Introduction: Buprenorphine is a partial agonist of the μ-opioid receptor and one of the main drugs used for maintenance treatment of opioid use disorder. The widespread misuse of buprenorphine, particularly via non-sublingual routes, poses significant health risks. Case Presentation: This paper presents a detailed case study of a 39-year-old male with a history of polydrug use, focusing on the respiratory complications arising from intranasal buprenorphine use, which he had been snorting for the past three years. Conclusions: It appears that buprenorphine snorting can lead to serious and irreversible injuries and complications, including congestion and erythema of the nasal mucosa, deviation and perforation of the middle nasal septum, chronic sinusitis, and reduced sleep quality.

Purpose: Opioid use disorder has increased worldwide in recent years, and Iran ranks first in terms of opium smoking in the world. Opium smoking by traditional methods, in addition to dependence on morphine, is a behavioral addiction in Iran. The body position during opium smoking is usually non-ergonomic. This study aims to compare sway-back posture and musculoskeletal problems between opium smokers and non-drug users. Methods: This cross-sectional research is a comparative study. We selected 80 people with opium use disorder (whose main method of their consumption was smoking) and 74 non-drug users. We compared them regarding sway angle (sway back posture) and musculoskeletal complaints (NORDIC questionnaire), and the association of possible risk factors was investigated. We analyzed data using the Kolmogorov-Smirnov test, correlation coefficient, and paired t-test using SPSS software, version 23. Results: Two study groups were significantly different in terms of sway back posture (P=0.007), neck (P<0.001), upper back (P<0.001), and lower back (P=0.006) musculoskeletal complaints. Homelessness had a significant correlation with sway back posture and musculoskeletal complaints. Also, the daily duration of opium smoking (in minutes) and opium smoking duration in lifetime (in months) were significantly correlated. Homelessness was the strongest predictor and had the strongest correlation. Conclusion: In general, increasing the duration of sitting in non-ergonomic positions can increase sway angle and sway back posture and increase musculoskeletal complaints of the neck, upper back, and lower back due to the non-neutral posture of opium smoking. It seems that plasticity and structural and functional adaptations of the posture occur due to opium smoking. So, further studies are recommended.

Opioid use disorder has increased in the world in recent years and Iran ranks first in terms of opium smoking in the world. In fact, opium smoking by traditional methods, in addition to dependence on morphine, is a behavioral addiction in Iran. The body position during opium smoking is usually non-standard and non-ergonomic. Over time, changes in muscle tissue, tendons and ligaments, and the connective tissue go from elasticity to neuromuscular plasticity. This study aims to compare sway back posture and musculoskeletal problems between opium smokers and non-drug users. In this comparative and cross-sectional study, 80 opium smokers were compared with 74 non-drug users in terms of sway angle (sway back posture), and musculoskeletal complaints (NORDIC questionnaire) and the association of possible risk factors was investigated. Data were analyzed by Kolmogorov-Smirnov, Correlation Coefficient and paired-t tests using SPSS version 23. There were significant differences between two groups in terms of sway back posture (P=0.007), and neck (<0.001), upper back (<0.001) and lower back (0.006) musculoskeletal complaints. Homelessness, the lifetime duration of opium smoking (in months), and the duration of daily opium smoking (in minutes) had significant correlation with sway back posture and musculoskeletal complaints. Homelessness was the strongest predictor and had strongest correlation. Overall, an increase in the duration of sitting in non-ergonomic positions could lead to increase in sway angle and sway back posture and increase in musculoskeletal complaints of neck, upper back and lower back due to the non-neutral posture of opium smoking. It seems that plasticity and structural and functional adaptations of the posture occurs due to opium smoking and further studies are recommended.

The introduction explains the problem well, and the reasons for the need to study are mentioned.The paper provides a comprehensive and detailed description of the methods used for research design and conduction and data collection & analysis.The study has a large enough sample size of participants, providing a more robust analysis.The results of the study show the main variables and predictor factors of QOL, which can have an effective role for a better life and increasing the patients' survival.The paper acknowledges the limitations of the study and provides suggestions for future research, demonstrating a critical and reflective approach.

Background: Many studies have shown that non-ergonomic positioning of the spine is one of the main causes of postural deformity. In this regard, opium smoking requires sitting in non-ergonomic positions, which increases the possibility of posture disorders due to exposure for several hours a day and over many years. Objectives: This study aimed to compare neck pain and disability, forward head posture (FHP), and the curvature of the thoracic spine (thoracic hyperkyphosis [THK]) in opium users and non-drug users. Methods: In this comparative cross-sectional study, 80 opium smokers were compared with 74 non-drug users in terms of craniovertebral angle (FHP), THK, and neck pain (Visual Analog Scale [VAS]) and disability (neck disability index [NDI]). Data were analyzed by Kolmogorov-Smirnov and independent t-tests using SPSS version 23. Results: The difference between the 2 groups was significant in all variables, including VAS (P = 0.004), NDI (P < 0.001), craniovertebral angle (P = 0.003), and THK (P = 0.006). Conclusions: Forward head posture, THK, neck pain, and neck disability are more prevalent in opium smokers than non-drug users. This could be due to the long hours of the non-ergonomic position while smoking opium.

ObjectivesOpium smoking is commonly practiced via traditional and novel routes in Iran. Both smoking methods are practiced in a non-ergonomic position. According to previous studies and our hypothesis, it can be potentially harmful to the cervical spine. Thus, the present study aimed to investigate the relationship between opium smoking and neck range of motion and neck muscle strength.MethodsIn this cross-sectional and correlational study, the range of motion and strength of the neck muscles of 120 men with drug use disorder were measured by a CROM goniometer and a hand-held dynamometer. Other data gathering was performed using a demographic questionnaire, the Maudsley Addiction Profile, and the Persian version of Leeds Dependence Questionnaire. The obtained data were analyzed by Shapiro–Wilks test, Pearson’s correlation coefficient and stepwise linear regression.ResultsThere was no significant correlation between the age of drug use onset and range of motion and muscle strength of the neck; however, the daily duration of opium smoking and the number of years of opium smoking were inversely and significantly correlated with the range of motion and muscle strength of the neck in some directions. Daily opium smoking time for decreasing in neck range of motion and total duration of opium smoking for reduction of neck muscles strength are stronger predictor variables.ConclusionOpium smoking by traditional routes causes non-ergonomic positions and has a moderate significant correlation with reduced range of motion and neck muscle strength, in Iran.Highlights– The harm of drug use disorder is not only AIDS and hepatitis, and harm reduction programs should go beyond the prevention of AIDS and hepatitis. According to more than 90% of smoking use of drug compared to other methods (oral and injectable, etc.) musculoskeletal disorders caused by the smoking use of drugs, have a greater cost burden in reducing the quality of life and the need for rehabilitation.– Drug abuse treatment and harm reduction programs should focus more seriously on replacing smoking use of drugs with oral medications assisted treatment.– Although in Iran and some countries in the region, a large number of people smoke opium for many years and sometimes all their lives, daily in a completely non-ergonomic position, but studying the deformation of the posture and musculoskeletal disorders related to the body position in them, is not a scientific concern and neither physical therapy researchers have paid attention to it nor addiction researchers.– Neck muscles strength and range of motion in opium addicts are correlated to the number of years of opium smoking and daily minutes of opium smoking, but not to its oral use.– There is no significant correlation between the onset age of continues and permanent opium smoking and substance dependence severity with neck range of motion and muscles strength.– People with drug use disorder (especially smoking users) as a large group of vulnerable people, should be the target population of musculoskeletal disorders researchers and addiction harm reduction researchers, and more experimental, comparative, cohort, etc. researches should be designed and implemented for them.

Opium smoking has been a common practice in Iran for many years, with people often smoking for long hours. During the COVID-19 pandemic, there was an increase in opium smoking due to false beliefs about its protective effects against COVID-19 infection. In this study, we aimed to examine the association between the non-ergonomic positions associated with traditional opium smoking in Iran and the development of neck pain and disability, forward head posture (FHP), and hyperkyphosis (HK). In this cross-sectional, correlational study, a total of 120 individuals who smoked opium were selected based on the inclusion criteria. They were interviewed about their addiction profile using the Lite version of the Addiction Severity Index and the Leeds Dependence Questionnaire. The presence of neck pain and disability was also evaluated using the Visual Analog Scale and the Neck Disability Index. The participants were examined for FHP via side-view photography and for HK using a flexible ruler. Data were analyzed using correlation coefficient tests and stepwise linear regression analysis. Based on the results, homelessness, the lifetime duration of opium smoking (in months), the duration of daily opium smoking (in minutes), and the severity of drug dependence had significant relationships with the severity of neck pain, neck disability, FHP, and HK. Homelessness was the strongest predictor of neck pain and disability (R2 = 0.367, p < 0.001), FHP (R2 = 0.457, p < 0.001), and HK (R2 = 0.476, p < 0.001), followed by the lifetime duration of opium smoking and the duration of daily opium smoking, respectively, in which R2 increased to 0.505 (p = 0.011), 0.546 (p = 0.022), and 0.570 (p = 0.004) with the addition of two other variables. Overall, an increase in the duration of sitting in non-ergonomic positions could lead to neck pain and disability, FHP, and HK due to the non-neutral posture of opium smokers.

Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted people with substance use disorders (SUDs) worldwide, and healthcare systems have reorganized their services in response to the pandemic. Methods: One week after the announcement of the COVID-19 as a pandemic, in a global survey, 177 addiction medicine professionals described COVID-19-related health responses in their own 77 countries in terms of SUD treatment and harm reduction services. The health responses were categorized around ( 1 ) managerial measures and systems, ( 2 ) logistics, ( 3 ) service providers, and ( 4 ) vulnerable groups. Results: Respondents from over 88% of countries reported that core medical and psychiatric care for SUDs had continued; however, only 56% of countries reported having had any business continuity plan, and 37.5% of countries reported shortages of methadone or buprenorphine supplies. Participants of 41% of countries reported partial discontinuation of harm-reduction services such as needle and syringe programs and condom distribution. Fifty-seven percent of overdose prevention interventions and 81% of outreach services were also negatively impacted. Conclusions: Participants reported that SUD treatment and harm-reduction services had been significantly impacted globally early during the COVID-19 pandemic. Based on our findings, we highlight several issues and complications resulting from the pandemic concerning people with SUDs that should be tackled more efficiently during the future waves or similar pandemics. The issues and potential strategies comprise the following: (1) helping policymakers to generate business continuity plans, (2) maintaining the use of evidence-based interventions for people with SUDs, (3) being prepared for adequate medication supplies, (4) integrating harm reduction programs with other treatment modalities, and (5) having specific considerations for vulnerable groups such as immigrants and refugees.

1. Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. 2. Psychiatry and Behavioral Sciences Research Center, Addiction Institute and Department of Psychiatry, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. 3. Department of Psychiatry, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. 4. Research Institute for Islamic and Complementary Medicine, School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran. 5. Department of Psychology, Persian Gulf University, Bushehr, Iran.

Methamphetamine dependence has been known as a serious health problem in a large proportion of illicit drug users in Iran. Compared with the opium problem, methamphetamine dependence is a new epidemic concern in Iran. The prevalence of methamphetamine dependence is associated with crucial health problems such as poor psychological well-being, social dysfunction, craving, and a higher rate of addiction severity. This issue necessitates professional attention to the rehabilitation of methamphetamine users and treatment of craving. To date, few research studies have been conducted on this health concern. Studies in Iran indicate that methamphetamine craving shows resistance to treatment. While few pharmacological treatments have been found to be effective, motivational interviewing, matrix model and cognitive-behavioral therapy have been all evaluated in Iran to treat methamphetamine craving. However, the treatment effects need to be more long-lasting. Previous studies show that methamphetamine users lapse and relapse for a variety of reasons include “pleasure-seeking”/“impulsivity”/“habits”/“pain avoidance”/“craving”/“bad feelings eliminating such as boredom & loneliness” which have a strong neurological basis in the central nervous system and emotions and decisions that result from them. Thus we should use a range of different modalities to treat and prevent relapse.

Objectives: Female methadone patients need specific education on HIV. However, few studies have been conducted on the essential characteristics of designing an online HIV education program for this population. Therefore, the current qualitative study aimed at addressing this research gap. Methods: Semi-structured interviews were conducted with 34 female patients and 19 methadone treatment providers in 11 methadone treatment centres in Tehran, Mashhad and Sari, Iran. Both focus group discussions and individual interviews were conducted and a narrative analysis approach was implemented. The NVivo 9 software was used for data analysis. Results: The qualitative analyses of the data revealed three major themes and six minor themes as follows: a. information for focused action (knowing the epidemic response) using the effective visual presentation and audio presentation; b. interventions for impact evaluation (covering the needed services) by short-term documentary movies and animations; and c. program delivery for understanding (covering the population in need of services) using problem-solving and taking quizzes. Discussion: Audio and visual components, as well as the role of documentary movies and animations, should be considered in HIV education. The active role of women in learning using problem-solving and taking quizzes was highlighted. The findings of this study can be used in designing women-specific HIV education programs in Iran. Randomized controlled trials are suggested to evaluate the effectiveness of such programs.

Objectives: The follow-up treatment or rehabilitation and monitoring of patients with drug abuse disorders require an efficient tool with a convenient and short-time implementation to measure psychological aspects of dependence. The Leeds Dependence Questionnaire (LDQ) has such features; thus, the present study aimed at evaluating the validity and reliability of its Persian version. Methods: The current validation study explored the data obtained from 142 substance dependent patients selected from drug addiction treatment centers in Tehran City, Iran. The criterion-related validity of the Persian version of the LDQ was evaluated by measuring its correlation with the Substance Dependence Severity Scale (SDSS). The construct validity of the Persian version of the LDQ was evaluated using the General Health Questionnaire (GHQ). Moreover, the internal consistency and reliability of this scale were calculated by Cronbach’s alpha coefficient and test-retest reliability methods, respectively. Results: The correlation coefficients between the LDQ and SDSS and GHQ were 0.773 and 0.780, respectively; the correlations were statistically significant (P<0.001). A Cronbach’s alpha coefficient of 0.809 was obtained by investigating the internal consistency of the tool. Test-retest reliability for a two-week interval was 0.963. Discussion: The criterion-related validity, construct validity, internal consistency, and test-retest reliability values of the Persian version of the LDQ are approvable; therefore, it can be applied as a valid and reliable tool on the Iranian population.

Objective Methamphetamine use in patients treated with methadone is a health problem in Iran that reduces the benefits of this treatment. This has been more reported by women than by men. Short-term psychological interventions are one of the major methods of rehabilitation to solve this problem. The current study aimed to explore the reasons for methadone patients for using these interventions to quit daily MA use while in treatment. Materials & Methods In this qualitative-descriptive study, 64 women undergoing maintenance treatment from three methadone clinics in Tehran, Iran, were selected through a simple and accessible method and were interviewed. in 2016. All women met the Diagnostic and Statistical Manual, Edition Five (DSM-V) criteria for regular MA use in the past 12 months while in methadone treatment. A researcher-made questionnaire was devised to interview with the patients. Quantitative-descriptive data were analyzed by PPSS software V. 22 and qualitative data were analyzed by content analysis method. Results The mean age of the women was 37.8 years (age range: 18-56 years). Overall, 50% of the participants reported living with their families. The average duration of undergoing methadone treatment was 18 months. Overall, 84.3% of participants consumed MA by smoking. The main reasons women expressed as self-reporting to use short-term psychological interventions were as follows: learning short-sighted cognitive skills is easy and affordable to quit smoking (79%): routine counseling and training on methadone treatment does not have a significant effect on stopping the use of MA, as it requires cognitive-behavioral skills and techniques (76%); with continued consumption, there is a possibility of increased divorce and separation from the family and consequently, lack of financial support (71%), which caused lack of paying for methadone treatment charges; therefore, learning cognitive-behavioral skills was necessary; regular MA use is against the religious and traditional values of family and society (66%); likelihood of homelessness was high due to continued MA use (53%); the stigma and social labeling and discrimination against consumption for women are higher than men (51%); positive feedback of methadone-therapy has been greatly reduced due to consuming MA and therefore the probability of expulsion from methadone-therapy is high P(43%). Problems related to work (38%) and risk of losing the right to foster care (31%) were also other reasons. Conclusion A combination of individual, familial, social and therapeutic reasons were described by MA dependent women as their needs for having short-term psychological treatments while experiencing methadone treatment. More studies should be conducted to investigate the effects of short-term psychological treatments in reducing regular MA use among women in methadone treatment services. Family therapy needs to be provided to reduce the likelihood of divorce, separation, homelessness, and lack of financial support among these women. Mass media should provide educational programs to reduced stigma and discrimination against women with regular MA use.

Objectives: Methamphetamine (MA) use disorder is a new health problem among Iranian female methadone patients that needs special treatment and rehabilitation services. However, few describe their baseline characteristics, their reasons for MA use while in treatment, and their treatment needs and success. The study aimed at investigating these research gaps. Methods: The participants were 70 women with MA use disorder in two large women-only methadone treatment services in Tehran, Iran. A researcher-made checklist, the Severity of Dependence Scale, the Contemplation Ladder, and the General Health Questionnaire-28 were completed by women in a baseline interview. Results: The mean±SD age of the participants was 35.84±8.62 years. The participants reported high severity of MA dependence (mean±SD = 6.88±3.19), poor motivation to change (mean±SD = 4.0±2.31]), and impaired psychological well-being (mean±SD = 16.35±4.04) in the treatment. The most important reasons for MA use while undergoing methadone treatment included self-treatment (55%) and pleasure-seeking (43%). The most important MA treatment needs included effective psychological treatments (75%), continued family support (72%), and life skills (68%). Stable living and financial conditions (90%), drug-free living and working places (86%), continued family support (78%), and psychological counseling (69%) were the most important reported factors associated with MA treatment success. Discussion: The current study indicated that participants reported a number of MA-related problems. This issue needed a comprehensive treatment program at individual, social, psychological, and professional levels. The findings have important implications for delivering psychosocial treatments, as well as gender-specific research.

Objectives: This study aimed to compare the ratio of suicide attempts between female opium and Methamphetamine (MA) users to determine the relationship between the increased prevalence of MA and suicide risk. Methods: In this cross-sectional study, 136 drug dependent females were randomly selected from Tehran. Data gathering was performed by a demographic questionnaire and Beck Scale for Suicidal Ideation. Data were analyzed by Chi-squared test and Independent Samples t-test. Results: There was no significant different in suicidal ideation between the two groups; however, the suicide attempt was significantly higher in the MA users compared to opium users (P<0.001). Discussion: Suicide attempt is much higher in females who use crystal MA, compared to female opium users. This could be a warning to prevent associated risks.

Millions of children are left to survive on the streets around the world. Investigations on drug use disorders among street children reveal that they not only abuse all types of drugs higher than their peers who live at home or in shelters, but also they abuse more harmful drugs such as injection drugs or methamphetamines. This guideline provides a comprehensive approach to the treatment and management of substance use disorders among children of 3 to 18 years of age for the staff of substance use disorder clinics. It highlights examples of how to perceive and approach the management and issues of substance abuse among street children at an early stage of development through various medical, psycho-social, and other interventions. It also defines the characteristics of the street children with a focus on prevention. These provisions consist of addressing the applicability matters in this area and necessity of a decision model in our country.