1. Background
Amphetamine-type stimulants, including methamphetamine (MA), are the second most commonly used illicit drugs in the world, after cannabis (1). Methamphetamine dependence in Iran is associated with multiple harms (2-4). A previous study assessed the clinical course of patients with MA-induced psychotic disorder in a 3-month follow-up. Overall, 50 patients (7 females and 43 males) were assessed. Forty-six patients (92%) were re-assessed at follow-up. More than half of the patients, who relapsed to MA use, did not adhere to the treatment again. Positive, negative, and manic symptoms were improved in abstinent patients (5). In a qualitative study, 45 males (35 MA-dependent patients, 5 family members, and 5 psychiatrists and medical doctors) were interviewed. The results showed the negative impacts of MA dependence on sexual function. A dramatic increase in libido, erectile dysfunction, premature ejaculation, and losing control during sexual intercourse was reported (6).
Methamphetamine dependence has increased in Iran (7). A review from Iran indicated that MA dependence has increased among females and opioid-dependent people on methadone maintenance treatment (medication assisted treatment). The result showed that MA and ecstasy dependence in 2016 was < 1% in the general population, yet this prevalence was higher in patients on methadone (7). Another study showed that dependence on methamphetamine requires special treatment and rehabilitation programs (8).
2. Objectives
The study aimed at determining the prevalence of MA dependence among a group of female methadone patients. The other aims were to investigate current psychological well-being, high risk sexual, criminality, and the status of receiving MA treatment.
3. Materials and Methods
This study was a cross-sectional survey of the prevalence of MA dependence in central female-only methadone services of Tehran and Karaj, Iran. All the female-only methadone services in Tehran and Karaj were included in this study. All of the females in these 5 methadone services were recruited. Females were needed to be at least 17 years old and being on methadone treatment for at least 2 months. All females met the criteria of the diagnostic and statistical manual of mental disorders, fourth edition, third revision for MA dependence (9). There were several exclusion criteria including reporting withdrawal symptoms and drug intoxication at the time of interviewing.
A questionnaire was devised to collect data. Part of the questionnaire, included open-ended questions regarding lifetime MA treatment and problems associated with MA treatment. The questionnaire assessed 36 females in a 2-week test-re-test; the reliability was a = 87%. Females were MA-dependent and on treatment. General health questionnaire (10) and opiate treatment index (11) were used to assess mental health, criminality, and high-risk sexual behaviors. Both questionnaires were assessed on the same females and showed high reliability (a=83% on the first one, a=89% on the second one, respectively).
Females were informed that the study was confidential and voluntary. Participants received 8 USD for participation. Tehran University of Medical Sciences (90-01-49-25493) approved the study. Consent forms were obtained from all participants. Data were analyzed using SPSS version 23 software.
3.1. Study Procedures
An interview room was used for conducting the study at each center. Participants were interviewed between 10th of January 2011 and 26th of December 2013. Each individual was invited and interviewed by a female clinical psychologist.
4. Results
Overall, 245 female methadone patients were registered at the sites. Of them, 201 females (82%) met the criteria for MA dependence (9) while in treatment. Most of the participants reported stable living conditions (63.6%). Duration of MA dependence was 6 years. However, only 14.3% of the participants reported lifetime MA treatment. No participant was on MA treatment while in treatment (Table 1).
Table 1.Participant Characteristics (n = 201)
| Characteristics | Mean/Percent |
|---|---|
| Female | |
| Mean age, y (range 19 - 62) | 039 (SD 8.5) |
| Mean schooling, y (Range 0 - 12) | 007 (SD 6.5) |
| Living conditions | |
| Stable | 128 (63.6) |
| Unstable | 073 (36.4) |
| Employment | |
| Jobless | 137 (68.1) |
| Employed | 64 (31.8) |
| Marriage | |
| Currently married | 76 (37.8) |
| Currently unmarried | 125 (62.2) |
| Current MA dependence | (100) |
| Age of MA dependence | 31 (SD 5.8) |
| Duration of MA dependence | 6 (SD 8.2) |
| Duration of methadone treatment (range 2 - 26 months) | 8 (SD 5.3) |
| Lifetime MA treatment | |
| Matrix Model | 029 (14.3) |
| Present MA treatment | 000 (0) |
Dependence on MA was accompanied with high rates of depression (76.4%), anxiety (68.4%), social dysfunction (41.2%), and somatic symptoms (38.2%) on the general health questionnaire-28, respectively. Furthermore, MA dependence was associated with engagement in high-risk sexual behaviors (43.8%) and criminality (28.7%) on the Opiate Treatment Index. Among participants, who reported lifetime Matrix treatment, all reported that the Matrix Model was long (100%) and it was not easily available (56%) in methadone services (Table 2).
Table 2.Adverse Health Impacts of Methamphetamine Dependence (n = 201)
| Characteristics | Mean/Percent |
|---|---|
| General Health Questionaire-28 | |
| Depression | 153 (76.4) |
| Anxiety | 138 (68.4) |
| Social dysfunction | 83 (41.2) |
| Somatic symptoms | 77 (38.2) |
| Opiate Treatment Index | |
| High risk sexual behaviors | 87 (43.8) |
| Criminality | 58 (28.7) |
5. Discussion
To the best of the author’s knowledge, this brief report is the first survey of the prevalence of MA dependence amongst 5 Iranian female-only methadone treatment services. The report is important because it shows how MA dependence can be associated with multiple harms, which may negatively influence methadone outcomes. The present report addressed MA dependence among Iranian female methadone users, who have been underreported (12). In this study, female patients were middle-aged. Most of them reported stable living conditions yet they were generally unemployed. This is consistent with a study, which indicated that most female methadone patients were unemployed and middle aged (13).
In this study, MA dependence was associated with high rates of MA-related depression, anxiety, social dysfunction, and somatic symptoms. This indicated poor psychological well-being. Furthermore, MA dependence in treatment was associated with engagement in high-risk sexual behaviors and criminality. This issue demands an effective treatment. Comorbidities, such as poor mental health, can reduce positive drug treatment outcomes (14). Further studies are suggested in this regard.
At the time of interviewing, no participant was on MA treatment. Among participants, who reported lifetime Matrix treatment, all of them reported that the matrix model was long and it was not easily available in methadone services. Some studies showed that the matrix model might be used for the treatment of MA dependence (15-18). Effective psychosocial treatments should be provided.
5.1. Conclusions
The study showed the high prevalence of MA dependence and its adverse health impacts while receiving MA treatment remained constant. As MA dependence continues among female patients, it is necessary to ensure that adequate resources are allocated to different treatment approaches, such as the Matrix Model. However, the treatment is intensive and may not be cost-effective for female patients. Methadone services should provide short psychological treatments.
