An Epidemic Problem: A Commentary on Stimulant Use in Opioid Maintenance Treatment


avatar Saeed Nateghi 1 , * , avatar Hosein Effatpanah 2

School of Medicine, Ziaeian Hospital, International Campus, Tehran University of Medical Sciences, Tehran, Iran
Department of Public Health, Asadabad School of Medical Sciences, Asadabad, Iran

how to cite: Nateghi S, Effatpanah H. An Epidemic Problem: A Commentary on Stimulant Use in Opioid Maintenance Treatment. Iran J Psychiat Behav Sci. 2019;13(4):e97805.

Dear Editor,

A paper by Danesh and Noroozi entitled ‘‘Concurrent amphetamine and methamphetamine use among clients of opioid maintenance treatment programs in Golestan, Iran’’ has been recently published in your journal. In our view, the authors have highlighted the prevalence of the critical problem of amphetamine and methamphetamine use in OPIOID MAINTENANCE TREATMENT PROGRAMS (OMTPs) (1). The concurrent use of stimulants in OMTPs remains a challenging concern in Iran, associated with important health implications (2-4). This health concern is serious due to the effects of the stimulant use on OMTPs such as poor treatment outcomes, poor treatment retention, and compliance (1-4).

In their study of 750 patients, 8.1% had positive urine samples for amphetamine or methamphetamine. Overall, 41.8% of the participants had positive samples for morphine. Interestingly, the authors highlighted that positive urine specimens for morphine were significantly higher among those who had positive urine samples for amphetamines. Furthermore, lifetime alcohol use and imprisonment were associated with positive urine samples for amphetamines (1).

Recently, at the research level, psychological treatments such as motivational interviewing, the Matrix model, and cognitive-behavioral therapy have been evaluated for stimulant users in OMTPs (5-10). However, at the clinical level, these treatments need to be widely considered for stimulant use.

In our view, Danesh and Noroozi s’ research paper is a valuable and influential study that aimed to identify and investigate the prevalence of a new health problem. As a well-designed research study, the paper benefits the clinicians and researchers by providing a summary of the existing evidence, generating new hypotheses, and showing the research gaps. We suggest that the delivery of effective psychological treatments be considered for Persian stimulant users in OMTPs.


  • 1.

    Danesh A, Noroozi A. Concurrent amphetamine and methamphetamine use among clients of opioid maintenance treatment programs in Golestan, Iran. Iran J Psychiatry Behav Sci. 2019;13(2). e74234. doi: 10.5812/ijpbs.74234.

  • 2.

    Dana S, Effatpanah M, Mahjoub A. The new epidemic problem of psychoactive drugs at drug treatment centers of Iran: Implications for education, prevention and treatment. Iran J Psychiatry Behav Sci. 2018;12(2). doi: 10.5812/ijpbs.63555.

  • 3.

    Rafiey H, Ghaderi S, Morovat B, Noori R, Effatpanah M, Mahjoub A, et al. Amphetamine type stimulants use in the adult population of Tehran: Implications for long term rehabilitation. Iran Rehab J. 2017;15(4):303-8. doi: 10.29252/nrip.irj.15.4.303.

  • 4.

    Massah O, Effatpanah M, Moradi A, Salehi M, Farhoudian A, Karami Z. Barriers to hepatitis C treatment among women in methadone treatment: A study from Iran, the most populous Persian Gulf country. Addict Health. 2017;9(4):229-36. [PubMed: 30574286]. [PubMed Central: PMC6294482].

  • 5.

    Salimi S, Effatpanah M, Mahjoub A. Motivational interviewing can facilitate entry to matrix treatment for methamphetamine dependence. Iran J Psychiatry Behav Sci. 2018;12(2). doi: 10.5812/ijpbs.63560.

  • 6.

    Shakiba K, Effatpanah M, Moradi A. Cognitive-behavioral therapy for methamphetamine dependence among methadone-maintained patients. Iran J Psychiatry Behav Sci. 2018;12(2). doi: 10.5812/ijpbs.63615.

  • 7.

    Massah O, Effatpanah M, Shishehgar S. Matrix model for methamphetamine dependence among Iranian female methadone patients: The first report from the most populated Persian Gulf country. Iran Rehab J. 2017;15(3):193-8. doi: 10.29252/nrip.irj.15.3.193.

  • 8.

    Sami S, Effatpanah M, Moradi A, Massah O. Matrix model as an intensive rehabilitation in three methadone services in Iran. Iran Rehab J. 2017;15(3):293-8. doi: 10.29252/nrip.irj.15.3.293.

  • 9.

    Shariatirad S, Mahjoub A, Haqiqi A, Rezaei Hemami M, Tofighi B, Ekhtiari H, et al. Buprenorphine added on brief cognitive behavioral therapy for treatment of methamphetamine use disorder. Iran J Psychiatry Behav Sci. 2018;12(2). doi: 10.5812/ijpbs.11529.

  • 10.

    Effatpanah M, Moradi A. Methamphetamine dependence and technology-based interventions in Iran. Iran J Psychiatry Behav Sci. 2018;12(2). doi: 10.5812/ijpbs.62935.

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