The evolution of addiction treatment and harm reduction programs in Iran: a chaotic response or a synergistic diversity?
The evolution of addiction treatment and harm reduction programs in Iran: a chaotic response or a synergistic diversity?
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DOI：
10.1111/add.14905
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发表时间：
2019-12-29
期刊：
影响因子：
6
通讯作者：
Rawson, Richard
中科院分区：
文献类型：
--
作者：
Ekhtiari, Hamed;Noroozi, Alireza;Rawson, Richard
伊朗15-64岁人口中分别有2.1%和1.8%的人患有非法物质和阿片类药物使用障碍。为了解决这些问题，伊朗一直在开发一个大型和多模式的成瘾治疗系统，时间跨度跨越伊斯兰革命前后。伊朗目前的戒毒治疗是一种服务组合，从医疗/减少伤害服务到惩罚/刑事司法方案。这一系列服务包括提供低门槛减少伤害服务的救助中心，如分发无菌针头和注射器;提供美沙酮、丁丙诺啡和鸦片酊的阿片类药物维持治疗诊所;以及以禁欲为基础的住宅中心。我们将分四个阶段回顾这一制度的演变。结果1980年，伊朗革命政府关闭了所有自愿治疗计划，代之以住宅矫正计划。成瘾治疗政策的第一次转变是在15年后面临负面后果之后。成瘾被视为一种疾病，并建立了新的自愿治疗中心，提供非激动剂药物和心理社会服务。随着注射吸毒者人数的增加和艾滋病毒/艾滋病的流行，在第二次转变中，广泛采取了减少危害战略和阿片类维持方案，以减少与艾滋病毒有关的高风险行为。甲基苯丙胺使用危机的出现导致越来越多的社会边缘化成瘾者，导致公众和政治要求更严格的政策，并在2010年开始的第三次转变中结束，延长了基于法院的强制性居住计划。目前，出现了一种新的转变，即减轻对使用/销售毒品的刑事处罚的严厉程度，并促进鸦片合法化的建议。结论伊朗的演变经验，在医疗/减少伤害和惩罚性/刑事司法成瘾治疗的复杂组合，制定一个大型成瘾治疗方案，可以在其政治，临床和务实的背景下进行检查。
Backgrounds and aims Iran has 2.1 and 1.8% of its 15-64-year-old population living with illicit substance and opioid use disorders, respectively. To address these problems, Iran has been developing a large and multi-modality addiction treatment system, spanning the time before and after the Islamic Revolution. Methods Iran's current drug treatment scene is a combination of services, ranging from medical/harm reduction services to punitive/criminal justice programs. Included in this array of services are drop-in centers providing low-threshold harm reduction services, such as distribution of sterile needles and syringes; opioid maintenance treatment clinics providing methadone, buprenorphine and opium tincture; and abstinence-based residential centers. We will review the evolution of this system in four phases. Results In 1980, Iran's revolutionary government shut down all voluntary treatment programs and replaced them with residential correctional programs. The first shift in the addiction treatment policies came 15 years later after facing the negative consequences. Addiction is viewed as a disease, and new voluntary treatment centers offering non-agonist medications and psychosocial services were established. With an increased number of people who inject drugs and HIV/AIDS epidemics, in the second shift an extensive move towards harm reduction strategies and opioid-maintenance programs has been implemented to reduce HIV-related high-risk behavior. The emergence of a methamphetamine use crisis creating an increased number of socially marginalized addicted people resulted in public and political demands for stricter policies and ended in the third shift starting in 2010, with extended compulsory court-based residential programs. Currently, there is a new shift towards reducing the severity of criminal penalties for drug use/sales and promoting proposals for opium legalization. Conclusion Iran's evolutionary experience in developing a large addiction treatment program in a complex combination of medical/harm reduction and punitive/criminal justice addiction treatment can be examined in its political, clinical and pragmatic context.