responses

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Brief Results

• According to the Epidemiology of Substance Abuse
  in the I.R of Iran (2001) the total number of
  those using opioid drugs at the time of interview
  was 3.7 millions, with 1.16 millions at the level
  of dependence. The study estimated a total number
  of ca. 130,000 Injecting Drug users (IDUs) in the
  country i.e. 19.2 of heroin users and 55.3 of
  buprenorhine users

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In the past decade several major surveys on the
situation of drug abuse were carried out

• 3.Rapid Assessment and Response (RAR), Multi
  Centre Project on Injection Drug Use (2001)
  conducted by the State Welfare Organisation and
  supported by the WHO, was conducted as a part of
  a multi centre survey to look into injecting drug
  use in the city of Tehran. 6 districts were
  selected on the basis of secondary data obtained
  from drug treatment clinics. Recruitments were
  carried out according to opportunistic sampling
  in treatment centres, snowballing in the
  community and ethnographic observations. Key
  informants were recruited through purposive
  sampling

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Brief Results

• According to the RAR study the number of
  injecting drug users should be at least 100,000
  .It is noticeable that the same research team has
  also stated a higher estimation of 200,000 IDUs
  elsewhere . Typical characteristics of IDUs were
  identified as males 21-30y, middle high school
  education, unemployed, opium initiation drug of
  abuse. Main reasons for switching mentioned by
  interviewees were tolerance and costs. Blood play
  with the syringe in the injection site was often
  reported as useful (to use the whole available
  drug with out waste) and pleasurable at the same
  time.

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In the past decade several major surveys on the
situation of drug abuse were carried out

• 4. Rapid Situation Assessment of drug Abuse and
  Dependency in Iran (2004) was carried out
  through the Dariush Institute of Education and
  Research of Substance Abuse. All 28 Provinces of
  Iran were included. A total of 4930 drug users
  were selected 452 from treatment centres
  according to opportunistic sampling, 387 from
  prisons through random sampling and 4091 from the
  community by snowball sampling. Key informants
  were also included according to purposive sampling

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Results of RSA 2004

• The RSA of 2004 estimated the total number of
  drug addicts to be between 1,200,000- 1,800,000.
  In the same study 12.2 of respondents have
  stated that their main route of drug use is
  injecting, 16 have stated that they at least
  occasionally inject. The life time prevalence of
  injection was 21.1 versus 28.4 for those with a
  history of imprisonment. Drugs of injection
  included more drugs than heroin namely opium
  (1,6), Sukhteh and Shireh i.e. Opium Residue
  and Juice respectively (1.7), Ecstasy (2)
  cocaine, LSD and other drugs (13.9). 48.1 of
  heroin users and 90.7 of buprenorhine users were
  IDUs as well.

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• 50.6 of IDUs start injecting already under the
  age of 24 years and only 10.2 in ages above 35
  years. Three forth of the IDUs were not informed
  on consequences of injecting drug use. First
  injections were made in 62.4 of cases by someone
  else and only 23.4 had self injected for the
  first time. Injection is conducted usually in
  48.5 of cases at home and in 18.9 in ruins
  including shooting galleries. Sterile syringes
  are always used by 55.7 of cases however 84.5
  most commonly use sterile syringes. In 49.5 of
  cases injection occurs alone. 43 had mentioned
  that they have some time lent or burrowed an
  already used syringe.

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• Only 11.6 stated to be knowledgeable on the
  infection status of a co-injector on the basis of
  testing. More than 50 inject twice or more often
  a day. 38.8 of IDUs injects in other sites than
  extremities testicular, femoral or neck veins.
  38.6 had been arrested in the past year by the
  police and 29.5 had a history of imprisonment

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• In the next slides we can see some chart and
  tables that shows us a better view of drug
  situation in Iran .

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Drug Abuse/Dependence by Age Group, Year 2002
  Drug of Abuse   15-24 25-34 35-45 45-54 55-64 gt65
Opium 12 25.8 22 17.4 8.4 14.4
Opium Residue 13.2 24.5 21 15 10.4 15.9
Heroin 28.3 36.5 28.3 4.6 2.3 0.0
Other Opiates  12.6 26.2 21.8 17 8 14.4
Hashish 49.8 24.9 20 5.3 0.0 0.0
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Profile of Drug Abusers Marital Status, 2004
Year in Review 1999 1999 2000 2000 2001 2001 2002 2002 2003 2003
Year in Review 1999 1999 2000 2000 2001 2001 2002 2002 2003 2003
Marital Status No. No. No. No. No.
Marital Status No. No. No. No. No.
Single 5691 25.3 7883 26.4 8559 26.3 5221 26 5835 23.3
Married 15821 70.4 20665 69 22649 69.7 13934 69.4 17960 71.8
Separated 469 2.1 574 1.9 518 1.6 344 1.7 420 1.7
Divorced 280 1.2 431 1.4 419 1.3 382 1.9 525 2.1
Widowed 104 0.5 102 0.3 118 0.4 97 0.5 115 0.5
Temporary Marriage 8 0 12 0 10 0 18 0.1 23 0.1
Second Marriage 72 0.3 142 0.5 70 0.2 47 0.2 96 0.4
Polygamy Marriage 6 0 24 0.1 23 0.1 4 0 18 0.1
Others 59 0.2 116 0.4 140 0.4 60 0.2 49 0.1
TOTAL 22510 100 29949 100 32506 100 20107 100 25041 100.1
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   Profile of Drug Abusers Occupation, 2004
Occupation 1999 1999 2000 2000 2001 2001 2002 2002 2003 2003
Occupation 1999 1999 2000 2000 2001 2001 2002 2002 2003 2003
by Class No. No. No. No. No.
Student (High School etc.) 87 0.4 166 0.5 132 0.4 80 0.4 87 0.3
University Student 164 0.7 210 0.7 166 0.5 115 0.6 97 0.4
Housewife 661 2.9 798 2.6 1187 3.6 741 3.7 966 3.9
Soldiers (Draftees) 151 0.7 162 0.5 164 0.5 108 0.5 114 0.5
Workers 3282 14.3 4724 15.2 5651 17.1 3250 16.1 5439 21.7
Farmers 1084 4.7 1455 4.7 1850 5.6 1077 5.3 1875 7.5
Police and Military personnel 381 1.7 544 1.7 547 1.7 291 1.4 583 2.3
Public servants 1511 6.6 1662 5.3 1554 4.7 938 4.7 1097 4.4
Shop Owners (middle lower) 1624 7.1 2338 7.5 2276 6.9 1314 6.5 1502 6
Retired 651 2.8 558 1.8 591 1.8 476 2.4 409 1.6
Un-employed 5416 23.6 7278 23.4 7975 24.1 5316 26.4 6964 27.7
Occupation hold confidential 7926 34.5 11194 36.1 10990 33.2 7055 32 6255 23.9
TOTAL 22938   31089   33083   20761   25388  
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Frequency of respondents by age group (RSA,2004)
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Mean Age of Respondents by Location of Sampling
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Frequency of Respondents by Sex (RSA,2004)
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Frequency of Respondents by Location of Residence
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Frequency of Respondents in RSA,2004 by Education
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Frequency of the Respondents by the First Man
that Offered Drugs
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Frequency of the Respondents by Location of First
Use
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The causes of First Use based on the Opinion of
Respondents
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Frequency of the Respondents by Current Main Drug
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Frequency of Respondents by the Main Route of
Administration
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Frequency of the Respondents by Age at their
First Injection
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Frequency of the Respondents by Borrowing or
Giving Syringes and needles from/to Others
68
Frequency of the Respondents by their Last Sexual
Relation Time
69
Frequency of Respondents by History of Sexual
Relation with Strangers
70
Frequency of Respondents by History of
Homosexuality
71
Frequency of Respondents by History of
Imprisonment
72
Frequency of Respondents by History of Treatment
73
Frequency of Respondents by Centre of First
Treatment Centre
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Afghanistan situation and TraffickingSupply
Reduction in Iran
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Our Situation

• Unfortunately Iran is in the way of trafficking
  drugs from Afghanistan to Europe. And as United
  Nation say the consumer market has remained
  encouragingly
• stable, despite important increases in the
  countries
• along major trafficking routes. Countries
  experiencing
• an increase in heroin usage include those
  surrounding
• Afghanistan (Pakistan, Iran and Central Asia), as
  well as
• Russia, India and parts of Africa.

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• In next slides you can see the situation of opium
  poppy cultivation in Afghanistan that has about
  1000 Km common border with Iran!

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• As you saw in last slides , poppy cultivation in
  Afghanistan increase year by year ,And after that
  it is worse that in other cultivation areas in
  the world, the poppy decrease year by year! (next
  slide)

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• Despite of all of the problems that we have had
  in last years such as imposed war with Iraq ,
  instability in Afghanistan , Iraq and Persian
  gulf ,more than 3 million migrants in some years
  and,Iran is pioneer in the supply reduction
  .Some other facts about Iran situation based on
  World Drug Report 2007 Confirms that

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• In 2006, out of all opiates that left
  Afghanistan, 53 per
• cent went via Iran, 33 per cent via Pakistan and
  15 per
• cent via Central Asia (mainly Tajikistan). If
  only heroin
• and morphine are considered, the bulk is
  estimated to
• have left Afghanistan via Pakistan (48),
  followed by
• Iran (31) and Central Asia (21).1
• The route from Afghanistan continues to go mainly
  via
• Pakistan, Iran, Turkey and the Balkan countries
  to distribution centres in West Europe.

87
The worlds largest opiate seizures are made by
Iranand Pakistan

• In 2005, Iran made the worlds largest opiate
  (heroin, morphine and opium in heroin
  equivalents) seizures (29), followed by Pakistan
  (20), Afghanistan (15 ),China (7.5), Turkey
  (7), the Russian Federation (4) and Tajikistan
  (2). The UK4 accounted for 1.8 per cent, the USA
  1.4 per cent and Italy 1.1 per cent of global
  opiates seizures.

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• If the opiate seizures of 2005 are broken down by
  substance,
• the following picture emerges
• Opium (342 mt) Iran 68 per cent (reflecting
  large
• domestic consumption), Afghanistan 27 per cent
• and Pakistan 2 per cent.
• Heroin and morphine together (91 mt) Pakistan
• 27 per cent, Iran 14 per cent, China, Afghanistan
• and Turkey 10 per cent each, the Russian
  Federation
• 5 per cent and Tajikistan 3 per cent.
• Morphine (32 mt) Pakistan 69 per cent, Iran 22
• per cent, Afghanistan 6 per cent and Turkey 2 per
• cent.

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FINAL POINT IN SUPPLY REDUCTION

• In last 30 years ,more than 3500 people from
  Iranian military forces became martyr

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Laws about drugs after Islamic Revolution
95
Laws Against Drugs after Islamic Revolution

• After victory of Islamic revolution in 1977,some
  law against drugs and drug smuggler had been
  approved that I will mention in next slides

96

• Prohibition of Using all types of psychoactive
  drugs,1980
• Giving Opportunity for Detoxification in 6 months
  for all of the users that were under opium coupon
  before revolution
• With this strategy 154389 addicts were
  rehabilitated

97

• After this time all of the rehabilitation
  facilities were removed and no legal types of
  treatment facilities were available for addicts.
• Then imposed war of Iraq against Iran had been
  started and we see a silence period about drugs
  for about 8 years.
• Immediately after finishing the war at year
  1988,second law against drugs had been approved
  by Expediency Council

98

• Based on this law
• 6 months opportunity gave to drug users for
  rehabilitation , again!!!
• After this period all of drug users had been sent
  to rehabilitation camps based on the judge order

99

• This law reformed at 1998
• Based on this reform all of the addicts are in
  criminal situation except of those who admitted
  for treatment in rehabilitation centres (this
  drug users considered as patient and had no
  penalty)

100

• Finally with change in situation the Iranian laws
  against drug reformed at 2006,I will present it's
  components and articles in next slides ,it should
  be informed that this is an informal translation

101
FULL TEXT OF APPROVALS MADE BY EXPEDIENCY COUNCIL
ON 22 JULY, 2006 CONCERNING REGIME'S GENERAL
POLICIES FOR FIGHT AGAINST NARCOTICS

• 1.  Sweeping and decisive fight against all
  illegal activities and actions connected with
  narcotics and psychotropic substances and their
  precursors such as cultivation, production,
  importation, exportation, keeping and supply of
  narcotics
• 2.    Sweeping reinforcement, development,
  equipment and use of intelligence, military,
  disciplinary and judicial possibilities for
  identifying, chasing and destroying networks and
  for fighting main domestic and international
  elements connected with narcotics and different
  kinds of psychotropic substances and their
  precursors

102
FULL TEXT OF APPROVALS MADE BY EXPEDIENCY COUNCIL
ON 22 JULY, 2006 CONCERNING REGIME'S GENERAL
POLICIES FOR FIGHT AGAINST NARCOTICS

• 3.      Reinforcement, equipment and development
  of units and mechanization of information
  concentration control systems for controlling the
  country's borders and points of entry, for
  preventing illegal activities connected with
  narcotics, psychotropic substances and their
  precursors and for reinforcing the specialized
  anti-narcotics structure in the Disciplinary
  Force and other relevant departments
• 4.      Adoption of preventive ways for fighting
  threats and damage resulting from narcotics and
  psychotropic substances by using governmental and
  non-governmental possibilities with concentration
  on the reinforcement of people's religious
  beliefs, cultural, artistic, sports, educational
  and propaganda activities in places of living and
  work as well as in educational, cultural and
  public centres

103
FULL TEXT OF APPROVALS MADE BY EXPEDIENCY COUNCIL
ON 22 JULY, 2006 CONCERNING REGIME'S GENERAL
POLICIES FOR FIGHT AGAINST NARCOTICS

• 5.      Adoption of appropriate measures in order
  for the use of narcotics, psychotropic substances
  and their precursors to be considered a crime
  except for scientific, medical and  industrial
  cases as well as for programmes approved for 
  treatment and for reducing damage

104
FULL TEXT OF APPROVALS MADE BY EXPEDIENCY COUNCIL
ON 22 JULY, 2006 CONCERNING REGIME'S GENERAL
POLICIES FOR FIGHT AGAINST NARCOTICS

• 6.      Setting up and development of public
  facilities for diagnosis, treatment and
  rehabilitation and adoption of alternative
  scientific measures in an effective,
  comprehensive and sweeping way with a view to
• Treating and rehabilitating users
• Reducing damage
• Preventing a change in the consumption pattern
  from relatively dangerous substances to highly
  dangerous substances
• Disconnecting links between users and
  drug-traffickers
• Adopting necessary measures for paving the ground
  for social support in connection with employment
  and leisure time after the treatment of those
  addicted to narcotics and different kinds of
  psychotropic substances and providing
  consultative and medical services as well as
  legal and social support for rehabilitated
  persons and their families as well as providing
  facilities for treatment and support services for
  the said persons
• Adopting necessary measures for paving the ground
  for social support in connection with employment
  and leisure time after the treatment of those
  addicted to narcotics and different kinds of
  psychotropic substances and providing
  consultative and medical services as well as
  legal and social support for rehabilitated
  persons and their families as well as providing
  facilities for treatment and support services for
  the said persons

105
FULL TEXT OF APPROVALS MADE BY EXPEDIENCY COUNCIL
ON 22 JULY, 2006 CONCERNING REGIME'S GENERAL
POLICIES FOR FIGHT AGAINST NARCOTICS

• 7.      Reinforcement and promotion of regional
  and international diplomacy linked to narcotics
  and psychotropic substances by
• Making relations objective-oriented
• Making serious efforts at removing threats and
  turning them into opportunities
• Playing an active role in shaping and making
  decisions and in taking related actions
• Using experiences and technical, support and
  economic possibilities
• Paving the ground for concerted actions aiming at
  preventing the illegal transit of narcotics

106
FULL TEXT OF APPROVALS MADE BY EXPEDIENCY COUNCIL
ON 22 JULY, 2006 CONCERNING REGIME'S GENERAL
POLICIES FOR FIGHT AGAINST NARCOTICS

• 8.      Adoption of necessary measures for active
  presence and participation of people and their
  families and support for popular groups in the
  fields of prevention, reduction of damage and
  treatment of addicts
• 9.      Development of fundamental, applied and
  developmental studies and researches on the fight
  against narcotics and psychotropic substances and
  prevention and treatment of addicts by relying on
  the world's modern knowledge and by using the
  related scientific and specialised capacities in
  the country

107
FULL TEXT OF APPROVALS MADE BY EXPEDIENCY COUNCIL
ON 22 JULY, 2006 CONCERNING REGIME'S GENERAL
POLICIES FOR FIGHT AGAINST NARCOTICS

• 10.  Promotion and amendment of the structure of
  the system for managing the fight against
  narcotics and psychotropic substances with a view
  to achieving the regime's general policies, to
  accelerating activities and to co-ordinating the
  adoption of operational policies and all
  executive, judicial and legal actions.

108
Drug Abuse Prevention

• A simple view at Iran situation as described
  before ,clears that effective prevention
  interventions should be started very soon for
  reducing drug abuse epidemy in Iran , before that
  it is useful that we have a look at a table that
  verifies the time of different interventions due
  to drugs in the world and Iran

109
.years ago Iran started at .years ago World experiences at Process
46 1961 117 1890 Epidemy of Opium Addiction
39 1968 107 1900 Opium Coupon
27 1980 93 1914 Prohibition of Opium use
16-26 1981-19991 77-87 1920-30 Mandatory Rehabilitation and Grand Camps
12 1995 47 1960 Using effective Treatment
12 1995 47 1960 MMT
4 2003 37 1970 Attention to Primary Prevention
- Last Year Recent years BMT
110

• As you saw in last slide ,we are going to
  decrease our distance with best experiences
  regarding drugs in the world. So the Iranian
  Government considers prevention of social harms
  as one of top priorities. Too many young people
  are engaging in drug use more over the pattern
  of drug use is demonstrating a change in trend
  towards the use of synthetic drugs with a lower
  inhibition threshold compared to the use of
  narcotics- the classic drugs of abuse in the
  country. Areas of precedence in prevention in the
  programmes of the Iranian Drug Control HQs
  constitute of the family, schools, work paces
  and the community.

111
Policies on Drug Prevention

• The article 97 of the fourth Iranian
  developmental programme(2005-2010) requires the
  government to compile a comprehensive programme
  on control and reduction of social Harms with
  special focus on addiction to prevent and reduce
  social harm with the following axes

112
Policies on Drug Prevention(Continue)

• 1.      Enhancement of the Mental Health levels,
  Expansion of social work services, fortification
  of pillars of the family and empowerment of
  vulnerable groups and individuals
• 2.      Deployment of cheerful, succulent,
  hopeful, social trusting, deepening of religious
  values and social norms spirits

113
Policies on Drug Prevention(Continue)

• 3.       Identification of social problem
  creating and vulnerability issues in cities and
  their outskirts and focusing on social support,
  provision of health care, social work services,
  legal and social counseling and supported
  employment programmes utilizing intersectoral
  cooperation and social harms management
  strategies in the mentioned areas
• 4.      Primary prevention of social harms
  through reform in curricula of the public
  education system, foreseeing social education and
  advancement of life skills.

114
Policies on Drug Prevention(Continue)

• Based on mentioned axes main strategies include
• Creating a cultural context discouraging drug use
  and related risky behaviours
• Enhancing life skills, so that drug use is not
  considered as a solution to problems
• Promotion of healthy and alternative behaviours
  and life styles other than drug use and related
  risky behaviours
• Promotion of mental health and healthy
  relationships protective of drug use
• and finally modification of attitudes,
  motivation and behaviour in youth.

115
Treatment and Rehabilitation

• Actually implementation of treatment systems for
  addicts in recent years refers to 1995,after
  reformation of the laws against drug. At that
  time ,for the first time after Islamic revolution
  some outpatient clinics for self introducing drug
  users had been created by State Welfare
  Organization. For many years until 2003,the main
  and the only drug that were used for
  detoxification in these centers were Clonidine
  for detoxification ,and individual and group
  counseling for relapse prevention. Also in a
  parallel route empowerment process of self help
  groups such as NA and NARANON were one of the
  priorities of SWO .

116

• One of the other activities of SWO in treatment
  and rehabilitation of drug users was providing an
  Iranian modified protocol for Therapeutic
  Communities in Iran and changing the physical
  location of former camps to TC for long
  residential rehabilitation of the addicts.

117

• Approximately ,it was in year 2001 that Ministry
  of Health directly engaged the process of
  treatment and rehabilitation . After that time we
  can see a rapid progress in the methods ,quality
  and quantity of the treatment systems. Schematic
  pattern of the treatment systems in Iran will be
  showed at next slides

118
Algorithm of Treatment system in SWO
NSP, Safe sex , VCT and MMT
MMT,BMT Detoxification
Relapse Prevention and Rehabilitation
119
Algorithm of Treatment system in Ministry of
Health
NSP, Safe sex , VCT and MMT
MMT,BMT Detoxification
Detoxification UROD
120

• I wish you find this lecture useful , In next
  session about Harm Reduction programes in Iran
  we will talk more about MMT and DIC centres in
  Iran and also we will have a look at Iran prisons
  facilities and interventions for reducing HIV
  among prisoners

121

• Thank you and Have a Nice Time