BACKGROUNDS AND AIMS Iran has 2.1 and 1.8 percent of its 15-64 years old population living with illicit substance and opioid use disorders, respectively. To address these problems, Iran has been developing a large and multi-modality addiction treatment system, spanning the time before and after the Islamic revolution. METHODS Iran's current drug treatment scene is a combination of services ranging from medical/harm reduction services to punitive/criminal justice programs. Included in this array of services are drop-in centers providing low-threshold harm reduction services, such as distribution of sterile needles and syringes; opioid maintenance treatment clinics providing methadone, buprenorphine and opium tincture; and abstinence-based residential centers. We will review the evolution of this system in four phases. RESULTS In 1980, Iran's revolutionary government shut down all voluntary treatment programs and replaced them with residential correctional programs. The first shift in the addiction treatment policies came 15 years later after facing the negative consequences. Addiction is viewed as a disease and new voluntary treatment centers offering non-agonist medications and psychosocial services were established. With an increased number of people who inject drugs and HIV/AIDS epidemics, in the second shift, an extensive move towards harm reduction strategies and opioid-maintenance programs have been implemented to reduce HIV-related high-risk behavior. The emergence of a methamphetamine use crisis creating an increased number of socially marginalized addicted people resulted in public and political demands for stricter policies and ended up in the third shift starting in 2010 with extended compulsory court-based residential programs. Currently, there is a new shift toward reducing the severity of criminal penalties for drug use/sales and promoting proposals for opium legalization. CONCLUSION Iran's evolutionary experience in developing a large addiction treatment program in a complex combination of medical/harm reduction and punitive/criminal justice addiction treatment can be examined in its political, clinical and pragmatic context.

中文翻译：

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伊朗成瘾治疗和减少危害计划的演变：混乱的反应还是协同的多样性？

背景和目标 伊朗 15-64 岁人口中分别有 2.1% 和 1.8% 患有非法物质和阿片类药物使用障碍。为了解决这些问题，伊朗一直在开发一个庞大的、多模式的成瘾治疗系统，跨越伊斯兰革命前后的时间。方法 伊朗目前的药物治疗场景是从医疗/减少伤害服务到惩罚/刑事司法项目的综合服务。包括在这一系列服务中的是提供低门槛降低危害服务的临时中心，例如分发无菌针头和注射器；提供美沙酮、丁丙诺啡和鸦片酊剂的阿片类药物维持治疗诊所；和以禁欲为基础的居住中心。我们将分四个阶段回顾这个系统的演变。结果 1980 年，伊朗 革命政府关闭了所有自愿治疗计划，取而代之的是住宅矫正计划。成瘾治疗政策的第一次转变是在面临负面后果后 15 年。成瘾被视为一种疾病，并建立了提供非激动剂药物和社会心理服务的新的自愿治疗中心。随着注射吸毒者人数的增加和艾滋病毒/艾滋病的流行，在第二个转变中，已经实施了广泛的减少危害战略和阿片类药物维持计划，以减少与艾滋病毒相关的高危行为。甲基苯丙胺使用危机的出现导致社会边缘化成瘾者数量增加，导致公众和政治要求更严格的政策，并最终在 2010 年开始的第三个转变中结束，扩大了基于法院的强制性居住计划。目前，有一个新的转变，即降低对毒品使用/销售的刑事处罚的严厉程度和促进鸦片合法化的建议。结论 伊朗在制定综合医疗/减少伤害和惩罚性/刑事司法成瘾治疗的大型成瘾治疗计划方面的演变经验可以在其政治、临床和务实背景下进行审查。有一个新的转变，即减少对毒品使用/销售的刑事处罚的严厉程度和促进鸦片合法化的提议。结论 伊朗在制定综合医疗/减少伤害和惩罚性/刑事司法成瘾治疗的大型成瘾治疗计划方面的演变经验可以在其政治、临床和务实背景下进行审查。有一个新的转变，即减少对毒品使用/销售的刑事处罚的严厉程度和促进鸦片合法化的提议。结论 伊朗在制定综合医疗/减少伤害和惩罚性/刑事司法成瘾治疗的大型成瘾治疗计划方面的演变经验可以在其政治、临床和务实背景下进行审查。