ABSTRACT
The prevalence of opium, residual opium juice (shireh), crystal methamphetamine, hashish, and heroin use in Iran is 150, 660, 590, 470, and 350 per 100 000 population, respectively.1 Substance use disorder is ranked as one ofthe top four health burdens in Iran.2 Addressing this health crisis has required the legalization of a variety of treatments and harm reduction services, the domestic production of opioid medications, available and low-cost opioid medications, available opium tincture with its short induction period, using seized opium to produce opium tincture, online self-help groups, and coordination among government agencies, the private health care sector, and nongovernmental organizations. HARM REDUCTION SERVICES IN IRAN The largest number of patients are served in private outpatient clinics that offer opioid agonist treatment, although abstinence-based residential centers and therapeutic communities are available in the private sector and the government runs compulsory residential centers.6 In 2018, an estimated 60 000 persons were under methadone maintenance treatment (MMT) while in prison, about 720 000 community residents were receiving MMT, approximately 120 000 were receiving buprenorphine, and about 93 000 were receiving opium tinctures from 1 of 196 government-run outpatient clinics or one of 7029 private outpatient clinics.6 Harm reduction services and facilities such as drop-in centers and outreach programs provide needle and syringe programs, low-threshold methadone treatment, condom promotion, and safer sex education. [...]clinics were authorized to provide larger take-home supplies of methadone, buprenorphine, and opium tincture for their stable patients.8 Although patients did not experience any shortage of opioid maintenance medications, there were fewer psychological services available because of COVID-19 prevention policies and the lack of online services. Methadone is also much less expensive than buprenorphine, and there are seven times more methadone patients than buprenorphine patients in Iran.10 Moreover, local opium tincture manufacture uses seized opium,11 which reduces production costs.12 * Reducing the need for harm reduction: Because of the availability of opioid maintenance medications, in past years the number of PWID decreased and the impact of this is seen in the reduced prevalence of HIV among PWID in Iran.13 This phenomenon has reduced the costs of harm reduction services because fewer harm reduction facilities are needed.