180 male patients treated with methadone with an average age of 36.77 and a range of changes from 20 to 61 years, to investigate the changes in the pattern of drug use in them, were evaluated during three periods after the earthquake in the west of the country. The majority of the patients, with frequencies of 75 (41.7%), 50 (27.8%), and 43 (23.9%), were in the age group of 31–40, 20–30, 41–50 years, respectively and the lowest number of the participants was 12 (6.7%), who were over the age of fifty. More than half of the patients, 99 (55.0%) of them had a high school diploma and 50 (27.8%) of them had a university degree. Those who did not have a high school diploma or had lower education than high school, 31 (17.2%) people, had the lowest number of participants. 13 (7.2%) patients reported a positive history of psychiatric illness in their family, the majority of whom, 12 (6.7%) people, had a mood disorder (depression-bipolar disorder) and 1 (0.6%) patient had an anxiety disorder. 51 (28.3%) of them reported a positive history of SUDs in their family. Among the surveyed people, 18 (10.0%) of them reported the loss of family members or relatives during the earthquake. In terms of the number of financial losses caused by the earthquake, the majority of the participants in the study, 75 (41.7%) people, reported more than 1000 million Tomans loss, and 49 (27.2%) people reported about 210–1000 million Tomans loss. Also, 56 (31.1%) people reported the maximum amount of these losses up to 200 million Tomans (Table 1).
Table 1
Frequency distribution of demographic characteristics and self-report records of men treated with methadone
Variables | Levels | Frequency (%) |
age(year) | 20–30 | 50(27.8) |
31–40 | 75(41.7) |
41–50 | 43(23.9) |
> 50 | 12(6.7) |
education | <High school | 31(17.2) |
high school | 99(55.0) |
Bachelor and more | 50(27.8) |
history of psychiatric illness in the patient's family | Yes | 13(7.2) |
No | 167(92.8) |
Kind of psychiatric illness in the patient's family | Mood disorder (depression-bipolar) | 12(6.7) |
Anxiety disorder (Obsession-Anxiety) | 1(0.6) |
No | 167(92.8) |
family history of addiction | Yes | 51(28.3) |
No | 129(71.7) |
loss of family members of the patient in the earthquake | Yes | 18(10.0) |
No | 162(90.0) |
amount of financial damage caused by the earthquake (million rials) | <= 200 | 56(31.1) |
210–1000 | 49(27.2) |
> 1000 | 75(41.7) |
Total | 180(100.0) |
The results of the initial assessments showed that at the beginning of the study, the majority of the subjects, 104 (57.8%), were married, 62 (34.4%) were single and 12 (6.7%) were divorced. Also, 2 (1.1%) of them reported the death of their spouse in the years before the earthquake. The results of the second and third evaluations of the study at the time of eight and twelve months, respectively, after the earthquake, showed that the earthquake and its aftermath did not change the marital status of the subjects who were studied. In the initial assessment, 122 (67.8%) of the people declared that they were employed and 58 (32.2%) declared that they were unemployed. In the second evaluation, one percent of the unemployed, 56 people, decreased from 32.2–31.1%, and the number of employed, 124 people, increased from 67.8–68.9%. In the initial evaluation, the majority of the people with a frequency of (47.2%), 85 people, and (41.1%), 74 people, had low (< 1.5) and average (1.5-3.0) income respectively and only 21 people (11.7%) were reported to have a good income level, (> 3.0) million Tomans. In the second evaluation, the percentage of the people with good income decreased by about one percent, and the number of the people with average and low income increased by an equal percentage and in the third evaluation, there was only a 0.6% decrease in the ratio of the people with good income levels and there was the same increase (0.6%) in the ratio of the people with low-income levels. However, in all three evaluations, the majority of the people had low, average, and good income levels, respectively. In terms of a person’s history of mental illness, only 9 people (5.0%) reported a history of mood disorders as depression or bipolar disorder before the earthquake, which increased to 17 people (9.4%) in the first post-earthquake evaluation. Also, in the initial evaluation 5 patients (2.8%) reported anxiety disorders. In the second and third evaluations of the study, only mood disorders such as depression and bipolar disorder were reported whose ratio was reported (3.3%), 6 people, in the second evaluation and (5.6%), 10 people, in the third evaluation. This means that the prevalence of mood disorder during the earthquake and subsequent follow-up had increased and was higher than before the earthquake (Table 2).
Table 2
Frequency distribution of demographic characteristics and medical records of the studied men treated with methadone before the earthquake and three stages of post-earthquake evaluation
Variables | Levels | Before the earthquake | 4months after the earthquake | 8 months after the earthquake | 12 months after the earthquake |
occupation | Employed | --- | 122(67.8) | 124(68.9) | 124(68.9) |
unemployed | --- | 58(32.2) | 56(31.1) | 56(31.1) |
income | Low | --- | 85(47.2) | 86(47.8) | 85(47.2) |
Middle | --- | 74(41.1) | 75(41.7) | 75(41.7) |
High | --- | 21(11.7) | 19(10.6) | 20(11.1) |
history of mental illness | Mood disorder (depression-bipolar) | 9(5.0) | 17(9.4) | 6(3.3) | 10(5.6) |
Anxiety disorder (Obsession-Anxiety) | 0(0.0) | 5(2.8) | --- | --- |
No | 171(95.0) | 158(87.8) | 174(96.7) | 170(94.4) |
Total | 180(100.0) |
The first age of SU for 111 (61.7%) of the patients participating in the study was 21–30 and 48 (26.7%) of them were < = 20. Also, 21 (11.7%) of the patients reported the age of over 40 as the first age for SU, of whom 120 (66.7%) patients reported 1–2 g and 37 (20.6%) reported > 2 g as their first dose that they took. Also, the type of substance that was first used by the majority of the patients was reported, for 162 (90.0%) of them, to be in the category of opium and for 12 (6.7%) in the category of stimulants. 5 (2.8%) of the patients also expressed that their first drug use was as a combination of opium, stimulant, and hallucinogenic drugs. Among the patients about (63.9%), 115 patients, had no history of simultaneous use of several substances and the rest of the patients, (28.4%) 51 of them, had a history of simultaneous use of several substances and, 50 patients (27.8%) reported a history of simultaneous use of different substances derived from opium and 1 (0.6%) reported a history of simultaneous use of different substances from the stimulants. 85 (47.2%) had a history of drug withdrawal, the majority of whom, 45 (25.0%), had been hospitalized and 17 (9.4%) had tried to go through withdrawal using possible methods at home. In terms of the type of substances that were used before methadone treatment, the majority of the people, 162 (90%), reported opium, and 11 of them (6.1%) stimulants as the substance they used earlier. Also, 6 people (3.3%) reported several kinds of substances they used before starting methadone treatment. Among them, only 1 person (0.6%), in terms of the type of drug used before, used a substance in the category of hallucinogenic drugs. The first age of methadone consumption, as the first age of SU for the majority of the patients participating in the study, 95 patients (52.8%), was in the age group of 21–30 years. For 72 people (40.0%) age > 30 and for 13 people (7.2%) < = 20 were reported as the first ages of methadone consumption. More than half of the patients, 93 people (51.7%), had access to methadone shortly after the earthquake and the rest of the patients, (48.3%) 87 people, had access to methadone between 1–15 days after the earthquake and among them, 18 people (10.0%) reported relapse of SU until they had access to methadone. 16 (9.0%) of them reported the use of opium and 2 of them (1.1%) reported the use of stimulants before having access to methadone and almost in all cases of relapse, the person continued to use it in the months that followed. It should be noted that in terms of the type of the substance that was used, except methadone after the earthquake, 5 patients mentioned the use of other drugs including 3 patients (1.7%) who reported drug abuse and 2 patients (1.1%) who reported neurological drug use and one patient, who had drug abuse experience, reported relapse of SU by using opium until he had access to methadone (Table 3).
Table 3
Frequency distribution of drug use records in the studied men treated with methadone before the earthquake and three evaluation stages after the earthquake
Variables | Levels | Frequency (%) | Variables | Levels | Frequency (%) |
the first age of SU | <=20 | 48(26.7) | Kind of SU before starting methadone treatment | opium | 162(90.0) |
21–30 | 111(61.7) | stimulants | 11(6.1) |
> 30 | 21(11.7) | hallucinogenic | 1(0.6) |
kind of SU | opium | 162(90.0) | alcohol | --- |
stimulants | 12(6.7) | multi substance | 6(3.3) |
hallucinogenic | --- | first age of methadone use | <=20 | 13(7.2) |
alcohol | --- | 21–30 | 95(52.8) |
multi substance | 5(2.8) | > 30 | 72(40.0) |
the average dose of the substance | < 1 gr | 3(1.7) | Time to access methadone after an earthquake(day) | 0 | 93(51.7) |
1–2 gr | 120(66.7) | 1 | 8(4.4) |
> 2 gr | 37(20.6) | 2 | 12(6.7) |
N/A | 20(11.1) | 3 | 27(15) |
history of multi SU | opium | 50(27.8) | 4 | 22(12.2) |
stimulants | 1(0.6) | 5 | 10(5.6) |
hallucinogenic | --- | 7 | 4(2.2) |
alcohol | --- | 9 | 1(0.6) |
multi substance | 14(7.8) | 10 | 2(1.1) |
No | 115(63.9) | 15 | 1(0.6) |
history of quit substance | Yes | 85(47.2) | SU before accessing methadone after an earthquake | Yes | 18(10.0) |
No | 95(52.8) | No | 162(90.0) |
Therapeutic methods in quitting SU | N/A | 5(2.6) | kind of substance before access to methadone | opium | 16(9.0) |
hospitalization in the ward | 4(2.2) | stimulants | 2(1.1) |
hospitalization in the camp | 45(25.0) | hallucinogenic | --- |
Home remedies and self-medication | 17(9.4) | alcohol | --- |
Camp and self-medication | 7(3.9) | No | 162(90.0) |
Methadone treatment | 3(1.7) | drugs use other than methadone after an earthquake | drug abuse | 3(1.7) |
herbal therapy | 2(1.1) | using psychiatric drugs | 2(1.1) |
N/A | 2(1.1) | No | 175(97.2) |
total | 180(100.0) | total | 180(100.0) |
Before the earthquake, in terms of the average daily dose of methadone used by the patients, the majority of them were reported with the frequency of 127 (70.6%), 33 (18.3%), 17 (9.4), respectively, to use 11–20 and < 10 and 21–30 cc methadone per day, and only (1.7%) 3 people used methadone over 30 cc per day. However, there were significant changes in these results in the first evaluation after the earthquake. So that in this evaluation, the majority of the patients with frequencies of 117 (65.0%), 22 (12.2%), and 18 people (10.0%) were reported to be in the consumption categories of 11–20 and 21–30 and less than 10 cc of methadone per day, respectively, and about (12.8%) 23 people were in the methadone category consumption over 30 cc per day. The results showed an increase in the daily dose of methadone used by the patients in the first evaluation after the earthquake, compared to the previous time. However, the amount of methadone used by the patients in the second evaluation after the earthquake decreased significantly and in the third evaluation after the earthquake, a significant decrease was also observed. In these two evaluations, over time, the number of people who used methadone with daily doses above 30 cc per day decreased, and the number of the people who used it with daily doses below 30 cc per day increased. This means that in the second evaluation after the earthquake, only 6 people (3.4%) and in the third evaluation after the earthquake, only 3 people (1.7%) with daily used doses of methadone above 30 cc per day were reported. In terms of the history of relapse before the earthquake, 18 people (10.0%) reported a positive history of relapse, among whom 8 people (4.5%) reported relapse once and 10 (5.5%) reported 1–3 times. In the first post-earthquake evaluation, the number of patients with a positive history of relapse increased and reached 32 people (17.8%). Of the 18 people (10.0%) who had a history of relapse before the earthquake, 16 (8.9%) had a relapse of using opium, 1 (0.6%) had a relapse of using stimulants, and 1 (0.6%) also reported relapse of simultaneous use of several drugs, and none reported relapse of using new substances. The relapse of use for all of them was reported as a return to their previous drug consumption. In the first evaluation after the earthquake, 32 people (17.8%) reported relapse of drug use, among whom, only 4 (2.2%) reported relapse with a tendency to new drug 2 (1.1%), opium and 2 (1.1%) reported stimulant. In the second and third evaluations after the earthquake, 26 (14.4%) and 24 (13.3%) reported relapse, respectively that none of these people reported a relapse with a tendency to a new substance and in fact, all of them expressed the relapse of their SU by using the previous substance they had used. Before the earthquake, 37 people (20.6%) reported a positive alcohol history, which in the first post-earthquake evaluation decreased to 5.0%, 9 people. In the second and third evaluations after the earthquake, the alcohol use ratio, which was the same in both evaluations, reached 8 people (4.4%). In terms of housing conditions, in the first post-earthquake evaluation, 129 people (71.7%) reported that they were living in Conex boxes and only 3 (1.7%) were living in tents. The rest of them, 48 people (26.7%) reported that they were living in either their own or rented homes. In the second post-earthquake evaluation, 133 people (73.9%) reported living in Conex boxes, and only 1 person (0.6%) lived intent. In the third post-earthquake evaluation, 121 people (67.2%) lived in Conex boxes and 2 (1.1%) lived in tents, and the rest lived in their own or rented homes (Table 4).
Table 4
The pattern of change in drug use and related records in the studied men treated with methadone before the earthquake and three stages of post-earthquake evaluation
variables | Levels | before the earthquake | 4months after the earthquake | 8 months after the earthquake | 12 months after the earthquake |
average daily dose of methadone(CC) | <= 10 | 33(18.3) | 18(10.0) | 20(11.1) | 29(16.1) |
11–20 | 127(70.6) | 117(65.0) | 133(73.9) | 139(77.2) |
21–30 | 17(9.4) | 22(12.2) | 21(11.7) | 9(5.0) |
31–40 | 1(0.6) | 18(10.0) | 5(2.8) | 2(1.1) |
41–50 | --- | 2(1.1) | --- | --- |
51–60 | 2(1.1) | 3(1.7) | 1(0.6) | 1(0.6) |
history of relapse | Yes | 18(10.0) | 32(17.8) | 26(14.4) | 24(13.3) |
No | 162(90.0) | 148(82.2) | 154(85.6) | 156(86.7) |
Kind of substance used in relapse | opium | 16(8.9) | 29(16.1) | 25(13.9) | 24(13.3) |
stimulants | 1(0.6) | 3(1.7) | 1(0.6) | --- |
multi substance | 1(0.6) | ---- | --- | --- |
No | 162(90.0) | 148(82.2) | 154(85.6) | 156(86.7) |
history of alcohol use | Yes | 37(20.6) | 9(5.0) | 8(4.4) | 8(4.4) |
No | 143(79.4) | 171(95.0) | 172(95.6) | 172(95.6) |
Current residence status | tent | --- | 3(1.7) | 1(0.6) | 2(1.1) |
Conex | --- | 129(71.7) | 133(73.9) | 121(67.2) |
personal home | --- | 46(25.6) | 40(22.2) | 51(28.3) |
rental house | --- | 2(1.1) | 6(3.3) | 6(3.3) |
total | | | 180(100.0) | |