Originally, MMT programs were launched in Iran as a harm-reduction initiative. Although buprenorphine maintenance therapy (BMT), a well-known type of OST, is now available in Iran, MMT programs are the most frequently used therapy. In recent years, more than 80% of the recognized drug-treatment seekers in Iran were primarily dependent on opioids. There is evidence that in low- and middle-income countries where there is a lack of treatment programs, the expansion of MMT programs might lead to savings in social and health expenditures. For instance, a research study conducted in California during 20 found that substance abuse treatment has a benefit-to-cost ratio greater than 7:1. MMT is also a more cost-effective treatment intervention than other opioid maintenance treatments. All these returns ultimately have a positive influence on public health and security as well as human capital and social productivity. Studies have also shown that stabilizing patients in MMT programs provides them with a better chance to find and hold a suitable job, work more productively, build strong family and social relations, and enhance their quality of life. Furthermore, MMT seems to improve HIV treatment outcomes, reduce HIV and hepatitis transmission, control dysfunctional behaviors, and suppress criminal activities, notably drug-related crimes such as drug dealing. Scientific evidence has demonstrated that MMT has the capacity to reduce the need to use opioids, particularly opioid injection decrease the adverse health effects of drug use, such as fatal and nonfatal drug overdoses and keep patients in treatment and decrease the risk of relapse to drug use. Stable, prolonged MMT yields prominent benefits to both patients and communities. It is readily available for patients seeking opioid treatment in many countries, and it was implemented in 60 out of 70 countries providing opioid treatment services (OTS) in 2009. Methadone maintenance therapy (MMT) is the most frequently used opioid therapy. Illegal opioid markets are also linked to rises in crime and social insecurity. In addition, opioid markets increase illegal careers and negatively affect the resources available in legal economies. Beyond the health burdens of opioid use disorder on individuals and communities, dependence on drugs hinders economic productivity and diminishes human capital. Opioid use harms individuals physically and psychiatrically, imposes economic and social burdens on society and raises huge public health concerns in Iran as well as internationally. Although opium is the dominant type of opioid used in Iran, over time, the pattern of opioid use in Iran has changed into other types of opioids, such as shireh, heroin, and kerack-heroin. Opioid use has a long history in Iran, as a result of which there is some level of social tolerance toward it in some regions. The United Nations Office on Drugs and Crime (UNODC) reported that in 2013, the universal prevalence of opioid use among adults was around 0.7%, which ranked opioids as the second most common form of illicit drug used worldwide. 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.
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.
In-depth interviews were conducted with 23 opioid users between 27 and 58 years of age from Kurdistan provinces. 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. 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.
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