Methamphetamine Use Among Patients Undergoing Methadone Maintenance Treatment in Iran; a Threat for Harm Reduction and Treatment Strategies: A Qualitative Study

Abstract

Author(s): Radfar, Seyed Ramin; Cousins, Sarah J; Shariatirad, Schwann; Noroozi, Alireza; Rawson, Richard A | Abstract: 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.