Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.
Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran.
Int J Drug Policy. 2022 Feb;100:103529. doi: 10.1016/j.drugpo.2021.103529. Epub 2021 Nov 23.
There has been a marked growth in methadone maintenance treatment (MMT) in Iran in the past two decades with positive health outcomes. We conducted a systematic review of studies on the prevalence of non-prescribed methadone use, methadone use disorder, and methadone-related poisoning and mortality in Iran.
We searched International and Iranian databases up to May 2020 and contacted relevant experts. The pooled proportions were estimated through random-effects model. Methadone-related adverse outcomes were evaluated over time.
Sixty-five studies were included. The pooled estimates of non-prescribed methadone use in the last 12-month were 2.7% (95%CI: 0.9-5.4) and 0.1% (95%CI: 0.03-0.2) in the male and female general population, respectively. Among people who use drugs, 8.4% reported daily non-prescribed use in 2018. Four heterogeneous studies in drug treatment centers reported the existence of treatment-seeking for methadone use disorder. Methadone was responsible for 10.4% (95%CI: 4.5-18.3) of cases of acute poisoning in adults and 16.0% (95%CI: 9.3-24.1) in children. Methadone was reported as a cause of death in 53.5% of substance-related deaths referred to the Legal Medicine Organization while being the only cause in 35.8% of all cases.
Non-prescribed use of methadone in the general population is much less than opiates and some other available prescription opioids, like tramadol. However, notwithstanding the large and successful MMT program in Iran, increasing trends in methadone-related poisoning and deaths pose serious public health concerns. There is an urgent need to explore these fatal and non-fatal poisoning cases and implement policies to curb the harms associated with methadone use.
在过去的二十年中，伊朗的美沙酮维持治疗（MMT）显著增长，取得了积极的健康成果。我们对伊朗非处方美沙酮使用、美沙酮使用障碍以及与美沙酮相关的中毒和死亡的研究进行了系统评价。
我们检索了国际和伊朗数据库，截至 2020 年 5 月，并联系了相关专家。通过随机效应模型估计合并比例。评估了随时间推移的美沙酮相关不良结局。
共纳入 65 项研究。在过去 12 个月中，普通人群中美沙酮非处方使用的合并估计值分别为男性 2.7%（95%CI：0.9-5.4）和女性 0.1%（95%CI：0.03-0.2）。在吸毒者中，2018 年有 8.4%的人报告每天非处方使用美沙酮。4 项在药物治疗中心进行的异质性研究报告了寻求美沙酮使用障碍治疗的情况。美沙酮导致成人急性中毒的比例为 10.4%（95%CI：4.5-18.3），儿童为 16.0%（95%CI：9.3-24.1）。在提交给法医组织的与物质相关的死亡中，有 53.5%的死亡报告归因于美沙酮，而在所有病例中，仅有 35.8%的死亡报告归因于美沙酮。
在普通人群中，非处方使用美沙酮的情况远少于阿片类药物和其他一些可用的处方类阿片类药物，如曲马多。然而，尽管伊朗的美沙酮维持治疗项目规模庞大且取得了成功，但与美沙酮相关的中毒和死亡呈上升趋势，这对公共健康构成了严重威胁。迫切需要探索这些致命和非致命中毒病例，并制定政策遏制与美沙酮使用相关的危害。
