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Title: History of Addiction and Related Strategies in Iran


1
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2
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

3
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

4
  • 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

5
  • 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    (unpublished ).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

6
  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

7
History of Opium
8
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

9
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

10
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.

11
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.

12
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."

13
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.

14
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.

15
History (continue)
  • 1600s Residents of Persia and India begin eating
    and drinking opium mixtures for recreational use.

16
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.

17
  • History of Addiction and Activities against drug
    before Islamic Revolution in Iran

18
  • 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)

19
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.

20
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

21
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

22
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

23
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

24
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

25
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!!)

26
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

27
  • Review of Iran and Iran
  • governmental system

28
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.

29
  • 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).

30
  • 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.

31
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.

32
  • 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.

33
  • 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.

34
  • 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.

35
  • 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.

36
Drug Abuse Epidemiology In Iran
37
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.

38
  • 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

39
  • 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.

40
  • 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.

41
  • 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

42
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

43
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

44
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

45
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

46
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

47
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.

48
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

49
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.

50
  • 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.

51
  • 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

52
  • In the next slides we can see some chart and
    tables that shows us a better view of drug
    situation in Iran .

53
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
54
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
55
   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  
56
Frequency of respondents by age group (RSA,2004)
57
Mean Age of Respondents by Location of Sampling
58
Frequency of Respondents by Sex (RSA,2004)
59
Frequency of Respondents by Location of Residence
60
Frequency of Respondents in RSA,2004 by Education
61
Frequency of the Respondents by the First Man
that Offered Drugs
62
Frequency of the Respondents by Location of First
Use
63
The causes of First Use based on the Opinion of
Respondents
64
Frequency of the Respondents by Current Main Drug
65
Frequency of Respondents by the Main Route of
Administration
66
Frequency of the Respondents by Age at their
First Injection
67
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
74
Afghanistan situation and TraffickingSupply
Reduction in Iran
75
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.

76
  • 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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81
  • 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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85
  • 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

86
  • 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.

88
  • 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

94
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

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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.

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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

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.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
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  • 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.

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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

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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.

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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.

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  • 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
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  • 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
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