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Helping Iran tackle its drugs problem

Some Persepolis outreach workers use bikes to get help to Tehran's drug addicts.

(Bijan Nassirimanesh)

An Iranian doctor who is helping to lead the fight against drug addiction in Tehran has been in Switzerland to see what he can learn from Swiss drugs policy.

Switzerland has adopted a four-pillar strategy which includes therapy, prevention and treatment as well as harm reduction measures such as needle-exchange services and heroin-assisted treatments.

Bijan Nassirimanesh is director of Persepolis, a non-governmental organisation that is pioneering new ways of dealing with drug addicts in Iran.

Invited by Ambros Uchtenhagen, a leading Swiss specialist in drug issues, he visited projects in Bern and Zurich to get a better idea of how Switzerland cares for its drug users.

"Iran is in the process of accepting the four-pillar approach and looking at the drug user problem as a public health issue as well as a law enforcement, treatment and prevention matter," Nassirimanesh told swissinfo.

"But the problem is huge because there are officially two million registered drug users, mostly opiate drug users, and... we are facing a serious problem of HIV and other problems like prison crowding and family disruption."

Persepolis set up the first NGO-based methadone programme in Iran and offers addicts, many of whom are homeless, services such as HIV testing services and clean syringes.

The programme's acceptance showed that Iran was slowly realising it had to change its former policy of repression against drug users, according to the doctor.

He has also been encouraged by the fact that a high level Iranian delegation visited Swiss drug projects last year.

Way forward

Nassirimanesh believes that the four-pillar strategy is the way forward for Iran. However, just like Switzerland 20 years, ago, it's a case of gaining acceptance.

"We have adopted [some measures], maybe it's too early to have safe injection rooms or heroin prescription trials but we hope to go slowly and stepwise based on evidence [of success]."

He cited the example of how Switzerland had cleaned up parks used by addicts through projects such as safe injection rooms near parks and outreach activities for young people.

"[The policy] opened the possibility for a decent and respectful type of treatment that benefits both society and drug users and their families," said Nassirimanesh.

Swiss drugs policy is aimed at preventing damage to the addict's health from low-quality street heroin and at reducing drug-related crime.

Some of its measures, such as heroin-assisted treatments, have been criticised as too liberal, but Uchtenhagen, head of the Addiction and Public Health Research Foundation at Zurich University, says the policy has been successful.

"We have a constant decrease of overdose mortality, of people starting heroin use and in HIV infection due to intravenous injections," he told swissinfo.

Model for others

Uchtenhagen believes the Swiss model could help other countries, even those with strong cultural or religious differences.

"You cannot just export what we do, but the overall concept is valuable around the world," he said.

"Our experiences can be shared, so people can think what is best for themselves and by sharing our experiences we can help them to avoid some of the mistakes we made."

The professor and World Health Organization expert is hoping to start training programmes in Iran this year.

Both Uchtenhagen and Nassirimanesh hope that the four-pillar approach can be extended to other Middle East and even Asian countries, where drug use still largely remains a taboo.

Uchtenhagen says it is also important to highlight what is being done in Iran to combat the drug problem, particularly by NGOs like Persepolis, which operate with limited resources.

"The political discussions here [in Switzerland] are completely dominated by some negative aspects and political quarrels, and we have no idea about the really very positive and impressive work that is done in this country," he said.

swissinfo, Isobel Leybold-Johnson

In brief

The Federal Health Office defines the four elements of Swiss drugs policy as prevention, therapy, harm reduction and law enforcement.

The concept of a fourfold approach to the reduction of drug-related problems was developed in the early 1990s.

A mid-1980s experiment to allow addicts to use the Platzspitz in Zurich, which become known as "Needle Park", was abandoned in the mid 1990s.

end of infobox

Iran's drug problem

There are an estimated 2 million opiate drug users in Iran, which has a population of 70.7 million people.

Experts say drug use is increasing due to changing patterns of drug trafficking. Iran shares its borders with Afghanistan, the leading producer of opium. Heroin is also increasingly available.

According to UNAids, high levels of HIV infection have been found in male injecting drug users in Iran, especially in prison.

Other problems include overburdened criminal and justice systems and increases in drug-related deaths.

end of infobox

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