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Submitted: 17 Dec 2020
Accepted: 02 Mar 2021
ePublished: 19 May 2021
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Health Promot Perspect. 2021;11(2): 240-249.
doi: 10.34172/hpp.2021.29
  Abstract View: 66
  PDF Download: 59

Original Article

Opium dependence and the potential impact of changes in treatment coverage level: A dynamic modeling study

Hosein Rafiemanesh 1 ORCID logo, Afarin Rahimi-Movaghar 2 ORCID logo, Ali Akbar Haghdoost 3,4 ORCID logo, Alireza Noroozi 2 ORCID logo, Jaleh Gholami 2 ORCID logo, Bita Vahdani 5 ORCID logo, Amin Afshar 6,2, Mohammad Salehi 6, Koorosh Etemad 1* ORCID logo

1 Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
3 Modeling in Health Research Center, Institute for Futures Studies in Health, University of Medical Sciences, Kerman, Iran
4 HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
5 Assistant Professor of Psychiatry, Clinical Research Development Unit, 22 Bahman Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
6 Department of Neurosciences and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
*Corresponding Author: Koorosh Etemad, Email etemadk@sbmu.ac.ir

Abstract

Background: The most common drug, illegally used in Iran is opium. The treatment of people with substance use disorder is one of the most important strategies in reducing its burden. The aim of this study was to investigate the effect of different increasing and decreasing opium treatment coverage on the patterns of abstinence, transition to heroin dependence and mortality, over 30 years.

Methods: This study was a dynamic compartmental modeling conducted in three stages: 1) presenting a conceptual model of opium dependence treatment in Iran, 2) estimating model’s parameters value, and 3) modeling of opium dependence treatment and examining the outcomes for different treatment coverage scenarios. The input parameters of the model were extracted from the literature, and secondary data analysis, which were finalized in expert panels.

Results: The number of opium dependence will increase from 1180550 to 1522063 [28.93% (95% CI: 28.6 to 29.2)] over 30 years. With a 25% decrease in coverage compared to the status quo, the number of deaths will increase by 459 cases [3.28% (95% CI: 0.91 to 5.7)] in the first year, and this trend will continue to be 2989 cases [15.63% (95% CI: 13.4 to 17.9)] in the 30th year. A 25% increase in treatment coverage causes a cumulative decrease of heroin dependence by 14451 cases [10.1% (95% CI: 9.5 to 10.8)] in the first decade.

Conclusion: The modeling showed that the treatment coverage level reduction has a greater impact than the coverage level increase in the country and any amount of reduction in the coverage level, even to a small extent, may have a large negative impact in the long run.

Keywords: Opium, Opium dependence, Heroin dependence, Iran
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