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Iran now officially has more humane drug laws

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Karl Vick, Washington Post Foreign Service

Washington Post, Tue, 05 Jul 2005


Health Concerns Given Precedence Over Prosecution


TEHRAN -- Fearing an AIDS epidemic, Iran's theocratic government has

dropped a zero-tolerance policy against increasingly common heroin use

and now offers addicts low-cost needles, methadone and a measure of

social acceptance.


For two decades, Iran largely avoided the global AIDS crisis. But

today, officials are alarmed by a 25 percent HIV infection rate that one

survey has found among hard-core heroin users and worry that addicts may

channel the virus into the population of 68 million.


Supporters of the government's new approach laud it as practical and

devoid of the wishful thinking and moralism that they contend hampers

policies on drug abuse and AIDS in some other countries, including the

United States. "I have to pay tribute to Iran on this," said Roberto

Arbitrio, head of the U.N. Office on Drugs and Crime in Tehran.


Bijan Nasirimanesh, who heads a drop-in clinic that dispenses needles,

bleach and methadone in a hard-hit area of south Tehran, said, "It's

ironic that Iran, very fundamentalist, very religious -- very religious

-- has been able to convince itself" to embrace such policies.


Opponents often argue that tolerance of life-destroying drugs is simply

unacceptable and in the long run breeds acceptance and higher drug use.

But in the theocracy's most dramatic rejection of that approach, the

ayatollah who heads Iran's conservative judiciary issued an executive

order embracing "such needed and fruitful programs" as needle exchanges

and methadone maintenance.


Ayatollah Mohammad Esmail Shoshtari, the justice minister who has shut

more than 100 newspapers and imprisoned political opponents, instructed

prosecutors in a Jan. 24 letter to ignore laws on the books and defer

to Iran's Health Ministry to counter the spread of AIDS and hepatitis C.



"This was a very crucial step," said Ali Hashemi, director of Iran's

Drug Control Headquarters, a cabinet-level office. "Inevitably we have

to do this in order to reduce the risk of AIDS."


The policy demonstrates the complexities of Iran a quarter-century after

the Islamic revolution and U.S. Embassy takeover that still defines its

theocratic government for many Americans. Though power remains

concentrated in unelected clerics who brook little political dissent,

the government has demonstrated flexibility on a variety of subjects,

including birth control and sex-change operations, which the clerics

recently authorized.


After the revolution, Iran treated drug users as criminals, throwing

hundreds of thousands of them in jail. Now it has joined the ranks of

countries that acknowledge the difficulty of eradicating drug addiction

and focus instead on curbing the most immediate dangerous behaviors that

go with it.


Surveys of Iranians who test positive for HIV show that two-thirds were

infected by dirty needles. To reduce the spread of infections, the

government not only makes needles available without a prescription, but

through subsidies makes them extremely cheap, so as to discourage



"You pay less than 5 cents for a syringe," said Azarakhsh Mokri, of the

government's National Center for Addiction Studies. "People purchase up

to 100 at a time."


The government also encourages addicts to stop injecting by providing

free methadone, a surrogate opiate that is taken orally. This spring,

the parliament, dominated by conservatives, voted to allow any doctor in

Iran to dispense methadone, though under strict monitoring guidelines.


"It's quite amazing there's been this shift," said Rich Schottenfeld, a

professor of psychiatry at Yale University, which won a waiver from U.S.

sanctions on Iran to carry out a study financed by the National

Institute of Drug Abuse to compare drug treatments. "Five years ago, my

colleagues there didn't anticipate that methadone would even be

allowed," he said.


Robert Newman, director of the Baron Edmond de Rothschild Chemical

Dependency Institute at Beth Israel Medical Center in New York, said

Iranian policies are "in very dramatic contrast to what has been

happening with increasing frequency in America, where the judiciary and

the criminal justice system in general . . . does not let the

patients receive the treatment that the physician says is necessary."


Newman, who has traveled twice to Iran in the last five years to consult

on addiction programs, said only a quarter of an estimated 900,000

heroin addicts in the United States receive treatment. He attributes

that in large part to laws that restrict methadone to large-scale

treatment facilities. "In other words, the AIDS epidemic has done

nothing to open the way for treatment with methadone or any other

treatment for heroin addiction" in the United States, Newman said.


In Iran, heroin addiction is rising in a population of drug users

estimated at between 2 million and 4 million. Heroin use rose abruptly

about five years ago, when the Taliban rulers in neighboring Afghanistan

sharply reduced opium production. That drove up the price of opium,

leading people who had been smoking or swallowing it to switch to

heroin, which remained comparatively cheap.


Because heroin is often injected, the switch resulted in a surge of HIV

infections as users shared needles.


Until recently, the HIV infection rate among intravenous drug users in

Iran had been estimated at 5 percent. But in blood tests of 900 users

over eight months, the Persepolis clinic headed by Nasirimanesh found a

rate of 25 percent. "The bomb exploded," he said.


Officials said that rate was confirmed by a more recent study conducted

through Japan's Kyoto University. A lower rate, about 13 percent, was

recorded among users who get their methadone at the addiction studies

treatment center. Mokri said that was presumably because the center's

clients are typically better off than the often homeless junkies at the

Persepolis drop-in center and have avoided time in prisons where dirty

needles are far more common.


But the rates in all surveys are headed up. "The potential is very

bad," said Arbitrio of the U.N. agency. "If you have 160,000 injecting

plus 3 million drug users, you have all the elements to have the spread

of HIV/AIDS very quickly."


How quickly the virus might reach into the general population via sexual

contact is a sensitive issue in Iran. Experts here do not see

transmission though gay sex as an important avenue, but fear HIV will

spread in a big way through heterosexual sex.


Though the government has promoted a puritanical view on premarital sex,

it has tolerated prostitutes, who by many accounts have risen sharply in

numbers in recent years.


"I know some who are drug addicts," said Sorraya Heidari, 39, as she

waited for methadone at the Persepolis clinic. "To get the money they

need for drugs, they have to work as prostitutes."


There is also evidence that young people -- half of Iran's population is

under age 20 -- are more sexually active than some researchers believed.

Fully 70 percent of capital residents ages 15 to 20 have had sex

outside marriage, and almost none reported using condoms, according to a

survey of 2,000 Tehran young people by Tehran University and the State

Welfare Organization.


"Before, Iran always said this is something from outside," said Hamid

Reza Setayesh, the UNAIDS officer for Iran. "Now they are accepting

this is not only for drug users, but growing among people who are

sexually active."


Experts say the official reluctance to promote condom use generally is a

major drawback in Iran's evolving policy toward AIDS. Another is the

lack of anonymous testing for the virus. "They ask for your name,"

Setayesh said. "And they should not ask."


Public health specialists also caution that many of the new policies

have yet to be launched on a large scale. "The policies are very good,"

said Gelareh Mostashari, a physician in the U.N. drugs office. "But

there are practical applications that have to be executed."


Still, many drug experts say the government has shown a consistent

disregard for orthodoxies in this fight. Mokri said he was astonished

to encounter no official resistance when he set out to launch a pilot

program that will dispense actual opium instead of methadone to addicts.



He noted a bill pending in the U.S. Congress calling for imprisoning

Americans who failed to report marijuana dealers. "Sometimes I think

the ayatollahs are more liberal," Mokri said.


I mean, seriously, what the fuck.

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