The Epidemiology of Drugs in Iran

There are more than 15 million people worldwide who consume illicit opiates (opium, morphine and heroin) with the large majority using heroin, the most lethal form. Opiates are one of the most costly drugs worldwide in terms of treatment, medical care and arguably drug-related violence. Moreover, using opiates can often lead to severe dependence and is frequently associated with IDU-related HIV/AIDS, Hepatitis B and C, as well as high mortality rates. The UNODC estimate that the mortality rate for dependent heroin users is between 6 and 20 times that expected for those in the general population of the same age and gender, as the difference between a ‘recreational’ dose and a ‘fatal’ one is small, and variations in street drug purity can result in overdoses. Hence, in most countries, opiate consumption constitutes the main cause of drug-related deaths.

Main problem drugs as reflected in treatment demand, by region,
from the later 1990s to 2008 (or latest year available)

Source: UNODC World Drug Report, 2010 (pp:14)

Opium consumption is not a new phenomenon to Iran, being used medicinally and recreationally as far back as the 17th Century. The Opium and Alcohol Enforcement Society estimated the number of opium addicts in the 1940s at one and a half million from a total population of 14 million, demonstrating nearly 11% of the total population as drug users (Razzaghi, 1998). The UNODC estimates there are now four million opium consumers worldwide. Heroin, a derivative of opium, is the most widely consumed and distributed illicit opiate in the world. Opium that is not converted to heroin remains highly prevalent in Asia with two thirds consumed in just five countries: the Islamic Republic of Iran (42%), Afghanistan (7%), Pakistan (7%), India (6%) and the Russian Federation (5%). Global opium production is concentrated in three areas: Afghanistan, South-East Asia (predominantly Myanmar) and Latin America (Mexico and Colombia). However, it is Afghanistan that monopolises the global supply and accounts for around 90% of global illicit opium production, and an estimated 85% of the global heroin and morphine supply.

During the past few decades Iran has moved from producing opium to becoming a transit country for opium from Afghanistan towards the European markets. The Islamic Republic of Iran’s eastern borders with Afghanistan and Pakistan are 1,845 km long and consist mainly of mountainous or harsh desert terrain. The UNODC estimate 1,000mt of opium and 140mt of heroin flow into the Islamic Republic of Iran through the Iran-Afghan-Pakistan borders. The trafficking of heroin has become a lucrative enterprise in Iran with an estimated US$450-600 million per year earned by crime groups between the Afghan-Iran border and the Iran-Turkey border. For the past 12 years, the Islamic Republic of Iran has accounted for more than two thirds of annual global opiate seizures, with 573mt seized in 2008. The prevalence of narcotics in Iran has led to a growing prison population where 40% of all crimes in Iran are drug-related.

Main Drug Trafficking Routes in the Islamic Republic of Iran

Source: UNODC World Drug Report 2010, (pp:64)

Concomitantly, Afghanistan’s production and export of illicit opium produces significant contagion effects for its bordering countries – the Islamic Republic of Iran, Pakistan, Tajikistan, Uzbekistan and Turkmenistan – who are estimated to consume 650mt per year; 60% of global consumption. The largest volume is consumed by the Islamic Republic of Iran which the UNODC estimates at 450mt of opium and 14mt of heroin for 2008; this constitutes 42% of global opiate consumption. The UNODC estimates Iran to have 1.2 million opiate users (2% of the population) and one the highest rates of heroin addiction per capita in the world: 20% of Iranians aged 15 to 60 are involved in illicit drug use, and 9-16% inject drugs. It is the magnitude of opium and heroin that travels into Iran to which the UNODC associates the nation’s high rates of addiction.

Drug Profile in Iran

With Iran’s geographical proximity to the world’s largest opium producer, Afghanistan, Iran has become a major conduit for opium, morphine base and heroin of Afghan origin. Consequently, the increased availability and price fluctuations of heroin have led to a precipitous escalation of heroin dependency, as well as injecting drug use (IDU) in Iran (Razzaghi et al, 2006). The most common reasons cited for switching from opium to heroin and from smoking to injection are: (I) opium not giving enough high; (II) opium becoming costly and unavailable; and (III) heroin is available and affordable. The rising IDU population during the past decade is causing alarming concern in Iran where an estimated 200,000 people use intravenous methods. It is under this rhetoric that drugs are considered the most lethal threat to Iran today (Razzaghi et al, 2006). The increased prevalence of IDU has been strongly associated with risks of HIV where the sharing of injection instruments has become commonplace, along with complex behaviours that accounts for more than two-thirds of HIV infections (Ibid). The traditional use of opium in Iran has led the general public to consider its use as less serious and they do not regard users as “real drug addicts” compared to the use of heroin and opium residue (RSA, 2000).

A study undertaken through joint cooperation of UNODC Iran and the Iranian Ministry of Health in 1998-1999 identified the vulnerable and high risk groups that became involved in and/or are substantially affected by drug use and its adverse social and health related consequences as being: youth, workers, women who live with a drug abusing member, families with drug abusing members, injecting drug users and drug abusers in prison. A subsequent study by Narenjiha et al (2005) provides a profile of drug abuse in Iran where the average Iranian addict is very likely to be male, married and employed. In 2003, of the 25,041 people sampled – 95% were male, 72% were married and 72% were employed. This profile is perhaps a paradox of the “low self-esteem” profile often associated with drug consumption in the West, where high levels of unemployment, boredom, lack of options drives people, particularly youth, to drug use. Whilst Narenjiha et al (2005) account for 27.7% of drug users as being unemployed, the preponderance are employed, reflecting that the socio-cultural idiosyncrasies that exist in Iran are not isolated to generic backgrounds such as class or ethnicity.

Therefore the aetiology of drug consumption in Iran is ambiguous, going beyond a simple typology; it has multivalent characteristics that influence and instigate drug use which include various individual, familial and socio-cultural factors. The magnitude of opiate availability in Iran’s transient economy provides a significant bulwark to its amelioration. The entrenched cultural rhetoric towards opiate use appears to legitimise its consumption and provides a foundation for progression onto heroin and intravenous transmission. The prevailing socio-economic ills such as high unemployment, a protuberant youth population, in addition to a politically repressive regime, compound supply availability and cultural attitudes. It is these facets, in conjunction with the revenues gained by crime groups from the transient narcotic trade, that entrench the aetiology of drug use in Iran and augment drug addiction.