Indicators of Drug-Related Community Impacts of Open Drug Scenes: A Scoping Review.

INTRODUCTION: Places where people deal and/or use drugs publicly are known as open drug scenes (ODSs). Drug-related community impacts (DRCIs) refer to drug-related issues that negatively influence public and individual health, communities, businesses, and recreational and public space enjoyment. There are no well-established criteria for identification of DRCIs. We therefore performed a scoping review of literature to determine DRCIs indicators associated with ODSs. METHODS: The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScP). We searched English articles in PubMed, Scopus, Web of Science, and EMBASE databases from 1990 to 2021. The keywords were drug-related crime, drug-related offense, misconduct, social marginalization, homeless drug users, open drug scene, drug-related street disorder, public nuisance, and community impact. RESULTS: Sixty-four studies were identified. Twenty-five studies were included. Two studies (8%) were about drug-related public nuisance, 1 (4%) considered drug-related social problems, 2 (8%) focused on drug-related social disorder, and 18 studies (72%) discussed indicators of community impacts such as crime, drug-related litter, safety, noise, and drug use in public. Two studies (8%) included the frequency of drug use in ODSs. DISCUSSION: DRCI indicators are heterogenic, and various factors affect the indicators. The factors include social mores, political discourse, and historical approaches to dealing with and using drugs. Some societies do not tolerate the existence of ODSs. In contrast, many countries have adopted harm reduction programs to manage DRCIs. Identified DRCI indicators were drug using and dealing in public, drug-related litter, crime, drug-related loitering, street-based income generation activities, noise, and unsafety feelings in inhabitants. To solve the problems associated with DRCIs and to make a major change in ODSs, it is necessary to pay attention to the improvement of the economic conditions (e.g., employment opportunities), amendment (e.g., determine the limits of criminalization in drug use), and adoption of social policies (e.g., providing low-threshold and supportive services for homeless drug users).

Substance Use among Poisoned Teenage Patients.

BACKGROUND: Substance use is a growing problem in many countries especially among teenagers. We aimed to estimate the prevalence and complications of substance use in teenagers referring to a tertiary hospital following intoxication. METHODS: In a cross-sectional study between 2012 and 2013 in Loghman Hakim Hospital, Tehran, Iran, sixteen substances were checked in teenagers referring due to poisoning. They divided into two groups of young (13 to <16 yr; group 1) and old-teenagers (16 to 19 yr; group 2). History of lifetime substance use and drug use within the week prior to admission were recorded. RESULTS: Mean (range) age of young teenagers was 14.5±0.6 [13, 15] and 17.7±1.1 [16, 19] in old-teenagers with female predominance. Of 264 teenagers, four in group 1 and 27 in group 2 were admitted due to drug overdose. Six and 69 patients in groups 1 and 2 claimed that they had used some kind of substance in the week prior to admission. Twenty (37%) and 106 (50.5%) patients in the young and old-teenager groups were defined as drug users and rates of unreported substance use were 27.8% (15 cases) and 23.8% (50 cases) respectively. Ninety-six substance users (36.4%) had referred due to poisonings other than recreational intoxication (P<.001). Screening toxicological lab data showed significant opioid and sedative exposure in old-teenagers. CONCLUSION: It seems young adolescents hide their drug abuse more than old teenagers. Using illicit drugs screening tests may help us to provide hidden rate of abuse in teenagers.

Drug-related community issues and the required interventions in open drug scenes in Tehran, Iran: a qualitative study protocol.

BACKGROUND AND OBJECTIVES: Many low-income and middle-income countries experience problems with open drug scenes and drug-related community issues (DRCIs). These experiences occur in settings with varying levels of health and law enforcement initiatives, and accordingly a range of approaches are implemented to curb the problem. Most of the published literature stems from Western and high-income societies. With this concern, the present study aims to describe a planned project to explore DRCIs in the open drug scenes of Tehran, including its typology, and predisposing and reinforcing factors. In addition, the study attempts to investigate the perceptions with respect to the required interventions and barriers to their accessibility. METHODS: To this end, the current study focuses on the Farahzad drug scene due to its structure and the difficult access to the scene by harm reduction providers. Data collection techniques encompass field observation, indepth interview and focus group discussion. Further, semistructured interviews are conducted with people who use drugs and other key informants who are engaged at this drug scene, including business, community, voluntary and statutory stakeholders, for an average of 90 min (average of 45 min for each part of the study). Furthermore, as a complementary method, field observation is performed regarding the themes of DRCIs at this scene. Then, focus group discussions are held to further describe the themes of DRCIs as well as to explore the required interventions, for an average of 90 min. Finally, the results are evaluated using qualitative content analysis. ETHICS AND DISSEMINATION: Ethical approval for the study was obtained from the Ethics Committee of Iran University of Medical Sciences, Iran. Additionally, participants are to provide written informed consent. The findings of the study are expected to play a role in promoting the current intervention.

Typology of Substance Use Disorder Based on Temperament Dimensions, Addiction Severity, and Negative Emotions.

Objective: Individuals with substance use disorder are not homogeneous as we might regard. Thus, this study was conducted to present a novel classification of substance use disorder based on temperament, addiction severity, and negative emotions. Method : In this correlation study, Temperament and Character Inventory, Addiction Severity Index, Aggression Subscale of MMPI-2, Depression, Anxiety, Stress Scale, Emotional Schema Questionnaire, and Psychosocial Checklist were used for data collection. Results: The cluster analysis of 324 individuals with substance use disorder explored 4 subtypes. Subgroups were named based on the main features as emotionally distressed, constitutional, nonconformist, and impulsive. Significant differences were found among groups in emotional schemas, history of mental disorder in the family, rate of relapse, and history of imprisonment. Conclusion: It seemed that temperament dimensions, addiction severity, and negative emotional states were valid components in classifying individuals with substance use disorder.

The effect of methadone-maintenance therapy with and without interactive treatment on improving emotion-regulation strategies and resilience among opiate-dependent clients.

BACKGROUND: Due to the chronic and recurrent nature of addiction, many people who quit drug addiction may slip back into the pattern of using drugs shortly after the detoxification period. Emotion-regulation strategies and resilience play an important role in preventing the recurrences of substance abuse. OBJECTIVES: This study aimed to compare the effects of methadone-maintenance therapy (MMT) and interactive therapy (a combination of MMT and cognitive-behavioral therapy) on improving emotion-regulation strategies and resilience among opiate-dependent clients. PATIENTS AND METHODS: This pretest-posttest quasi-experimental study was performed on 60 patients with substance abuse admitted to Methadone Addiction Treatment Centers and Detox Centers in Sari within three months of therapy for their addiction (from October to December 2013). Then, the participants were randomly assigned to two different groups (n = 30) were examined in two groups of 30 people targeted to be available in the selected population. Participants in all three groups, before and after the intervention, filled out the questionnaires of Schutte emotional intelligence scale and Connor-Davidson resiliency questionnaire. Data were analyzed using the analysis of covariance method. RESULTS: The results showed that an interactive therapy would be significantly more effective than the MMT on improving emotion-regulation strategies and promoting the resilience level among opiate-dependent clients. Moreover, the results showed that cognitive- behavior therapy combined with MMT may improve emotion-regulation strategies, and promote the amount of resiliency and recovery. CONCLUSIONS: The cognitive-behavior therapy combined with MMT can improve emotion-regulation strategies and resiliency and thus prevent the substance-abuse relapse.

Iran's Activities on Prevention, Treatment and Harm Reduction of Drug Abuse.

CONTEXT: In the present review study, authors investigated Iran's activities regarding prevention, abuse and harm reduction of drugs nationwide. The issue appears to be important in order to show the trend of activities in the country. EVIDENCE ACQUISITION: In this report, authors gathered data from different Farsi/English peer review journals issued both in printed and online versions. These journals have been indexed in PubMed, ISI, ISC, SID, Magiran, UN, etc. These are among the most referred and cited databases. RESULTS: Summarizing the data led to three distinguished sections: 1) drug supply reduction activities; 2) drug demand reduction activities; 3) harm reduction activities. CONCLUSIONS: As the results showed, the trend of activities was encouraging and some additional activities could be included to future programs relying on early-onset preventions.

Six-month follow-up study of ultrarapid opiate detoxification with naltrexone.

BACKGROUND: Illicit opiate use has an increasing incidence and prevalence, which increases mortality and morbidity, marginalization, and criminal behaviors, and causes major adverse effects on society. OBJECTIVES: This study aimed to investigate and follow the outcome of patients who underwent ultrarapid opiate detoxification (UROD) prospectively. PATIENTS AND METHODS: In this randomized clinical trial, 64 patients who underwent UROD were evaluated. The opiate antagonist regimen of naloxone was administered intravenously under general anesthesia, and detoxification was confirmed by naloxone challenge test. All patients were cared in intensive care unit (ICU) for 24 hours, and oral naltrexone was prescribed the next day, after recovery and discharge. Patients were followed up for one month after the procedure. Relapse was considered if routine use of opiates (daily use for at least two weeks) was reported by the patient after detoxification. The data was analyzed by SPSS 16.5 and the study was performed using descriptive analysis and Chi square test. RESULTS: All 64 participants were opiate-dependent males (ASA physical status of I or II) who aged over 18 years with a mean age of 31.11 ± 8.93 years at the time of UROD. One month after UROD, 48 patients (75%) reported relapse and 16 (25%) reported abstinence; however, four patients of the non-relapsed group reported one episode of opiate use. There was no significant difference between relapsed and non-relapsed patients regarding their marital status, level of education, and family history of opiate dependency (P > 0.05). CONCLUSIONS: Although UROD by naloxone is a safe and effective method of detoxification, if used alone, it has a very high relapse rate in long term.

Compulsory maintenance treatment program amongst Iranian injection drug users and its side effects.

BACKGROUND: Psychoactive substance use can cause a broad variety of mental health disorders and social health problems for the drug users, their family and society. OBJECTIVES: The Ministry of Health, Treatment, and Medical Education of Iran has recently proclaimed an estimated number of 2 million drug abusers and 200,000 injecting drug users (IDUs). PATIENTS AND METHODS: For data collection, the directory of mental, social health, and Addiction designed a questionnaire in cooperation with Drug Control Headquarters of Iran. RESULTS: Among 402 IDUs patients, a large amount of them were male, single, and younger than 39 years. Regarding psychotic and somatic symptoms caused by methadone therapy, most of the participants had no problem with methadone maintenance treatment (MMT). CONCLUSIONS: There is a need to train health staff, and the community, concerning preventive measures, treatment, and reducing harm for substance drug users.

Descriptive Aspects of Injection Drug Users in Iran's National Harm Reduction Program by Methadone Maintenance Treatment.

BACKGROUND: The Ministry of Health, Treatment and Medical Education of Iran has recently announced an estimated figure of 200,000 injecting drug users (IDUs). The aim of this study was to pilot a national program using demographics, types of drug abuse and prevalence of blood-borne infections among IDUs. METHODS: In order to elicit data on demographics, types of drug abuse and prevalence of blood-borne infections among IDUs, a questionnaire was designed in the Bureau of Mental-Social Health and Addiction in collaboration with Iran's Drug Control Headquarters of the Police Department. Therapeutical alliance of addiction in Shafagh Center was based on Methadone Maintenance Therapy (MMT). RESULTS: Among 402 reported IDUs most of them were male, single and in age range of 20 to 39 years old with 72.7% history of imprisonment. Most of them had elementary and high school education and a history of addiction treatment. The majority were current users of opioid, heroin and crack. The prevalence of blood-borne infections was 65.9% and 18.8% for HCV and HIV/AIDS infections, respectively. CONCLUSION: Prevention programs about harm reduction, treatment and counseling should include young IDUs as a core focus of their intervention structure.

Injection drug use in Rural Iran: integrating HIV prevention into iran's rural primary health care system.

Major opium trafficking routes traverse rural Iran, but patterns of drug use and HIV infection in these areas are unknown. In 2004, Iran's Ministry of Health integrated substance use treatment and HIV prevention into the rural primary health care system. Active opium or heroin users (N = 478) were enrolled in a rural clinic. Participants received counseling for abstinence from substances, or daily needle exchange and condoms. On enrollment, 108 (23%) reported injecting; of these, 79 (73%) reported sharing needles. Of 65 participants tested for HIV, 46 (72%) tested positive. Participants who received daily needle exchange/condoms stayed in the program longer than those who did not (AOR 2.08, 95% CI 1.1-3.88). This project demonstrates that HIV risks exist in rural Iran and suggests the innovative use of Iran's rural health care system to extend prevention and treatment services to these populations.