CND day 2 – Plenary presentation of the National Centre for Addiction of the Republic of Iran on drug dependence as a health issue

Caution notes we have met. Core element for debate: drug use is a disease, which can be treated by medical means. Thus, we need to inform people through mass media, NGOs, by increasing awareness, that drug addiction IS A DISEASE.

But this is not so straightforward, and there are a number of problems associated with drug dependence treatment:
1- People need to see tangible results about the fact that drug dependence can be treated. When we look at a successful treatment programme, we need good quality of care, a long term and multi-factorial approach, and a highly organised and trained system. This is not always the case, which is why mass media was not very efficient.
2- Increased public awareness leads to massive demand for treatment, and the services will therefore downgrade in quality and quantity, which creates more disappointment.
3- Addiction medicine seems a relatively new discipline in comparison to other fields of medicine. Many types of interventions are not evidence-based, which creates confusion.
Example of non-evidence based treatment: randomised double-blind, double dummy placebo controlled trials; buprenorphone versus methadone maintenance, which one to choose – depends on what is more available and what is more usual in a specific country; effectiveness relying highly on staff attitudes and quality of training.
How to deal with the booming of non-supported interventions? Some of them only have a placebo effect, others that seem more culturally-adapted but do not work.

There is therefore a need to:
1- Be able to prove that drug dependence is a disease and can be treated with the available infrastructure to avoid disappointment.
2- Develop the interface between solid evidence and practice is essential.

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