Awareness and Attitude Towards Opioid and Stimulant Use and Lifetime Prevalence of the Drugs: A Study in 5 Large Cities of Iran

Document Type : Original Article

Authors

1 HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

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

3 School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences (TUMS), Tehran, Iran

4 Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences (TUMS), Tehran, Iran

5 MPH Department, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran

6 Research Center for Addiction & Risky Behavior (ReCARB), Psychiatric Department, Iran University of Medical Sciences, Tehran, Iran

7 Department of Sociology, Faculty of Social Sciences and Economics, Alzahra University, Tehran, Iran

8 Department of Mental, Social Health and Drug Use, Ministry of Health, Tehran, Iran

9 Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

Abstract

Background
Providing population-based data on awareness, attitude and practice of drug and stimulant use has policy implications. A national study was conducted among Iranian general population to explore life time prevalence, awareness and attitudes toward opioids and stimulant use.
 
Methods
We recruited subjects from 5 provinces with heterogenic pattern of drug use. Participants were selected using stratified multistage cluster sampling. Data were collected using a validated self-administered questionnaire. Logistic regression model was applied to identify the variables that are associated with drug and stimulant use.
 
Results
In total 2065 respondents including 1155 men (33.96 ± 10.40 years old) and 910 women (35.45 ± 12.21 years old) were recruited. Two-third of respondents had good awareness about adverse effects of opioid use. Corresponding figure in terms of stimulants was 81.4%. Almost 95% of participants reported a negative attitude towards either opioid or stimulant use. The lifetime prevalence of opioid use and stimulant use were 12.9% (men: 21.5%, women: 4.0%) and 7.3% (men: 9.6%, women: 4.9%), respectively. Gender (adjusted odds ratio [AOR]M/W = 6.92; 95% CI: 2.92, 16.42), education (AORundergraduate/diploma or less = 0.49; 95% CI: 0.26, 0.90), and marital status (AORothers/single = 2.13; 95% CI: 1.36, 3.33) were significantly related with opioid use. With respect to stimulant use, age was negatively associated with the outcome (AOR60+/20-29 years = 0.08: 95% CI; 0.01, 0.98) and men were 2 times more likely than women to use stimulants (ORM/W=2.15: 95% CI: 0.83, 5.56). In addition, marital status (AOROthers/singles = 3.45; 95% CI: 1.09, 10.93), and awareness (AORWeak and moderate/good = 0.40; 95% CI: 0.25, 0.61) were independently correlated with stimulants use.
 
Conclusion
While the attitude of Iranian adults toward opioid and stimulant use was negative, their awareness was not that adequate to prevent the drug use. Men and those with lower socio-economic status (SES) should be the focus of health promotion programs regarding opioid use. However, regarding stimulants use, promotion programs should target younger age groups and those with higher SES status.

Keywords

Main Subjects


  1. Maqbool S. UNODC report documents expansion in opioid crisis, prescription drug abuse. https://www.thenews.com.pk/print/364536-unodc-report-documents-expansion-in-opioid-crisis-prescription-drug-abuse. Published 2018.
  2. Whiteford HA, Ferrari AJ, Degenhardt L, Feigin V, Vos T. The global burden of mental, neurological and substance use disorders: an analysis from the Global Burden of Disease Study 2010. PLoS One. 2015;10(2):e0116820. doi:10.1371/journal.pone.0116820
  3. 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.
  4. Bahr SJ, Maughan SL, Marcos AC, Li B. Family, religiosity, and the risk of adolescent drug use. J Marriage Fam. 1998;60(4):979-992. doi:10.2307/353639
  5. United Nations Office on Drugs and Crime (UNODC). World Drug Report 2015. Vienna: United Nations; 2012.
  6. UNODC. United Nations Office on Drugs and Crime and United Nations Development Programme. Violence and Injury Prevention: Global status report on violence prevention. https://www.who.int/violence_injury_prevention/violence/status_report/2014/en/.  Accessed  December 2018.
  7. Iran Census 2016. Statistical Center of Iran website. https://www.amar.org.ir/english.  Published 2016.
  8. 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:10.1111/add.13453
  9. Mokri A. Brief overview of the status of drug abuse in Iran. Arch Iran Med. 2002;5(3):184-190.
  10. Samii AW. Drug Abuse: Iran's "Thorniest Problem." Brown J World Aff. 2003;9(2):283-299.
  11. Narenjiha H, Rafiey H, Jahani MR, Assari S, Moharamzad Y, Roshanpazooh M. Substance-dependent professional drivers in Iran: a descriptive study. Traffic Inj Prev. 2009;10(3):227-230. doi:10.1080/15389580902849017
  12. Tavakoli M, Mohammadi L, Yarmohammadi M, Farhoudian A, Jafari F, Farhadi MH. Status and Trend of Substance Abuse and Dependence among Iranian Women. Arch Rehabil. 2014;14(5):30-37.
  13. Momtazi S, Noroozi A, Rawson R. An overview of Iran drug treatment and harm reduction programs. In: el-Guebaly N, Carra G, Galanter M, eds. Textbook of Addiction Treatment: International Perspectives. Milano: Springer; 2015:543-554. doi:10.1007/978-88-470-5322-9_25
  14. Alam Mehrjerdi Z. Crystal in Iran: methamphetamine or heroin kerack. Daru. 2013;21(1):22. doi:10.1186/2008-2231-21-22
  15. Marshall BD, Werb D. Health outcomes associated with methamphetamine use among young people: a systematic review. Addiction. 2010;105(6):991-1002. doi:10.1111/j.1360-0443.2010.02932.x
  16. Meredith CW, Jaffe C, Ang-Lee K, Saxon AJ. Implications of chronic methamphetamine use: a literature review. Harv Rev Psychiatry. 2005;13(3):141-154. doi:10.1080/10673220591003605
  17. Scott JC, Woods SP, Matt GE, et al. Neurocognitive effects of methamphetamine: a critical review and meta-analysis. Neuropsychol Rev. 2007;17(3):275-297. doi:10.1007/s11065-007-9031-0
  18. Farzanegan MR. Effects of international financial and energy sanctions on Iran's informal economy. SAIS Rev Int Aff. 2013;33(1):13-36. doi:10.1353/sais.2013.0008
  19. Mokri A, Schottenfeld R. Drug abuse and HIV transmission in Iran—Responding to the public health challenges. In: Celentano DD, Beyrer C, eds. Public health aspects of HIV/AIDS in low and middle income countries. New York, NY: Springer; 2008:583-599. doi:10.1007/978-0-387-72711-0_26
  20. Rahimi N, Gozashti MH, Najafipour H, Shokoohi M, Marefati H. Potential effect of opium consumption on controlling diabetes and some cardiovascular risk factors in diabetic patients. Addict Health. 2014;6(1-2):1-6.
  21. Geramian N, Akhavan S, Gharaat L, Tehrani AM, Farajzadegan Z. Determinants of drug abuse in high school students and their related knowledge and attitude. J Pak Med Assoc. 2012;62(3 Suppl 2):S62-66.
  22. Momtazi S, Rawson R. Substance abuse among Iranian high school students. Curr Opin Psychiatry. 2010;23(3):221-226. doi:10.1097/YCO.0b013e328338630d
  23. Rahimi-Madiseh M, Tavakol M, Dennick R. A quantitative study of Iranian nursing students' knowledge and attitudes towards pain: implication for education. Int J Nurs Pract. 2010;16(5):478-483. doi:10.1111/j.1440-172X.2010.01872.x
  24. Sharifi H, Shokoohi M, Ahmad RafieiRad A, et al. Methamphetamine Use among Iranian Youth: A Population-based Knowledge, Attitude, and Practice study. Subst Use Misuse. 2017;52(9):1232-1239. doi:10.1080/10826084.2017.1303509
  25. Stanekzai MR, Todd CS, Orr MG, et al. Baseline assessment of community knowledge and attitudes toward drug use and harm reduction in Kabul, Afghanistan. Drug Alcohol Rev. 2012;31(4):451-460. doi:10.1111/j.1465-3362.2011.00352.x
  26. Darke S, Hall W, Wodak A, Heather N, Ward J. Development and validation of a multi-dimensional instrument for assessing outcome of treatment among opiate users: the Opiate Treatment Index. Br J Addict. 1992;87(5):733-742.
  27. Furnham A, Thomson L. Lay theories of heroin addiction. Soc Sci Med. 1996;43(1):29-40.
  28. Chesney MA, Barrett DC, Stall R. Histories of substance use and risk behavior: precursors to HIV seroconversion in homosexual men. Am J Public Health. 1998;88(1):113-116.
  29. Molitor F, Truax SR, Ruiz JD, Sun RK. Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users. West J Med. 1998;168(2):93-97.  
  30. Bryan A, Moran R, Farrell E, O’Brien M. Drug-related knowledge, attitudes and beliefs in Ireland: report of a nation-wide survey. Dublin: Drug Misuse Research Division, The Health Research Board; 2000.
  31. World Health Organization (WHO). Substance use in Southern Africa: knowledge, attitudes, practices and opportunities for intervention: summary of baseline assessments in South Africa, the United Republic of Tanzania and Zambia. Geneva: WHO; 2003.
  32. Demaio AR, Dugee O, de Courten M, Bygbjerg IC, Enkhtuya P, Meyrowitsch DW. Exploring knowledge, attitudes, and practices related to alcohol in Mongolia: a national population-based survey. BMC Public Health. 2013;13:178. doi:10.1186/1471-2458-13-178
  33. Kalebka RR, Bruijns SR, van Hoving DJ. A survey of attitudes towards patient substance abuse and addiction in the Emergency Centre. Afr J Emerg Med. 2013;3(1):10-17. doi:10.1016/j.afjem.2012.09.004
  34. Babaie Asl F. Study of Knowledge of Kerman’s High School for Boys Students about the Consequences of Psychoactive Substance Abuse. Sci J Hamadan Nurs Midwifery Fac. 2008;16(1):18-28. [Persian].  
  35. Pourmovahed Z, Yassini Ardakani M, Ahmadieh M, Dehghani K, Kalani Z. Evaluation of the knowledge of rural high school students in Yazd about drugs. J Shahid Sadoughi Univ Med Sci. 2010;18(3):179-183. [Persian].
  36. Naderifar M, Ghaljaei F, Akbarizadeh MR, Ebrahimi Tabas E. An investigation in knowledge, attitude and performance of high school students regarding ecstasy abuse, Zahedan-2008. The Quarterly Journal of Fundamentals of Mental Health. 2011;12(4):710-719.
  37. Sajjadi M, Shariatifar N, Matlabi M, Abbasnezhad A, Basiri K, Nazemi H. The rate of knowledge and attitude toward psychoactive drugs and its abuse prevalence in Gonabad University students. Horizon Med Sci. 2009;15(2):58-64.
  38. Noori R, Daneshmand R, Farhoudian A, Ghaderi S, Aryanfard S, Moradi A. Amphetamine-type stimulants in a group of adults in Tehran, Iran: a rapid situation assessment in twenty-two districts. Iran J Psychiatry Behav Sci. 2016;10(4):1-7. doi:10.17795/ijpbs-7704
  39. Khazaee-Pool M, Moeeni M, Ponnet K, Fallahi A, Jahangiri L, Pashaei T. Perceived barriers to methadone maintenance treatment among Iranian opioid users. Int J Equity Health. 2018;17(1):75. doi:10.1186/s12939-018-0787-z
  40. Koohi-Kermani H. History of opium and opium users (Tarikh-e-Teriyak va Teriyaki). Tehran: Mohammad Ali Elmi; 1945.
  41. Prochaska JO. Transtheoretical model of behavior change. In: Gellman MD, Turner JR, eds. Encyclopedia of behavioral medicine. New York, NY: Springer; 2013:1997-2000. doi:10.1007/978-1-4419-1005-9
  42. Khademi H, Malekzadeh R, Pourshams A, et al. Opium use and mortality in Golestan Cohort Study: prospective cohort study of 50,000 adults in Iran. BMJ. 2012;344:e2502. doi:10.1136/bmj.e2502
  43. Ziaaddini H, Ziaaddini MR. The household survey of drug abuse in Kerman, Iran. J Appl Sci. 2005;5(2):380-382.
  44. Kheirandish P, SeyedAlinaghi S, Jahani M, et al. Prevalence and correlates of hepatitis C infection among male injection drug users in detention, Tehran, Iran. J Urban Health. 2009;86(6):902-908. doi:10.1007/s11524-009-9393-0
  45. Rajabizade G, Ramezani MR, Shakibi MR. Prevalence of opium addiction in Iranian drivers 2001-2003. J Med Sci. 2004;4(3):210-213. doi:10.3923/jms.2004.210.213
  46. Hamdieh M, Borujerdi A, Motalebi N, Abbasinejad M, Asheri H, Motamedi A. The prevalence of cigarette smoking, alcohol consumption, psychostimulant and cannabinoid drugs abuse among 15 to 35 years old Tehranis. Iran J Psychiatry Behav Sci. 2010;4(2):26-30.  
  47. Alam-mehrjerdi Z, Mokri A, Dolan K. Methamphetamine use and treatment in Iran: A systematic review from the most populated Persian Gulf country. Asian J Psychiatr. 2015;16:17-25. doi:10.1016/j.ajp.2015.05.036
  48. Zolala F, Mahdavian M, Haghdoost AA, Karamouzian M. Pathways to Addiction: A Gender-Based Study on Drug Use in a Triangular Clinic and Drop-in Center, Kerman, Iran. Int J High Risk Behav Addict. 2016;5(2):e22320. doi:10.5812/ijhrba.22320
  49. Nemati S, Rafei A, Freedman ND, Fotouhi A, Asgary F, Zendehdel K. Cigarette and Water-Pipe Use in Iran: Geographical Distribution and Time Trends among the Adult Population; A Pooled Analysis of National STEPS Surveys, 2006-2009. Arch Iran Med. 2017;20(5):295-301.
  50. Pinkham S, Malinowska-Sempruch K. Women, harm reduction and HIV. Reprod Health Matters. 2008;16(31):168-181. doi:10.1016/s0968-8080(08)31345-7
  51. Meysamie A, Sedaghat M, Mahmoodi M, Ghodsi SM, Eftekhar B. Opium use in a rural area of the Islamic Republic of Iran. East Mediterr Health J. 2009;15(2):425-431.  
  52. Brady KT, Sinha R. Co-occurring mental and substance use disorders: the neurobiological effects of chronic stress. Am J Psychiatry. 2005;162(8):1483-1493. doi:10.1176/appi.ajp.162.8.1483
  53. Elkington KS, Bauermeister JA, Zimmerman MA. Psychological distress, substance use, and HIV/STI risk behaviors among youth. J Youth Adolesc. 2010;39(5):514-527. doi:10.1007/s10964-010-9524-7
  54. Safizadeh M, Nakhaee N. Causes of increasing trend of divorce in Iranian community: what do the experts think? J Fam Med. 2016;3(4):1064.
  55. 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:10.5812/ircmj.7673
  56. 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:10.15171/ijhpm.2018.18
Volume 8, Issue 4
April 2019
Pages 222-232
  • Receive Date: 26 November 2017
  • Revise Date: 11 December 2018
  • Accept Date: 15 December 2018
  • First Publish Date: 01 April 2019