Afarin Rahimi-Movaghar Professor of Psychiatry Iranian National - - PowerPoint PPT Presentation

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Afarin Rahimi-Movaghar Professor of Psychiatry Iranian National - - PowerPoint PPT Presentation

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Afarin Rahimi-Movaghar Professor of Psychiatry Iranian National Center for Addiction Studies Tehran University of Medical Sciences WHS 2019, Kish, Iran April 29-30, 2019 WHO Collaborating Center Iranian National Center on Substance Use

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

Afarin Rahimi-Movaghar Professor of Psychiatry

Iranian National Center for Addiction Studies Tehran University of Medical Sciences WHS 2019, Kish, Iran April 29-30, 2019

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

11 million 30.1 million 275 million 4,900 million

Alcohol users: 2000 million Tobacco: 1000 million

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

Global Burden of Disease Study 2017:

  • 585,000 deaths
  • 42 million “health” years of life lost

Most resulted from overdose, HCV and HIV.

Over the past three decades, the number of deaths and DALYs attributed to the use of drugs have approximately doubled.

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health 4

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

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Examples

  • 1. Child wefare
  • 2. Financial stability
  • 3. Intimate partner violence
  • 4. Driving under the influence of drugs
  • 5. Crime against property and theft
  • 6. Lost productivity costs

Health Crime Economic Family Community 1 2 3 4 Drug user 5 6

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

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  • 2,000

4,000 6,000 8,000 10,000

1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018

Opium production in tons

Other countries Lao PDR opium production Mexico opium production Myanmar opium production Afghanistan opium production Total

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

1998 2008 2018

Opium

Heroin

Opium

Heroin Methamphetamine

Prescription opioids

Opium

Heroin Methamphetamine

Prescription opioids Cannabis

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health 0.89% 0.46%

0.08% 0.14%

21.67%

0.32%

0.91%

Drug use disorders Mood and anxiety disorders Alcohol use disorders

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health SOURCE: Adapted from Institute of Medicine (1994, p

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

Infancy & early childhood Middle childhood Early adolescence Adolescence & adulthood

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health Infancy and early childhood Middle childhood Early adolescence Adolescence Early adulthood Adulthood

(0-5 years old) (6-10 years old) (11-14 years old) (15-19 years old) (20-25 years old) (>25 years old)

Family

Prenatal & infancy visitation (Selective & indicated) Parental skills (Universal & selective)

School

Early childhood education (Selective) Personal & social skills education (universal & selective) Personal & social skills education (universal & selective) Classroom management (Universal) School policies (Universal & selective) Policies to keep children at school (Selective) Addressing individual psychological vulnerabilities (Indicated)

Community

Community-based multi-component initiatives (universal & selective) Media campaigns (universal & selective) Mentoring (Selective)

Workplace

Workplace prevention (universal, selective & indicated)

Health sector

Brief intervention (Indicated)

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

  • Long term treatment and supportive care is needed.
  • Use of medications, such as methadone, buprenorphine, and

extended-release naltrexone, significantly improve opioid use disorder outcomes.

  • The effectiveness of treatment is limited by problems at all

levels of the care cascade, including diagnosis, entry into treatment, and retention in treatment.

  • Trainingof health-care professionals in the treatment and

prevention of drug use disorder,

  • Researchfor development of alternative medications and new

models of care to expand capabilities for personalised interventions.

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

  • Target 3.5: Strengthening the prevention and treatment of substance

abuse

– Balance between prohibition with prevention and treatment – Wide access to prevention and treatment

  • Target 3.3: Ending epidemics of AIDS, hepatitis and tuberculosis

– Harm reduction interventions – Anti-retroviral treatment for PWID with HIV/AIDS

  • Target 3.8: Achieving universal health coverage, access to safe, effective,

quality and affordable services and essential medicines for all

– Adequate amount of funds available – Integration of the services in the PHC – Pain medications available to those in need

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

  • No. of drug users

received services

  • No. of centers

Available Services for drug users 764,500 6341 All services 530,091 5263 Drug treatment centers 399,508

  • Methadone maintenance treatment

65,182

  • Buprenorphine maintenance treatment

63,375

  • Outpatient detoxification

2,026

  • Inpatient detoxification

65,714 209 DICs 26,702 347 Outreach team 5,946 42 Shelter 2,107 20 Therapeutic Community 133,940 807 Residential drug treatment Centers

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health 50 100 150 200 250 300 350 400 450

Treatment Shut down Over-criminalization Treatment Prevention Treatment Harm reduction Prevention

Research Opium production in Afghanistan New HIV cases

Islamic revolution

End of Iran-Iraq war

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

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The prevalence of HIV was 14.6% (95% CI: 11.2-18.0) in 2005-2018 among PWID. Assessment of the trend over time did not show an increase in the HIV prevalence.

Heterogeneity between groups: p = 0.000 Overall (I^2 = 97.668%, p = 0.000); Ramezani, 2014 Rahimi-Movaghar, 2010 Zamani, 2006 Allahqoli, 2018 Momen-Heravi, 2013 2007-08 Subtotal (I^2 = .%, p = .) ≥2015 Rahbar,2004 2005-06 Moradi, 2012 Zamani, 2005 Sajadi, 2013 Kazerooni, 2009 Malekinejad, 2015 Subtotal (I^2 = 97.859%, p = 0.000) 2009-10 Khajehkazemi, 2013 Navadeh, 2013 Sofian, 2012 Eskandarieh, 2013 Khodadadizadeh, 2006 Lawrinson, 2008 2003-04 Noroozi, 2012 Subtotal (I^2 = 98.034%, p = 0.000) Mamani, 2013 SeyedAlinaghi, 2013 Subtotal (I^2 = 95.639%, p = 0.000) Javadi, 2014 Subtotal (I^2 = .%, p = .) Hashemipour, 2013 Zamani, 2008 2013-14 Kheirandish, 2010 2001-02 Javadi, 2007 First author, year SeyedAlinaghi, 2017 ≤2000 Taghizadeh Asl, 2013 Khani,2005 Alipour, 2013 Dibaj, 2013 Subtotal (I^2 = .%, p = .) Ostad Taghi zadeh, 2014 Amini, 2005 Subtotal (I^2 = 95.739%, p = 0.000) Doosti-Irani, 2017 Haghdoost, 2014 Mirahmadizadeh, 2001 Imani, 2008 2011-12 2012 2006-7 2004 2014 2010 2001 2010 2003-4 2010 2007 2006-7 Implementation 2010 2009 2009 2009 2003 2003-5 2012 2008-9 2007-8 2008-9 2009 2006-7 2006 2003 year 2014 2003-5 2001 2010 2009 2007-8 2003 2015 2014 1998 2004 0.115 (0.095, 0.135) 0.190 (0.125, 0.278) 0.107 (0.088, 0.129) 0.235 (0.183, 0.296) 0.226 (0.114, 0.398) 0.023 (0.011, 0.047) 0.081 (0.061, 0.101) 0.022 (0.011, 0.044) 0.042 (0.018, 0.095) 0.153 (0.107, 0.215) 0.110 (0.067, 0.177) 0.246 (0.204, 0.293) 0.265 (0.230, 0.304) 0.088 (0.047, 0.128) 0.151 (0.137, 0.165) 0.123 (0.101, 0.148) 0.059 (0.031, 0.108) 0.194 (0.150, 0.246) 0.097 (0.033, 0.249) 0.230 (0.142, 0.349) 0.042 (0.021, 0.081) 0.107 (0.066, 0.148) 0.295 (0.243, 0.352) 0.024 (0.015, 0.039) 0.121 (0.036, 0.206) 0.011 (0.005, 0.024) 0.024 (0.010, 0.038) 0.015 (0.010, 0.022) 0.153 (0.140, 0.167) 0.244 (0.207, 0.285) 0.140 (0.109, 0.177) ES (95% CI) 0.083 (0.067, 0.104) 0.432 (0.350, 0.517) 0.031 (0.012, 0.078) 0.108 (0.076, 0.151) 0.064 (0.050, 0.081) 0.060 (0.033, 0.087) 0.037 (0.031, 0.044) 0.094 (0.032, 0.242) 0.229 (0.168, 0.291) 0.168 (0.112, 0.245) 0.075 (0.065, 0.087) 0.013 (0.006, 0.028) 0.008 (0.001, 0.041) 100.00 2.19 3.13 2.56 1.18 3.16 7.52 3.17 2.92 2.61 2.61 2.79 2.90 29.87 % 3.18 3.09 2.90 2.72 1.72 1.70 3.03 15.01 2.60 3.19 14.80 3.21 6.17 3.22 3.18 2.87 2.96 Weight 3.14 2.05 3.01 2.91 3.17 5.22 3.22 1.77 15.84 2.37 3.20 3.20 3.17 0.115 (0.095, 0.135) 0.190 (0.125, 0.278) 0.107 (0.088, 0.129) 0.235 (0.183, 0.296) 0.226 (0.114, 0.398) 0.023 (0.011, 0.047) 0.081 (0.061, 0.101) 0.022 (0.011, 0.044) 0.042 (0.018, 0.095) 0.153 (0.107, 0.215) 0.110 (0.067, 0.177) 0.246 (0.204, 0.293) 0.265 (0.230, 0.304) 0.088 (0.047, 0.128) 0.151 (0.137, 0.165) 0.123 (0.101, 0.148) 0.059 (0.031, 0.108) 0.194 (0.150, 0.246) 0.097 (0.033, 0.249) 0.230 (0.142, 0.349) 0.042 (0.021, 0.081) 0.107 (0.066, 0.148) 0.295 (0.243, 0.352) 0.024 (0.015, 0.039) 0.121 (0.036, 0.206) 0.011 (0.005, 0.024) 0.024 (0.010, 0.038) 0.015 (0.010, 0.022) 0.153 (0.140, 0.167) 0.244 (0.207, 0.285) 0.140 (0.109, 0.177) ES (95% CI) 0.083 (0.067, 0.104) 0.432 (0.350, 0.517) 0.031 (0.012, 0.078) 0.108 (0.076, 0.151) 0.064 (0.050, 0.081) 0.060 (0.033, 0.087) 0.037 (0.031, 0.044) 0.094 (0.032, 0.242) 0.229 (0.168, 0.291) 0.168 (0.112, 0.245) 0.075 (0.065, 0.087) 0.013 (0.006, 0.028) 0.008 (0.001, 0.041) 100.00 2.19 3.13 2.56 1.18 3.16 7.52 3.17 2.92 2.61 2.61 2.79 2.90 29.87 % 3.18 3.09 2.90 2.72 1.72 1.70 3.03 15.01 2.60 3.19 14.80 3.21 6.17 3.22 3.18 2.87 2.96 Weight 3.14 2.05 3.01 2.91 3.17 5.22 3.22 1.77 15.84 2.37 3.20 3.20 3.17 .1 .2 .3 .4 .5 .6

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

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Iranian National Center for Addiction Studies

WHO Collaborating Center

  • n Substance Use Disorders

and Mental Health

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