Population Size Estimation of People Who Use Illicit Drugs and Alcohol in Iran (2015-2016)

Document Type : Original Article

Authors

1 Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

2 Center for Longitudinal and Life Course Research, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia

3 Research Center for Addiction & Risky Behaviors (ReCARB), Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran

4 Department of Psychiatry, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran

5 Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran

6 Centre On Drug Policy Evaluation, St. Michael’s Hospital, Toronto, ON, Canada

7 HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV, Kerman University of Medical Sciences, Kerman, Iran

8 Institute for Health Policy Studies, University of California, San Francisco, CA, USA

9 Ministry of Health and Medical Education, Tehran, Iran

Abstract

Background 
Estimating the number of people using illicit drugs and alcohol is necessary for informing health policy and programming. However, it is often challenging to reliably estimate the size of these marginalized populations through direct methods. In this study, we estimated the population size of these groups using the indirect Network Scale-Up (NSU) method in Iran from 2015 to 2016.

Methods 
Using a self-administered questionnaire, we asked 15 124 individuals (54% men) about the number of people they know who used different types of drugs at least once in the past 12 months. Prevalence estimates were reported per 100 000 population. The uncertainty level (UL) was calculated using the bootstrap method.

Results 
The average age of the respondents was 33 years old, and 35.1% of them were unmarried. The most common drugs and their prevalence were as follows: opium (2534 [95% UL: 2467-2598]), hashish (849 [95% UL: 811-886]), stimulants (methamphetamine, ecstasy pills, cocaine, and Ritalin) (842 [95% UL: 802-879]), heroin/crack (578 [95% UL: 550-607]), and drug injection (459 [95% UL: 438-484]). Additionally, we estimated the prevalence of alcohol use as 2797 (95% UL: 2731-2861). On average, substance use was 5.23 times more prevalent among men than women. Opium use was more prevalent among individuals aged >50 years old. Moreover, alcohol use was more prevalent among participants between 18 and 30 years old (5164 per 100 000 population).

Conclusion 
Although opium continues to be the most prevalent illicit drug in Iran, the patterns of illicit drug use are heterogeneous among different age groups, genders, and provinces. Age-gender specific and culturally appropriate interventions are warranted to meet the needs of people in different subgroups.

Keywords


  1. Han B, Gfroerer JC, Colliver JD. Associations between duration of illicit drug use and health conditions: results from the 2005-2007 national surveys on drug use and health. Ann Epidemiol. 2010;20(4):289-297. doi:1016/j.annepidem.2010.01.003
  2. Chen CY, Lin KM. Health consequences of illegal drug use. Curr Opin Psychiatry. 2009;22(3):287-292. doi:1097/yco.0b013e32832a2349
  3. Amin-Esmaeili M, Rahimi-Movaghar A, Sharifi V, et al. Alcohol use disorders in Iran: prevalence, symptoms, correlates, and comorbidity. Drug Alcohol Depend. 2017;176:48-54. doi:1016/j.drugalcdep.2017.02.018
  4. Moazen B, Shokoohi M, Noori A, et al. Burden of drug and alcohol use disorders in Iran: findings from the Global Burden of Disease Study 2010. Arch Iran Med. 2015;18(8):480-485.
  5. Moghanibashi-Mansourieh A, Deilamizade A. The state of data collection on addiction in Iran. Addiction. 2014;109(5):854. doi:1111/add.12505
  6. Amin-Esmaeili M, Rahimi-Movaghar A, Sharifi V, et al. Epidemiology of illicit drug use disorders in Iran: prevalence, correlates, comorbidity and service utilization results from the Iranian Mental Health Survey. Addiction. 2016;111(10):1836-1847. doi:1111/add.13453
  7. Mohd Safian YH. An analysis on Islamic rules on drugs. Int J Educ Res. 2013;1(9):1-16.
  8. Bernard HR, Hallett T, Iovita A, et al. Counting hard-to-count populations: the network scale-up method for public health. Sex Transm Infect. 2010;86(Suppl 2):ii11-15. doi:1136/sti.2010.044446
  9. Network Scale-Up: A Promising Method for National Estimates of the Sizes of Populations at Higher Risk. UNAIDS; 2010.
  10. Nikfarjam A, Shokoohi M, Shahesmaeili A, et al. National population size estimation of illicit drug users through the network scale-up method in 2013 in Iran. Int J Drug Policy. 2016;31:147-152. doi:1016/j.drugpo.2016.01.013
  11. Nikfarjam A, Hajimaghsoudi S, Rastegari A, et al. The frequency of alcohol use in Iranian urban population: the results of a national network scale up survey. Int J Health Policy Manag. 2017;6(2):97-102. doi:15171/ijhpm.2016.103
  12. Haghdoost AA, Baneshi MR, Eybpoosh S, Khajehkazemi R. Comparison of three interview methods on response pattern to sensitive and non-sensitive questions. Iran Red Crescent Med J. 2013;15(6):500-506. doi:5812/ircmj.7673
  13. Nasirian M, Hosseini Hooshyar S, Haghdoost AA, Karamouzian M. How and where do we ask sensitive questions: self-reporting of STI-associated symptoms among the Iranian general population. Int J Health Policy Manag. 2018;7(8):738-745. doi:15171/ijhpm.2018.18
  14. Rastegari A, Haji-Maghsoudi S, Haghdoost AA, Shatti M, Tarjoman T, Baneshi MR. The estimation of active social network size of the Iranian population. Glob J Health Sci. 2013;5(4):217-227. doi:5539/gjhs.v5n4p217
  15. Salganik MJ, Fazito D, Bertoni N, Abdo AH, Mello MB, Bastos FI. Assessing network scale-up estimates for groups most at risk of HIV/AIDS: evidence from a multiple-method study of heavy drug users in Curitiba, Brazil. Am J Epidemiol. 2011;174(10):1190-1196. doi:1093/aje/kwr246
  16. Ghiabi M. A history of the present on drugs: opium, heroin and methamphetamine. In: Stella A, Coppel A, eds. Living with Drugs. ISTE; 2020. p. 51-73. doi:1016/b978-1-78548-317-2.50005-2
  17. Baneshi MR, Zolala F, Zamanian M, Zarei N, Heydari MR. Estimating the visibility rate of alcohol consumption: a case study in Shiraz, Iran. Addict Health. 2020;12(1):18-24. doi:22122/ahj.v12i1.251
  18. Maghsoudi A, Baneshi MR, Neydavoodi M, Haghdoost A. Network scale-up correction factors for population size estimation of people who inject drugs and female sex workers in Iran. PLoS One. 2014;9(11):e110917. doi:1371/journal.pone.0110917
  19. Haghdoost A, Ahmadi Gohari M, Mirzazadeh A, Zolala F, Baneshi MR. A review of methods to estimate the visibility factor for bias correction in network scale-up studies. Epidemiol Health. 2018;40:e2018041. doi:4178/epih.e2018041
  20. Sarrami H, Ghorbani M, Minooei M. Survey of four decades of addiction prevalence researches in Iran. Research on Addiction. 2013;7(26):29-52. [Persian].
  21. Narenjiha H, Rafiei H, Baghestani AR, Nouri R, Shirinbayan P, Farhadi MH. Rapid Situation Assessment of Drug Abuse in Iran (Year 2004) Research Report. Tehran: Dariush Institute; 2007. [Persian].
  22. Farhoudi B, Kamali K, Gouya MM, et al. Islamic Republic of Iran AIDS Progress Report on Monitoring of the United Nations General Assembly Special Session on HIV and AIDS. National AIDS Committee Secretariat, Ministry of Health and Medical Education; 2018.
  23. Haghdoost AA, Mostafavi E, Mirzazadeh A, et al. Modelling of HIV/AIDS in Iran up to 2014. J AIDS HIV Res. 2011;3(12):231-239. doi:5897/jahr11.030
  24. Semá Baltazar C, Horth R, Boothe M, et al. High prevalence of HIV, HBsAg and anti-HCV positivity among people who injected drugs: results of the first bio-behavioral survey using respondent-driven sampling in two urban areas in Mozambique. BMC Infect Dis. 2019;19(1):1022. doi:1186/s12879-019-4655-2
  25. Larney S, Mathers BM, Poteat T, Kamarulzaman A, Degenhardt L. Global epidemiology of HIV among women and girls who use or inject drugs: current knowledge and limitations of existing data. J Acquir Immune Defic Syndr. 2015;69(Suppl 2):S100-109. doi:1097/qai.0000000000000623
  26. Darvishzadeh H, Mirzaee M, Jahani Y, Sharifi H. Age of onset of methamphetamine consumption among the Iranian youth aged 19-29: a cross-sectional study. Addict Health. 2019;11(3):138-147. doi:22122/ahj.v11i3.231
  27. Pienpinijtham P, Thammacharoen C, Naranitad S, Ekgasit S. Analysis of cosmetic residues on a single human hair by ATR FT-IR microspectroscopy. Spectrochim Acta A Mol Biomol Spectrosc. 2018;197:230-236. doi:1016/j.saa.2018.01.084
  28. World Health Organization (WHO). Global Status Report on Alcohol and Health 2018. WHO; 2019.

Articles in Press, Corrected Proof
Available Online from 10 August 2022
  • Receive Date: 30 June 2021
  • Revise Date: 13 July 2022
  • Accept Date: 09 August 2022
  • First Publish Date: 10 August 2022