Background: Opiates are the most commonly reported substances of abuse in Iran. Over two thirds (68%) of all newly identified HIV cases in Iran are among people who inject drugs. On the heels of the HIV epidemic, methamphetamine use has grown. Public health officials are concerned that methamphetamine use has gained popularity among individuals who use opioid substitution therapy, such as methadone maintenance therapy. Objectives: The purpose of this qualitative study is to inform stakeholders of the motivations and experiences of MMT patients who use methamphetamine. Patients and Methods: To gain a better understanding of patients' motivations and experiences with MMT and methamphetamine, the authors conducted 7 focus groups with 45 participants in drop-in centers, public outpatient clinics, and a private outpatient clinic in Isfahan, Iran. Results: Patients reported that their use of methamphetamine was motivated by methadone's side effects and encouraged by family and friends who promoted methamphetamine use to assuage the side effects of methadone in the early stages of treatment before the appearance of methadone maintenance therapy's effects on their life. Conclusions: Findings suggest that there is a need for evidence-based practices in methadone maintenance therapy programs in Iran to reduce methamphetamine use among methadone maintenance therapy patients. Methamphetamine use among methadone maintenance therapy patients in Iran can reduce the efficacy of these services in reducing risky behaviors as well as other desired outcomes of methadone maintenance therapy. Our findings suggest two strategies that may be of use (or our findings suggest that two strategies that may be of use are: 1) educate patients and their families about methadone's side effects and the contraindications of methamphetamine use by treatment team and/or peer groups' educators; 2) integrate routine amphetamine testing into methadone treatment. These findings may be useful to those designing and implementing strategies for reducing methamphetamine use in methadone maintenance therapy programs in Iran.
Background: Methamphetamine (MA) use remains a major public health concern around the world. Recent findings suggest that buprenorphine may be helpful for cocaine use reduction. Moreover, animal studies described reduced dopamine peak effect following MA use, due to the administration of low dose buprenorphine. Objectives: This study examined the effectiveness of buprenorphine with brief cognitive behavioral therapy on MA use disorder. Methods: The study was conducted in an outpatient substance abuse treatment center in Qazvin, Iran. Nineteen MA users received buprenorphine for 24 weeks combined with brief cognitive behavioral therapy in an outpatient substance abuse treatment program, three times per week, as a before and after non -randomization study. Clinical outcomes included treatment retention, MA use, degree of MA dependency and craving, quality of life, cognitive abilities questionnaire, addiction severity and also adverse events. Data was analyzed by performing repeated measures analysis and the Friedman test for nonparametric variables. Results: Fifteen participants completed the study during six months and frequency of MA use was significantly decreased at 24 weeks (P < 0.001). There were also significant reductions in craving (P < 0.001), degree of MA dependence (P < 0.001), and improvements in quality of life, cognitive ability, and some subscales of addiction severity.
Conclusions:The results of this preliminary clinical study demonstrated that buprenorphine could potentially attenuate MA craving and alternate rewarding effects of MA and had promising effects on cognitive impairment. Furthermore, buprenorphine can be considered as a harm reduction intervention in some communities, in which the people, as a result of cultural beliefs, do not accept a therapy, which only consists of counseling and no medications.
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 testretest 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.
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