The Rise of Harm Reduction in the Islamic Republic of Iran
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BRIEFING PAPER EIGHT JULY 2005 THE BECKLEY FOUNDATION DRUG POLICY PROGRAMME THE RISE OF HARM REDUCTION IN THE ISLAMIC REPUBLIC OF IRAN BIJAN NISSARAMANESH, MIKE TRACE and MARCUS ROBERTS The Beckley Foundation Drug Policy Programme (BFDPP) is a new initiative dedicated to providing a rigorous independent review of the effectiveness of national and international drug policies. The aim of this programme of research and analysis is to assemble and disseminate material that supports the rational consideration of complex drug policy issues, and leads to more effective management of the widespread use of psychoactive substances in the future. SUMMARY A tough anti-drugs campaign was launched in Iran following the revolution that established the Islamic Republic in 1979. Individuals caught in possession of drugs received fines, imprisonment and corporal punishment. The death penalty was prescribed for serious drug offences. Despite these measures, drug use and drug trafficking have continued to increase, and Iran has become the principal transit country for drugs from Afghanistan. In 2002, Iran accounted for a quarter of world opiate seizures. At this time, it was officially estimated that there were between 200,000 and 300,000 drug injectors in the country, and this is widely regarded as an underestimate. The costs of Iran’s drug problem include: high levels of dependency and addiction; strains on the capacity of the criminal justice system; increases in drug related deaths; and high rates of HIV/AIDS infection among injecting drug users. There is growing recognition in Iran of the limits of enforcement, and the importance of the medical and social dimensions of drug misuse. This has resulted in improvements in drug treatment and expansion of harm reduction services. estimated that there were 400,000 drug addicts, a quarter of IRAN’S DRUG PROBLEM them registered opium smokers. In 1975, there were also 30,000 identified heroin users (Moharreri M R 1978; McCoy A 1991). A long history of drug use Drug use has been widespread in Iran for hundreds of years. But there have been recent changes in the nature of, and For centuries, Iran was a major global centre of opium response to, the country’s drug problems. production and distribution. In the 1920s, it supplied around 100 tons of opium a year to internal and external markets The 1979 Islamic Revolution installed the theocratic state of (Kerimi N 2000). It has been estimated that by 1949 more than Ayatollah Khomeini. According to an assessment made by the one in ten adults in Iran (11 per cent) were using drugs; there United Nations in 1999, there was a significant increase in the were 1.3 million regular opium users; and the capital city, use of heroin in the years that followed. Official Government Tehran, contained 500 opium dens (McCoy A 1991). In 1969 sources claimed that five per cent of the Iranian population was there were, reportedly, 350,000 opium users, consuming a total drug addicted shortly after the revolution, some two million of 240 tons of opium a year. By the early 1970s, it was people (Razzaghi E et al 1999). This figure is much higher than 2 those that were being recorded less than a decade earlier, raising Traditionally, opium, opium residue and cannabis were smoked questions about definitions of drug addiction and the in opium pipes, or dissolved in tea or coffee and ingested.4 But collection, compilation and interpretation of the data. What is modes of drug administration are changing too. beyond dispute is that during the revolutionary period controls on the opium poppy became temporarily ineffectual. This In particular, an increase in heroin dependency has been combined with the new regime’s focus on alcohol to fuel a steep accompanied by a rise in injecting drug use. The RSA 1998/ escalation in drug use (York G 2000; Narcotics Control 1999 found that injecting drug use in Iran was significantly Strategy Report 2001). higher than previously believed. The main reasons that Iranian drug users gave for switching to injecting were that opium no longer gave them the desired high and had become too Changing problems expensive. In 2000, a gram of heroin could, reportedly, be purchased on the streets of Iran for as little as three to four US dollars (York G 2000).5 From producer to transit country Since the Islamic Revolution, there has been a fall in opium The Iranian Government estimated in 2001 that the number of cultivation within Iran’s borders. drug addicts in the country was 1.2 million. But national HIV/ AIDs experts have claimed that in reality the figure is nearer to In 1979, around 33,000 hectares of land were under opium 3.3 million addicts, using a rather different definition of cultivation in Iran. By 1993, this had fallen to 3,500 hectares addiction as repeated and continuing drug use over a nine (Narcotics Control Strategy Report 2001). The Iranian month period (Narcotics Control Strategy Report 2001). authorities have claimed that even this comparatively low Estimates of the numbers of injecting drug users in Iran ranged figure is an over-estimate (Mehryar A, personal from 200,000 to 300,000 (Iran News 2001; MAP 2001). The communication, 2001). A 1998/1999 survey of one million acres latest World Drug Report from the UNODC states that ‘Iran of land in traditional poppy growing areas concluded that could be home to as many as 200,000 injecting drug users’ opium cultivation was negligible (Narcotics Control Strategy (UNODC 2004). Report 2001).1 But as Iran’s importance as a producer of opium has declined, Drug-related harm its significance as a transit country has increased. This is The first Beckley Report concluded that the ultimate goal of because it shares a border with Afghanistan, now the largest drug policy should be to reduce drug-related harm. It shifted producer of opium in the world. It, therefore, links West Asian the evaluative emphasis ‘from effectiveness in reducing the use producers with markets in the Persian Gulf, Russia, Turkey and and production of illicit drugs to effectiveness in reducing the Europe. Drugs are flooding through the country. In the year harm associated with drug use and drug policy’ (Roberts M et 2000, 254,271 kilograms of controlled drugs were seized inside al 2004). Iran, including 6,189 kg of heroin, 20,275 kg of morphine, 179,053 kg of opium and 31,581 kg of hashish (UNDCP 2001). All else being equal, an increase in the availability of drugs will According to the World Drug Report 2004, 65 per cent of all result in a rise in drug-related harm. But other factors opiate seizures were in Asia in 2002, compared to 28 per cent in supervene on this relationship. These include methods by which Europe and 6 per cent in the Americas. In 2002, Iran accounted drugs are administered and the availability (or otherwise) of for a staggering 25 per cent of the world total - with services such as needle exchanges. Afghanistan’s other neighbour, Pakistan, accounting for 16 per cent (UNODC 2004).2 1 Although it was acknowledged that cultivation could be continuing in remote areas of the country that were not properly surveyed. More harmful patterns of drug use 2 There is a useful discussion of per capita seizures in the UNDCP report: ‘A It is widely accepted that levels of harmful drug use are calculation of [overall] seizures in unit equivalents on a per capita basis provides a somewhat different picture. The largest seizures are still found in the Americas increasing due to changing patterns of drug trafficking, and, (12 units per inhabitant in 2002) and in Europe (10 units), but Africa comes next particularly, the increase in the availability of heroin. It has (3 units) below the global average of 4 units, followed by Oceania (3 units). been estimated that 10 per cent of the populations of key cities Given the large population in Asia, per capita seizures in this region are relatively on the main trafficking routes are drug users.3 small (2 units per inhabitant). However, in the countries around Afghanistan (Pakistan, Iran, Central Asia) per capita seizures of 13 units in 2002 were even higher than in the Americas or in Europe’ (UNODC 2004, p. 40). A Rapid Situation Assessment (RSA) of ten urban sites conducted in 1998/1999 (Razzaghi E 1999) reported that the 3 In Tehran with a population of 12 million, it has been estimated that there are drug that had been most commonly used in the previous month about 240,000 drug users. It is widely felt by experts that this figure is far too low. was opium (73.3 per cent of respondents). But, in addition, over one third (39.4 per cent) of respondents had used heroin. In 4 Between the 1930s and 1950s it was a common practice to drink opium in tea some areas of Iran, life time prevalence rates for heroin use and coffee shops. But this is now subject to tough legal penalties. were extremely high: 70 per cent in Kermanshah, 62.7 per cent 5 The switch from opium to heroin use in these circumstances is a further in Khoransan and 60 per cent in Tehran. example of the substitution effect that has been discussed in detail in previous Beckley briefings and reports. 3 These points are well-illustrated in the case of Iran. A rise in quarter are aged between 15 and 30 years old. There has been a prevalence of drug use and changes in patterns of drug use have sharp fall in per capita incomes. Unemployment levels have been associated with a range of drug-related harms.