Friday, September 23, 2005

Opiates of the Iranian People

Karl Vick, The Washington Post:
Despair Drives World's Highest Addiction Rate

If he could afford it, Ali Nariman would drink beer, he says. But like most Iranians, he is poor, and so takes his solace in the form of a small gray ball of opium.

Swallowed whole for maximum absorption, the ball takes only half an hour to deliver the warm, surging relief that inhabitants of the Persian plateau have long associated with advanced age. For centuries in Iran, opium was regarded as a privilege of the elderly, a largely medicinal comfort for the pains and worries accumulated over a lifetime of work.

Nariman is 18. And like hundreds of thousands of Iranians turning to harder narcotics at younger ages, he regards drugs as the only alternative to work.

"We should have jobs," Nariman said, standing in the vast cemetery on the southern edge of Tehran. In a routine played out every Thursday, the day families traditionally visit the cemetery devoted mostly to war dead, young addicts sweep in afterward to scavenge the cookies and dates left on the graves.

"I sometimes find work," Nariman said, "collecting stale bread in town."

According to the U.N. World Drug Report for 2005, Iran has the highest proportion of opiate addicts in the world -- 2.8 percent of the population over age 15. Only two other countries -- Mauritius and Kyrgyzstan -- pass the 2 percent mark. With a population of about 70 million and some government agencies putting the number of regular users close to 4 million, Iran has no real competition as world leader in per capita addiction to opiates, including heroin.

When an earthquake leveled the city of Bam in 2003, among the emergency supplies rushed to the scene were doses of methadone, a synthetic drug used to treat heroin and morphine addicts, for the 20 percent or more of the population believed to be addicted. So many Iranians rely on opiates that an influential government analyst suggests the state itself should consider cultivating poppies.

"Yes," said Azarakhsh Mokri, director of the Iranian National Center for Addiction Studies: "A strategic reserve of narcotics."

Discount Prices

But if the utility of narcotics has roots in Iran's ancient culture, and the discount prices (about $5 for a gram of heroin, 50 percent pure) stem from proximity to the poppy fields of neighboring Afghanistan, experts, addicts and government officials agree that addiction has lately emerged as a corrosive new symptom of the country's economic failure, a marker for despair.

"You haven't got a job. You haven't got a family. You haven't got entertainment," said Amir Mohammadi, who at 30 has been an addict for 10 years. "For a few hours, you forget everything."

Heroin, a powerful derivative of opium, is taking hold among young people whose path to addiction typically stems from disappointment in the job market. A government poll shows almost 80 percent of Iranians detect a direct link between unemployment and drug addiction. Iran's government regularly fails to produce the 1 million jobs needed each year to accommodate the new workers entering the labor force from a baby boom still coming of age.

"We haven't reached the peak," said Roberto Arbitrio, head of the U.N. Office on Drugs and Crime in Tehran. "Unfortunately, there's room for increase."

After Iran's theocratic government came to power in 1979, it displayed zero tolerance for drugs, filling the prisons with addicts. "We paid a high price for it," said Ali Hashemi, head of the cabinet-level Drug Control Headquarters.

Having since embraced policies grounded in pragmatism, Tehran has provided surprising freedom in drug treatment, subsidizing needle exchanges and methadone centers. The government also has funded energetic efforts to stanch the flow of opiates on the trafficking routes into the country. In the last decade, thousands of Iranian troops and police officers have been killed battling smugglers, most along the porous borders with Afghanistan and Pakistan.

"Our people in Iran have been in the front line in this war on drugs," Hashemi said.

Yet despite such bloodstained evidence, drugs remain so prevalent that many Iranians describe their availability as evidence of a government plot.

After students rioted at Tehran University in 1999, residents of a locked-down dormitory told of drug dealers being allowed in to distribute narcotics for free.

"I believe this is the policy of the state, to make all the youth addicted," said Hamid Motalebi, 22, a police officer on duty in a south Tehran park almost overrun by junkies sleeping on the grass or staggering like zombies. "It's the lack of policy and management. If they could create enough jobs, enough entertainment, why would people turn to drugs?"

The Aftab Society, a drug rehab center, stands off a busy street toward the northern edge of a capital city where fortunes tend to follow geography. The farther north you live, the richer you are. Aftab's clients are wealthy enough to pay for beds in a detoxification ward upstairs from the offices where outpatients gather twice a week for group therapy.

"Those who are usually referred to us are educated," said Nassrin Tehrani, an executive at the Aftab Society. "Put yourself in their place. If you're educated, you've got high expectations. When the expectations are not fulfilled, the first reaction is depression. After that, the use of drugs begins."

In one evening session, 18 men and women nodded along as a bearded, middle-aged man listed withdrawal symptoms: achy joints, aggression, sleeplessness.

"But I got over all of them," the man said, "because I got a job."

A few miles to the south, on the broad streets of Tehran's aging core, taxi drivers and other working-class addicts lined up for free methadone at an imposing government building. The National Center for Addiction Studies deals mostly with addicts who have taken opium for years while essentially functioning normally. Mokri, the center's director, compares this type of use, called "instrumental use," to the chewing of cocoa leaves in South America or heavy addiction to nicotine.

But the toll on Iranian society is staggering. Mokri estimates that 20 percent of Iran's adult population is "somehow involved in drug abuse." The estimate includes half a million dealers, each selling to three or four people, at a total cost of $3 billion to $5 billion annually. The problem has reached proportions that could be approached only in terms of management, he said.

"I believe the narcotics dependence system has become so large you should try to enter it rather than to annihilate it," Mokri said. This year he launched a program of dispensing tinctures of opium in the medicinal form that physicians prescribed a century ago, when Iran cultivated its own poppies. He said the country should consider doing so again, under U.N. supervision, to prevent a replay of the events of the last five years.

As long as opium was in steady supply, Iran's drug problem was relatively stable. But when Afghanistan's ruling Taliban movement cut poppy production in 2000 and 2001, opium prices soared. Many addicts shifted to heroin, which became the affordable alternative.

"What you have is a society more or less used to dealing with opium, all of a sudden flooded with opiates, heroin, hashish," said Arbitrio, the U.N. official.

Running From Reality

Heroin -- and the way it obliterated anxiety instantly when injected -- took hold with special ferocity among the young, who account for most of the more than 200,000 known addicts.

"Opium, we just don't feel it. It's for old people," said Fariboorz Koocheki, 29, in the junkie park. "For us, it's heroin. And for those younger than us, it's crack and glass," slang for methamphetamine, the most common of the synthetic drugs growing more popular in Iran.

"Opium is used mainly as a painkiller or medicine," Koocheki said. "But heroin helps you to run away from the truth, from the facts. Youth wants something that helps us run away from the reality of everyday life, and that's heroin."

For many young people in Iran, one reality of everyday life is powerful boredom. Though rules enforcing Muslim dress have been relaxed in the past three years, there is little to do, even in a city of about 10 million. The stillness of a Tehran street on a weekend day is almost sepulchral.

"People here can't have a drink in the pub. The young people can't go to a music club," said Bijan Nasirimanesh, director of Persepolis, a drop-in center for drug addicts. "You have the paradox in this country of, coming at you from inside, everything is totally religious, and from outside, MTV and Western culture."

Located in an alley in Tehran's southern plain, Persepolis serves the capital's most hard-core addicts in its poorest neighborhood, a gray warren of shops, garages and rowhouses. Among the dozens of former heroin addicts milling in the lobby one morning was Davood Safdari, who said he used to be a dealer.

"I never had to go to anyone," he said. "Everyone found me."

Bahman Akbarizadeh, 25, wore a gray shirt and an intense look. "I think if people had hope and entertainment in their life, they would never go to heroin, because they know the risks."

A handful of women traded stories of habits that grew out of forced marriages and addicted spouses. A former weightlifter said a hit of heroin cost him less than a sandwich. There was talk of a new synthetic drug known as "Tear of God."

"In the social sphere," said Mehdi Golpaygani, the general practitioner who sees every new Persepolis client and found 68 percent started using drugs before age 20, "we have despair."

In the vast Martyrs Cemetery, which lies at the southern edge of Tehran, Nariman cursed the 1979 revolution that most of those laid to rest in the cemetery died defending during the eight-year war with Iraq.

"It was a rubbish thing to do," he said. He pointed to Nader Roosh, a homeless boy of 15 who sleeps at night in the shrine of Ayatollah Ruhollah Khomeini, the revered cleric who championed a rebellion grounded in social justice. Nariman said he saw no evidence of such change.

"The boys in the north, they can drink alcohol. They have enough money," he said. "But in the south, we only have money for drugs."