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Background: The prevalence of addiction is increasing in the world. Methadone Maintenance Treatment (MMT) can be associated with severe stress and mild to moderate depressive symptoms. Vitamins and minerals are commonly found in multivitamins seem to improve mood. Therefore, the aim of this study was to evaluate the effect of multivitamins on anxiety and depression in patients undergoing MMT in a double-blind randomized controlled trial. Methods: The study was designed as a double-blind, randomized controlled trial and involved 70 male MMT patients over the age of 18. Participants were randomized to one of two groups, either those receiving multivitamins or those receiving a placebo for 12 weeks. The multivitamin capsule included vitamin E, B1, B2, B3, B5, B6, B12, C, biotin, folic acid, and zinc. Anxiety and depression were measured using standard questionnaires, before and after the intervention. Results: The between-group comparison (i.e., intervention vs. placebo) indicated there was no significant difference in anxiety scores; however, there was a significant between-group difference in depression scores, favoring the intervention group. Conclusions: Multivitamin supplementation improved depression but did not have a significant impact on anxiety in patients undergoing MMT. [ABSTRACT FROM AUTHOR]

Introduction: Compulsory treatment has decades of history in Iran; both before and after the Islamic Revolution, but there are many debates regarding its efficacy and effectiveness. Retention Rate is one of the best indices to estimate the efficacy of treatment. This study will compare Retention Rate among people referred from compulsory treatment centers and volunteer participants. Methods: This was a retrospective (historical) cohort study that has been conducted among people who were taking methadone maintenance treatment (MMT). The study sample was selected from the MMT centers that admit both referral patients from compulsory centers and voluntary patients. All newly admitted patients from March 2017 to March 2018 were enrolled and followed up until March 2019. Results: A total of 105 participants were recruited for the study. All were males with a mean age of 36.6 ± 7.9 years. Fifty-six percent of individuals were referred from compulsory residential centers. The total one-year retention rate of participants in this study was 15.84%. The one-year retention rate for the patients referred from compulsory residential centers and the non-referred patients was 12.28 and 20.45%, respectively (value of p = 0.128). Among the other studied factors, only marital status was significantly associated with MMT retention (p = 0.023). Conclusion: Although the average treatment adherence time for non-referred patients was about 60 days higher than those referred from compulsory residential centers, this study found no significant differences in retention days and a one- year retention rate. Further studies with larger sample sizes and longer follow-ups are needed to explore the efficacy of compulsory treatment methods in Iran. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the effectiveness of Methadone Maintenance Treatment (MMT) from the perspective of drug users and their families. For this qualitative content analysis study, 15 participants were selected via purposive sampling. Data collection was done using deep and semi-structured interviews, which were then analyzed. The results showed that MMT can bring favorable impacts into the patients' lives and help them with the process of treatment and rehabilitation despite the medical side effects. [ABSTRACT FROM AUTHOR]

The current study has been carried out in order to investigate the effects of anxiety on the relapse of patients with opioid use disorders (OUDs) under methadone maintenance treatment (MMT). In this cross-sectional study, 2676 patients with OUDs, referred to MMT centers of Kermanshah from 2005 to 2017 were entered into the study. In order to evaluate the level of anxiety, Beck Anxiety Inventory (BAI) was used. The results showed that after controlling the role of other influential variables, the age of onset of substance use has significant effect on relapse, but there were no significance relationship between gender, age of quit, income, marital status, and education level with relapse. With the increase in anxiety score, the odds of relapse increased, so that people who had severe anxiety 3.43 (2.58 – 4.55) times greater relapse than those with a low level of anxiety. Nonlinear diagram showed that the highest increase in the odds of relapse was among those who had an anxiety score of 7 to 25 and then, with a moderate slope, the odds likelihood of relapse increased. Considering the effects of anxiety on relapse, it is recommended that health-care programs in all MMT centers need to have more focus in order to address anxiety among patients, in a more effective way. [ABSTRACT FROM AUTHOR]

Evaluation of costs and benefits of substance use treatment programs through a standard economic framework is necessary for optimal policy making. However, drug policy making is seldom supported by economic justification. Measurement of willingness to pay is a tool to provide better understanding of intangible substance use treatment outcomes and to help a balanced policy in treatment of substance use between maintenance treatment and abstinence-based approach. To assess the reciprocal association between economic indexes and attitudes about substance use and its treatment as indicators of tendency toward the two different treatment. Willingness to pay for treatment was measured by contingency valuation method among 109 treatment cost payers of which 78 subjects were from outpatient methadone maintenance clinics and 31 were from abstinence-based residential facilities. To analyze predictors of willingness to pay, we used income to capture heterogeneity of purchasing power among subjects. Further, we checked bivariate correlation of different attitudes of cost payers with willingness to pay. In the next step using backward regression equation we tried to reach the best specification of the model. Selected variables include cost payers' attitudes toward substance use and its treatment, effectiveness of treatment, social attitude toward the condition of substance use in Iran, fairness of treatment prices, and government financial support for addiction treatment. In methadone maintenance clinics the payers' income had a pivotal role in determining willingness to pay for substance use treatment by 50% (p <0.001). On the other hand, in abstinence-based residential facilities positive attitude toward substance use (61%, p <0.01) was the major direct determinant of willingness to pay for treatment. Attitude to public financial support for substance use treatment (55%, p <0.01) and consumption experience (45%, p <0.01) showed an inverse association with WTP in regression equation. This study expanded the understanding of the nature of payment in different substance use treatment modalities. The suggestion to policy makers is that before taking position on different types of treatment services, it is necessary to pay attention to factors that determine values cost payers put on treatment. In other words, economic indexes, payers' views about substance use and its treatment, and their opinion about effectiveness of substance use treatment programs may jeopardize the success of the policy. [ABSTRACT FROM AUTHOR]

Background: Women are the first victims in most of social damages and corruptions. However, due to some social and cultural reasons, the most of the drug addiction studies in Iran target male population. Hence, this study aimed to investigate the pattern of substance abuse and prevalence of HIV and hepatitis risk factors among addicted women. Methods: This is a cross-sectional study conducted on women referred to methadone maintenance treatment centers of Western Iran (Kermanshah province). Data were collected through interview by a psychologist who is working full time in the centers. Results: A total of 138 addicted women were studied. Among whom, 50 individuals were aged >45 years old (36.2%), 135 individuals (97.8%) had a history of substance abuse in their family, and 66 individuals (40.5%) initiated drug use before age 20. The most common substances were opium and crack with a proportion of 76.8% and 9.4%, respectively. Prevalence of positive HIV and hepatitis B among addicted women were 18.8% (26 persons) and 5.0% (7persons), respectively. Three (2.1%) of addicted women with HIV also had HBV. The most commonly HIV transmission were drug injections (30.7%) and unprotected sex (11.5%). Conclusions: Although women do not constitute a significant part of substance abuse, increasing trend of women addiction, on one hand, and high prevalence of risk factors related to HIV or hepatitis in women, on the other hand; show that officials and experts are required to seriously consider prevention and harm reduction programs for women. [ABSTRACT FROM AUTHOR]

Background: Methamphetamine (MA) abuse is a health concern among drug abuse patients in Iran. Objectives: This study aimed at determining the prevalence of MA dependence among a group of female methadone users and investigating the current psychological well-being, high risk sexual and criminality behaviors, and the status of receiving MA treatment. Methods: This study was a cross-sectional survey conducted in Iran. The study was conducted at 5 central female-only methadone services in Tehran and Karaj, during years 2011 to 2013. A questionnaire was devised to collect baseline data. The general health questionnaire-28 and the Opiate Treatment Index were used to assess psychological well-being, and criminality and high-risk sexual behaviors. Results: Overall, 245 females were registered at these sites. Of them, 201 females (82%) were dependent on MA while on treatment. Duration of MAdependence was 6 years. However, only 14.3% of the participants reported lifetimeMAtreatment. Noparticipant was on MA treatment. Participants reported high rates of MA-related depression (76.4%), anxiety (68.4%), social dysfunction (41.2%), and somatic symptoms (38.2%), respectively. Untreated MA dependence in methadone treatment was associated with engagement in high-risk sexual behaviors (43.8%) and criminality (28.7%). Only 10% of the participants reported receiving a lifetime matrix model. All of them reported that the Matrix model was long and it was not easily available in methadone services. Conclusions: The study showed that the high prevalence for MA dependence and its adverse health impacts while receiving MA treatment remained the same. Effective psychosocial treatments should be delivered forMAdependenceamong female methadone users. [ABSTRACT FROM AUTHOR]

Background: Methamphetamine as one of the most prevalent drugs can reduce the efficacy of interventions designed to reduce HIV prevalence such as opioid substitution therapy and other harm reduction interventions. Harm reduction facilities and interventions have mainly been designed for opioid users, but due to the high prevalence of methamphetamine use among the clients, these settings could be appropriate entry points for providing methamphetamine focused harm reduction interventions. Objectives: The present study aimed at examining the effects of the integration of a methamphetamine harm reduction intervention into opioid harm reduction services of drop in centers (DICs) on the high- risk behaviors of the participants. Methods: This prospective study was conducted to evaluate changes in high- risk behaviors associated with methamphetamine use among regular methamphetamine user clients of 10 DICs located in provincial capitals of Iran from September 2014 to March 2015. Participants were evaluated before and after a manual based psychoeducation intervention. Results: In total, 357 clients (18.5% females, and 81.5% males) entered the study; of whom, 60.3% of males and 83.3% of females were daily methamphetamine users at initial assessment. The prevalence of injection in the last 3 months was 8% and 1.6% among male and female participants, respectively. The frequency of sexual intercourse among participants had a significant reduction after intervention. The use of a condom in the last intercourse was increased significantly, moreover, having sexual intercourses without condom under the influence of methamphetamine was reduced, especially among females. Conclusions: The results of the present study provide provisional data on the effectiveness of stimulant harm reduction among clients of DICs in Iran. In addition, our findings revealed that service providers believe that this integration is feasible and the clients found it acceptable. Conducting studies with more rigorous design and longer follow-up is highly recommended. [ABSTRACT FROM AUTHOR]

Background: Considering different factors, such as high withdrawal rates in methadone maintenance treatment (MMT) programs alongside mental health (MH) problems appearing in patients with opioid use disorder and the lack of prior research on the effect of zinc supplementation in this respect, the present study aimed to investigate the effect of zinc supplementation on the probability of relapse (PoR) and MH problems in patients with opioid use disorder undergoing MMT., Methods: For this purpose, a randomized controlled trial with a clinical basis was fulfilled on a total of 68 patients with opioid use disorder receiving MMT, allocated to two groups, viz. intervention, and control (each one consisting of 34 individuals). Then, the participants in the intervention group were given zinc supplements combined with methadone for three months, and the controls only took methadone, according to the treatment plan. The data were collected using the Relapse Prediction Scale (RPS) and the Depression, Anxiety, and Stress Scale 21 (DASS-21) before, one month after, and at the end of the intervention program., Findings: Compared to the control group, the likelihood of drug use (p = 0.01), drug craving (p = 0.002), and the RPS total score (p = 0.002) in the intervention group was significantly lower. Moreover, the results revealed a significant decreasing trend in depression (p = 0.01), anxiety (p < 0.001), stress (p = 0.001), and the DASS-21 total score (p = 0.001) in the intervention. Compared to the control group, the DASS-21 total score (p < 0.001) in the intervention group was significantly lower., Conclusion: Accordingly, it was concluded that zinc supplementation could reduce the PoR and improve MH problems in patients with opioid use disorder experiencing MMT. However, further research is recommended to fill the gaps., Trial Registration: The research protocol has also been listed on the Iranian Registry of Clinical Trials (IRCT) with code no. IRCT2020050904736N1., (© 2023. The Author(s).)

Background: Methadone is a synthetic opioid, used in treatment of chronic pains. The current study was carried out to evaluate the QTc interval in Iranian causalities (Janbazan) of Iran-Iraq war receiving maintenance methadone treatment. Materials and Methods: In 2010, one hundred war causalities in Isfahan who chronically take daily dose of 20 mg or more of methadone (more than 2 weeks), and did not have the history of cerebrovascular or coronary artery diseases, cardiac pacemaker, congenital prolonged QTC, or taking drugs affecting QTc, or having electrolyte abnormalities, were selected for the study. An electrocardiogram was taken from each patient using cardiofax instrument, and QTC was calculated manually. The data was analyzed using SPSS software with descriptive statistical methods and Pearson's correlation coefficient. Findings: All patients were male and had the mean age of 45.6 ± 6.1 years. The patients received 20-240 mg methadone daily for 1 to 108 months. The QTc was prolonged in 25% of the patients (QTc 5 450 ms), with the mean of 472.72 ± 18.5 ms (range 450-508 ms) and the mean daily dose of methadone 85.2 ± 59.0 mg. No significant relationship was observed between QTC interval on the one hand, and methadone dose (R = 0.025, P = 0.8), duration of treatment (R =-0.048, P = 0.68), age (R = 0.037, P = 0.71), and weight (R = 0.1, P = 0.21) of the patients, on the other hand. None of the patients had faint, syncope, arrhythmia, or sudden death. Conclusion: Oral methadone causes prolongation of QTC interval. However, the dosage of methadone and duration of treatment were not statistically related to QTC interval. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study aimed to investigate the context in which methadone maintenance treatment (MMT) is provided for opioid-dependent prisoners, and to identify barriers against further scale-up of MMT in Ghezel Hesar prison in Tehran. Methods: This was a cross-sectional qualitative study using field observations, focus group discussions, and individual interviews. In total, 30 prisoners and 15 prison staff and health policymakers participated in this study in November 2006. Results: The rate of drug injecting in the prison unit was unanimously reported to have decreased drastically since introducing the MMT program. In addition to the health benefits to MMT recipients, interview data indicates that MMT has had positive effects on socio-economic status of prisoners’ families. Nevertheless, several impediments to the provision of MMT services and to its further expansion were also identified, including staff shortages, some degree of methadone diversion, widespread concerns over the possible side effects of methadone, and the stigma attached to methadone treatment. Conclusion: MMT constitutes one of the main components of the Iran Prison Organization''s comprehensive HIV prevention package and is becoming increasingly accessible to opioid-dependent prisoners in Iran. Our findings indicate that the MMT program in Ghezel Hesar prison has been helpful for many opioid-dependent prisoners to reduce their risk of drug-related harm and to ease social and financial burden over their families. Meanwhile, existing barriers against provision of MMT should be properly addressed before further scale up of the program. [Copyright &y& Elsevier]

Abstract: Background: Research evidence indicates that prisoners in Iran are at risk of drug-related harm, including acquisition of blood-borne infections. In response, several prevention interventions including methadone maintenance treatment (MMT) have been introduced into prisons in Iran. Methods: This report reviews and presents some important information extracted from published articles, and available documents on HIV sentinel surveillance and provision of MMT inside correctional settings in Iran. Results: Biological surveillance data in 2005 showed that on average about 3% of prisoners in the country tested positive for HIV infection. MTT that constitutes a main component of the Prison Organisation''s HIV prevention package is becoming increasingly accessible to opioid-dependent prisoners. Between 2002 and 2008, the number of opioid-dependent prisoners receiving MMT increased steadily from 100 to more than 25000. Conclusion: Experiences in Iran suggest that access to MMT would be helpful for reducing illicit drug injection in a prison setting and can be considered as a major intervention for preventing the transmission of blood-borne infections among prisoners. [Copyright &y& Elsevier]

Background: Opioid use is a severe problem in Iran. Despite methadone maintenance treatment (MMT) programs being one of the most important treatment strategies for reducing individual and public harms associated with opioid use, a large proportion of Iranian patients refuse to participate in such treatment programs. Methods: The present study aims to explore the beliefs and attitudes toward MMT programs of opioid-dependent patients who were participating or had participated in methadone therapy. In-depth interviews were conducted with 23 opioid users between 27 and 58 years of age from Kurdistan provinces. Results: Overall, six themes were discovered to be key barriers relating to methadone treatment, including financial barriers related to methadone treatment, lack of awareness about methadone treatment, negative attitudes regarding using methadone, worries about methadone's side effects, social stigma ascribed to methadone therapy, and systemic barriers to methadone treatment. Conclusion: Our study revealed that the cost of treatment is a major obstacle to attending and continuing at MMT programs and that addicts and their families are not always accurately informed about the duration of MMT programs and the side effects of methadone treatment. [ABSTRACT FROM AUTHOR]

Background: To identify correlates related to retention time of a cohort study of the opioid-dependent patients participating in the Methadone Maintenance Treatment (MMT) program offered by a major addiction treatment clinic in Tehran, Iran between April 2007 and March 2011., Methods: Several parametric Survival models assuming Weibull, Log-normal and Log-logistic distributions were compared to search for association between covariates and risk of relapse and dropping out of treatment among 198 patient participants., Results: According to Akaike Information Criterion (AIC), Log-normal model had the best fitting. Estimates of this model indicated that increase in average methadone dosage was associated with longer retention time. Correlates associated with shorter retention time were suffering from mental disorders, using stimulant drugs, being poly-substance dependents and having prior treatments., Conclusions: Findings of this study provide support for giving more attention to patients who are poly-substance or stimulant-drug dependents, have non-substance psychiatric comorbidity and the ones with addiction treatment history. Independent of patient characteristics, retention improved as the dose of methadone increased.