The Lion Chases Away the Dragon
Iran's drug treatment programs are among the world's most progressive
In the late 1990s and early 2000s, the Iranian authorities were fighting a losing battle with drug addiction and HIV. Some estimates say that following the NATO invasion of Afghanistan in 2001, Afghan opium production increased by 40 times. Iran, the first stop on the route to Europe and America, was unable to cope and was flooded with opiates.
A 2007 study by Saman Zamani and others in Karaj Central Prison (for the article “Patterns of Drug Use and HIV-Related Risk Behaviors among Incarcerated People in a Prison in Iran” in the Journal of Urban Health) found that 42 percent of prisoners had used intravenous drugs. In 2006, Mehdi Gooya, the chief of the Health Ministry’s Disease Management Center, estimated that there were 3.7 million drug users in Iran, although many feel this figure is far too low.
This increase in intravenous drug use led to an HIV crisis in Iran: in 2005 another study by Saman Zamani and others in Karmanshah prisons (“Scaling up methadone maintenance treatment for opioid-dependent prisoners in Iran” in the International Journal of Drug Policy) found that 14 percent of the prisoners tested HIV positive, and the UN Office on Drugs and Crime (UNODC) estimates that 68.6 percent of all HIV cases in Iran were directly related to drug abuse between 1987 and 2013.
Faced with rising numbers of addicts, overflowing prisons, and a rapidly worsening HIV epidemic, the Iranian government decided to radically overhaul its approach to drug users. In a move away from imprisonment and punishment, Iran decided to view drug addicts as patients rather than criminals and accordingly to focus on treating them and reducing the demand for narcotics.
According to Amir Afkhani’s article for Foreign Policy, “How Iran won the war on drugs,” by 2002 Iran was spending 50 percent of its drug control budget on public health campaigns to warn people of the dangers of drug use. In the same year, Iran set up “Triangle Clinics” in prisons to provide incarcerated injecting drug users with harm reduction services including bleach, condoms, Methadone Maintenance Treatment (MMT), anti-retroviral drugs and tuberculosis treatment. Iran then launched the largest prison MMT project in the world, with over 25,000 prisoners using MMT by 2008 according to Saman Zamani’s team. As of 2010, Iran was one of only 22 countries to provide such services for prison inmates.
Moreover, according to a study by Holly Catania (“Progressive Harm Reduction in Iran’s prisons” in Harm Reduction News), the majority of Iran’s provinces provided an aftercare center for released prisoners to continue their treatment, provide them with MMT, refer them to additional health services, and rehabilitate them into society.
The government then set about increasing the availability of harm reduction services and gave its blessing for the private sector and NGOs to do the same. In 2005, the Iranian parliament voted to allow any medical doctor to dispense methadone to heroin addicts. In 2006, the Iranian National Center for Addiction Studies was established at the Tehran University Medical School to research improved methods of treating drug addicts. The INCAS center is still a world leader in addiction treatment research.
In 2007, 221 drug rehabilitation facilities were built in West Azerbaijan Province alone, and a 2011 UNAIDS report said that Iran had 600 dedicated drug rehabilitation centers as well as 1,250 additional facilities offering harm reduction services. The government has sponsored needle exchange programs and MMT programs so extensively that by 2010 the number of new cases of HIV among drug users had halved, to 1,585. Furthermore, the Iranian Narcotics Law makes it clear that an addict undergoing treatment cannot be arrested or prosecuted for drug possession or use.
However, there is still a long way to go. The UNODC estimates that 88 percent of treatment is provided by the private sector and NGOs. And the 2011 UNAIDS report claimed that less than 20 percent of Iran’s 3 million addicts have adequate recourse to treatment and harm reduction services. In the same year, a revision to the Dangerous Drugs Act suspended the right of appeal for drug traffickers sentenced to execution. Estimates on the percentage of 2011 executions related to drugs range between 70 and 80 percent.
Despite the draconian policy towards punishing trafficking and the fact that treatment is not universally available, Iran’s drug policy is at the very least surprising, and perhaps even inspiring. Iran maintains a very progressive policy towards harm reduction and drug-related illnesses inside its prisons and among the general public. And the wide availability of needle exchanges, MMT and ARV drugs has had a dramatic impact.
But the economic sanctions placed on Iran are making their task ever harder, as the availability of medicine of all kinds in Iran has declined sharply. Iran even claims that European countries now refuse to send it drug sniffer dogs. Given the scale of the problem of drug abuse in Iran—largely due to its proximity to Afghanistan—and its importance in the global fight against illegal drugs, it seems bizarre at best that Western nations feel it is in their best interests to not support Iran in its battle with narcotics.