Iran's Quiet Epidemic
A small slim, small man stands up, his dark eyes bright with emotion, a full moustache filling up his face. 'My name is Shahram and I am an addict,' he says gently. He is greeted by an enthusiastic response from the other men sitting around the room, the standard opening of a Narcotics Anonymous meeting. Shahram proceeds to tell us that he was addicted to heroin, opium and hash for 14 years and has been clean – 'by the grace of God' – for one year. Today is the celebration of this anniversary and Shahram is presented with a cake set with a candle which he blows out, laughing and choking back the tears as the other men applaud him.
This may not be an unusual scene but it is not taking place in your local church hall. We are standing in a big hall in a park in Rey, in the deepest south of Tehran, the capital of the Islamic Republic of Iran. This Narcotics Anonymous meeting is at one of two types of NA centres – this one is called a 'camp' because it is a purpose-built compound in a park. The compound consists of tented buildings, the big hall Shahram is being applauded in is half tent, half rough plaster walls, the roof a vast sheet of tarpaulin with plastic windows letting in light which cuts through plumes of cigarette smoke. This camp is for men only (there are separate camps for women addicts) and, according to Iranian custom, the men have all shed their shoes on entry and are sitting barefoot and cross-legged on the floor. It is hard to guess their ages, so grizzled have they become after years of battling heroin. But it is clear that the score of men here are from the poorest strata of society, many are young and all are trying to remake their lives.
Until one year ago today, Shahram Khanalizadeh was one of Iran's estimated two million drug addicts – an official figure generally accepted to be much lower than the real number of perhaps three to six million.
Despite the strict Sharia laws which govern the country's Islamic system, according to the UN World Drug Report, Iran has the highest proportion of opiate addicts in the world – 2.8 percent of the population over the age of 15. The problem has reached epidemic proportions, with some 20 per cent of the population thought to be involved in drug abuse in some way.
As a neighbour to Afghanistan, the world's highest opium producer, Iran is the favoured route for drugs making their way to Europe. The UNODC reported in 2005 that 60 per cent of the opiates produced in Afghanistan leave the country via Iran, an increase of 20 per cent on the year before. Much of the opium that washes out through Pakistan is later smuggled into Iran over the south eastern border, meaning that practically all the opiates produced in Afghanistan end up in Iran at some point – of the 936 kilometre long eastern border with Afghanistan and Pakistan, much of it is either mountain or desert. And of this flood of drugs, much ends up being consumed locally. Iranian officials have long said that their country is paying the price for keeping heroin out of Europe, a fact confirmed by the International Narcotics Control Strategy Report from the US State Department: 'There is overwhelming evidence of Iran's strong commitment to keep drugs leaving Afghanistan from reaching its citizens… As Iran strives to achieve this goal, it also prevents drugs from reaching markets in the West.' The report goes on to comment that: 'The latest opiate seizure statistics from Iran suggest Iran is experiencing an epidemic of drug abuse, especially among its youth.'
The UN too has praised Iran's efforts in tackling its drug problems. Roberto Arbitrio of the UN Office for Drug Control and Crime Prevention (UNODC) in Tehran, referred to a report of the UN body last March which said Iran had set a world record in drug seizure and confiscation. The chief of Iran's national police force, General Ismail Ahmadi-Moqaddam, has reported that the seizure of 145 tons of drugs nationwide between March and August of last year marks a 29-percent increase over the same period in 2005.
Iranian attempts to control the flow from Afghanistan are an ongoing battle, often the drug smugglers have more high tech equipment and better artillery than the Iranian enforcement units – more than 4000 Iranian law enforcement forces have been killed in this continuing war.
Opium has traditionally been a panacea to the aches and pains of old age, but the new generation of drug addicts have scorned opium for heroin. When the Taliban drastically cut opium production in 2000/2001, prices soared making the cheap and widely available heroin the natural option for addicts.
Shahram's story is typical. Born 30 years ago into a poor family living in Rey, a suburb of Tehran's deprived southern reaches, Shahram grew up with low expectations, he explains as we move out into the open ground of the camp where a large urn dispenses tea and Shahram hands out fresh pastries he has brought for the celebration. Behind him the outside wall of the hall is painted with a large mural of a hand reaching down from heaven to take another hand that is reaching up from below, an image repeated on the sign announcing the camp, bearing the legend 'Society of the Delivered'. NA has been delivering addicts to health in Iran for around 15 years now and there are numerous meetings in most towns in the country. In Tehran alone there are 40,000 NA members, both men and women and the society publishes a newsletter and has a good website with details of meeting times and locations. Shahram tries to trace the roots of his addiction for me. 'There are no jobs and nothing to do with your time,' he tells me. 'I couldn't get along with my father and I thought he didn't love me. We couldn't communicate so I spent less and less time at home and more time with my friends who were smoking hash. We had nothing else to do.'
The baby boom that took place after the revolution of 1979 was encouraged by Ayatollah Khomeini, the post-revolutionary Islamic leader, who demanded more children to expand the revolution. Iranians duly obliged, and the population has jumped from 37 million in 1979, to around 70 million. This is a particularly remarkable figure when other factors are taken into account – up to four million people left the country at the time of the revolution and another million were killed in the eight-year war with Iraq. Of the present population around 70 per cent are under 30 – and these modern children of the revolution have very different needs and desires to their parents, making the generation gap particularly problematic.
Shahram's family problems were exacerbated by the gaping social and economic divide between the south and north of Tehran. Old fashioned and underdeveloped, the south of Tehran is home to traditional and conservative families, mostly poor while the north, nestling in the lap of the Alborz mountains, is prosperous and developed, with the apartments and houses becoming increasingly expensive as you head further north. The most elaborate villas occupy areas that until recently were still villages in the foothills of the mountains, and are sought out by Iran's richest ten per cent for the better air, perched above Tehran's horrific pollution.
Shahram explains the resentment that fed his sense of hopelessness. 'I saw the kids uptown and they had everything. We had nothing and life was hard. I got more and more depressed and eventually I started smoking hash. I was trying to erase my problems rather than face them,' he says. As hash made him feel better – 'and our basic human nature is to want to enjoy ourselves' – Shahram continued on to opium during his two-year obligatory national service and despite cleaning up for a few months when he was wooing his wife, at his wedding he was again slipping away to get high.
By this time the price hikes in opium, coupled with his rising tolerance to it, pushed Shahram into trying heroin. He loved it. 'First of all, it was much more practical, it only took 20 minutes to smoke,' he tells me in a fast staccato. 'I didn't get the drowsiness of opium, and it was just better value.' He blushes and apologises to me for what he is about to say, as discussing sex with a strange woman is anathema to a Muslim man. 'Er, once I was married, I used more because, you know, I wanted to enjoy my wife more. As I said, I think it is a human instinct to want to take pleasure in your life.'
Shahram's habit soon became the most important thing in his life. 'I lost my job as a builder and sold whatever I could get my hands on to get money. I took the gold earrings out of the ears of my two-year-old daughter so I could sell them to score. I sold all our carpets, the furniture. I am ashamed of the things I did.' His wife hated his heroin habit and tried to make him stop. She even sold her gold jewellery to finance treatment, but despite several attempts, Shahram invariably returned to heroin after a month or two. 'There are lots of different programmes and they prescribe heroin substitutes but even if I beat the physical addiction, I never lost the craving. I know people who have had complete blood transfusions who still go back to using. You have to deal with the root of the problem, otherwise the rest is useless.
By the time Shahram was introduced to NA, he had lost everything. His wife was living with her parents with their two children, 'although because we loved each other we never separated formally', and Shahram was living on the streets. He stole, lied, cheated and dealt drugs himself to feed his habit because 'I was just using in order to keep alive. It no longer made me high but my body couldn't function without it. Thank God I never got to injecting because then I would have ended up in jail with HIV.' He smiles broadly, 'I am just so happy that I survived to be given a second chance. Today is marking my rebirth, my second chance.'
The love and understanding he has found at NA has been key to Shahram's recovery. 'This is my refuge,' he says as his friends come up to congratulate him, hugging and kissing him. 'I get energy from the support I get here. If I have any problems, I go to a meeting and people help me. Before I came here, I couldn't even say out loud that I was an addict. Now I know myself.'
In keeping with NA policy, the addicts have to go through the arduous process of detoxing without any medicinal help, and they spend the first month living in the centre. They are encouraged to donate around £25 to the running of the centre, otherwise treatment is free. A few stops away on the metro line, I visit Persepolis, another NGO which takes a different approach, having been the first non-governmental organisation to be authorised to hand out methadone to addicts.
I enter a small courtyard filled to bursting with men, queuing. The queue snakes up stairs leading to a gallery where, from small window, methadone is handed out. I head up the steps, turn instead into a small office, also packed to bursting with people, desks and stacks of boxes. The boxes contain a package of syringes, clean needles, tape, alcohol pads, condoms and distilled water, all handed out to addicts for free. As all those who drop in every day – up to 600 people, mostly men but a handful of women too – are all homeless, the basic care the centre provide is vital, giving out food, clean clothes and even a shower. There is always a GP on hand to provide medical attention, including wound and abscess management – many of the addicts are suffering from diseases such as Hepatitis and HIV and have weeping sores on their bodies from their diseases and the hardship of their lifestyles. The care pack is designed to make sure those injecting at least do so hygienically and safely. Those registered for the syringe package have to bring back the used syringe before they can get another package. 'It's part of the education,' he says, 'And we don't want the streets littered with used needles.'
The team consists of doctors, a psychiatrist and an outreach team that takes the same packages out into the community – one worker tells me that he gives 60 condoms a day to just one prostitute working the park nearby. Although officially illegal in Iran, poverty, addiction and the disintegration of families forces many women into prostitution, and here in the poverty-stricken south of the city, there are few other choices. The lack of adequate social services has inspired many NGOs such as Persepolis to try to address the many inter-related social problems in Iran.
Like NA, most of Persepolis's staff are reformed junkies and often they just sit and listen. Despite the need for sensitivity in safe sex education in the Islamic Republic where pre- and extra-marital sex is illegal, teaching the addicts about condoms is essential.
Below the office there is a day room where people can drink tea and talk; lunch is offered on alternate days. 'There is such a need for what we are doing,' Dr Nassirimanesh, the founder, says. 'We have enough people who want to work, enough people needing treatment. What we don't have enough of is funding. Get me funding and we will open a Persepolis in every district in every town. What we do now is small in scale. We reach a very tiny percentage of the population.'
Persepolis' work may be frustratingly small scale, but the regime's new approach encompasses working with NGOs like this one to battle the epidemic. At a pre-sermon lecture at Friday Prayers last summer, Fada-Hossein Maleki, Secretary General of Iran's Drug Control Headquarters said that Iran 'is at the forefront of the campaign against narcotics throughout the globe' and described the role of the government as working alongside the 500 non-governmental organizations active in this field.
A comment by Ayatollah Hassan Marashi, who previously served on the High Council for Judicial Development and in the judiciary, illustrates the change of heart of the regime. Talking of drug dealers, he told an Iranian newspaper that many become dealers out of economic necessity, and that arresting and imprisoning them proves counterproductive as families then sink deeper into poverty and sometimes turn to prostitution. 'Punishment does not correct people's behavior,' he said. 'We pay no attention to the causes and we merely pursue the effects.'
Mehrdad Ehterami, an official at Iran's state Welfare Organization's prevention and addiction-treatment department has stated that Iran sees 90,000 new drug addicts every year, with more than 180,000 people treated for addiction in the state or private sector. He listed 51 government facilities, 457 private outpatient centers, and an additional 26 transition centers that all work together to combat the problem.
I ask Dr Nassirimanesh about the government's approach, which is one of the most enlightened in the world. Recently addicts were invited to present themselves at police stations and health care centres to undergo voluntary treatment and rehabilitation, in return for amnesty from arrest and prosecution. About half of the annual budget allotted to fighting drugs now goes towards harm reduction. 'The government is taking the four pillar approach, same as countries such as Switzerland and the UK,' says Dr Nassirimanesh. 'They are: harm reduction, treatment, prevention and then supply reduction. Without all four pillars, government drug policy is like an orchestra playing out of tune. Since we started our work, government policy has changed dramatically and we no longer have problems with the law and red tape. What we need now is more support for NGOs, and more NGOs willing to pull up their sleeves and help.'
As an Iranian who has grown up in the UK and regularly visits my homeland, I have heard many people are doing synthetic recreational drugs. Even with Iran's historical addiction to opium, this is a departure from the norm. I ask Dr Nassirimanesh about this, and he laughs: 'At Persepolis the people we treat are at the end of the road. They don't know what "recreation" means, they are just trying to survive.' But when I persist, he admits that 'anecdotally I have heard of the use of recreational drugs such as cocaine has rocketed. There needs to be research done to find out how to deal with the impact of recreational drug use at this level. Doctors need to be educated on how to handle the health consequences and the government needs to be prepared for the social consequences.'
There is quiet consensus among people working on the frontline of this problem that it has not yet peaked. Talking to Hamid, one of the young addicts in the centre, he tells me: 'The kids up there in the north of Tehran can afford to buy beer and vodka. We can't, so we take heroin cos it's cheap.' A shot of heroin can cost 80 cents, less than a packet of foreign cigarettes (20 Kent will set you back $2) and I have heard rumours that on university campuses drugs are more readily available than books. $16 will buy one gram of good quality heroin, about 50 per cent pure, which could last a novice addict about ten days, though a seasoned addict like Shahram could get through two grams a day. Poorer quality heroin costs $8 a gram. 'Opium is much more expensive,' says Shahram, 'So it's just not as popular. Crack is cheap too and I have seen kids start with crack, not even bothering with hash.' He tells me that one gram of crack cocaine costs between $12-$18, making it as good value as heroin, but with a high that packs an altogether different punch. Shahram tells me that in his neighbourhood, the age for using drugs is falling: 'I now see kids starting at 14, 15. I have seen them using around schools, in breaks, scoring in the playground.'
Alcohol, which is illegal in this dry Islamic state, can also be easily bought on the black market, but as Hamid rightly indicates, alcohol is not cheap – a bottle of red wine of the sort you might pick up at your local off licence for $10, will set you back $40 in Tehran – a professional such as a teacher earns around $350-$400 per month. And while different punishments for drinking, making or possessing alcohol are minutely set out in religious rulings that govern Iran, there are no specific fatwas given about narcotics, and so the laws on drugs have struggled to find a religious foundation – the most common one used is issued by Ayatollah Khomeini and states that 'one is not allowed to harm oneself'. The harshest punishment of execution can be meted out to individuals holding more than 30 grams of heroin or 5 kilograms of opium, and the much of the Iranian prison population comprises those arrested for drug offenses; of 46,930 imprisoned in December-January 2006, 31 per cent were addicts, with a further 40 per cent arrested on drug-related offences, according to Justice Minister Jamal Karimirad. But the high rate of HIV infection in prisons, through shared needles, is one of the factors that has persuaded the government to adopt a less punitive approach to tackling drug addiction. Although there are no firm statistics, according to Hamidreza Setayesh, UNAIDS country officer for Iran, around 48 per cent of prisoners are addicts and they tend to inject as it attracts less attention than smoking the drug. And in a study published last year, it was found that those at risk were 12 times more likely to contract HIV in prison. 'Prisons though have upscaled their approach now,' Hamidreza Setayesh points out. 'There are rehabilitation and education programmes inside jails and 6,000 people are being given methadone. Clean needles are given out and there is much less needle sharing.'
Up in the centre of town, I drop in on another drug rehabilitation centre, another NGO with another approach. Aftab is located on a quiet street and looks much like a regular house. With its bright blue painted banisters and doorframes, Aftab has a detoxification ward upstairs where addicts pay to be weaned off drugs, and offices downstairs used for outpatient meetings. Dr Masood Sedghy says that of the addicts he sees here, 80 per cent of them are addicted to crack. 'Most of the people we treat are poor, but we do have some middle class patients and even some from the rich section of society.' But he points out that many of the rich users prefer shisheh meaning glass, methamphetamine or crystal meth, so called after the glass pipe that it is smoked out of. And with house prices, drug prices are geographically sensitive, as you head further uptown, the drugs of choice become more expensive with one gram of crystal meth costing around $120, a huge expense in the Islamic Republic.
In 2005 the director of the Iranian National Centre for Addiction Studies estimated that 20 per cent of Iran's adult population was 'somehow involved in drug abuse' and an official survey, whose findings were released in 2005, showed that drug smuggling and sales in Iran was a 10 billion dollar market in 2004, nearly three quarters of the total revenue from Iran's oil market during the same period.
Southern Tehran, where Persepolis and the Iranian National Centre for Addiction Studies are located is the traditional, conservative heart of Iran. The city's poorest people live here, forming the backbone of the support enjoyed by President Mahmoud Ahmadinejad who was voted in by them and others like them, people who thrilled at his promises to fight the corruption crippling the country, to improve the economy, create jobs (official unemployment figures stand at 11 per cent but in reality are estimated to be around 25 per cent) and redistribute the country's oil wealth. But 18 months after he took power the economy is sorrier than ever. With inflation soaring – official figures put it at 20 per cent but the reality is thought to be at least double – and the price of basic foodstuffs fluctuating weekly, they have yet to see any of these promises fulfilled.
More than 50 per cent of the Iranian population lives under the poverty line, according to official estimates provided by the Iranian Central Bank (although again it has been suggested by members of Iran's parliament that the reality is 90 per cent), which sets the poverty line at an income of around $300 per month for a family of five.
A government poll showed that 80 per cent of Iranians believe that there is a direct link between unemployment and drug abuse, something I heard reiterated constantly. The government of Iran regularly fails to produce the one million jobs needed annually to accommodate new workers entering the job market, the result of Khomeini's baby boom.
Leaving south Tehran, I get on an efficient metro which whizzes me up to Mirdamad, up in the prosperous north of the city. Walking along the wide boulevards of uptown Tehran canopied by plane trees etched with snow, with the Alborz mountains rising up behind, I am struck by the stark difference between the two parts of the city, a divide that is not just aesthetic and financial, but also ideological. Now, a tragic epidemic unites the city of two halves – the devastation being wrought by drugs in all sections of society, with the authorities seemingly unable to stop it.
Shahram had said to me in Rey. 'The police are more likely to fine people than arrest them,' he said. 'Partly because the attitudes to addiction have changed, it has become so common that everyone realises it is a problem so they don't treat it so harshly. But also, well, people are very poor…' Shahram does not say so and nor does anyone I speak to, but I have heard of dealers bribing local police to allow them to work their patch. Unlike in the south up here in the north of the city, no-one goes to the local park to score. I have heard that in Tehran, you are never ten minutes away from a dealer – a reputation for efficiency the dealers up here cultivate. The preferred method of scoring is to have your drugs delivered, dealers just need a mobile phone and a motorbike to get through the traffic and most well-to-do kids make sure they arrange to meet in a quiet back street where they wait in their cars. But whether scoring in a shiny BMW in the foothills of the north or shooting up in a park in Rey, the young drug users of Tehran have a litany of dissatisfaction, disillusionment and disappointment spurring on their destructive habits.
With so much attention inside and outside the country fixed on Iran's nuclear programme, the issue most likely to change the face of Iranian society for ever seems destined to never make the headlines.