population size estimation of people who use illicit drugs and alcohol in iran (2015-2016)

Background  estimating the number of people using illicit drugs and alcohol is necessary for informing health policy and programming. however, it is often challenging to reliably estimate the size of these marginalized populations through direct methods. in this study, we estimated the population size of these groups using the indirect network scale-up (nsu) method in iran from 2015 to 2016.methods  using a self-administered questionnaire, we asked 15 124 individuals (54% men) about the number of people they know who used different types of drugs at least once in the past 12 months. prevalence estimates were reported per 100 000 population. the uncertainty level (ul) was calculated using the bootstrap method.results  the average age of the respondents was 33 years old, and 35.1% of them were unmarried. the most common drugs and their prevalence were as follows: opium (2534 [95% ul: 2467-2598]), hashish (849 [95% ul: 811-886]), stimulants (methamphetamine, ecstasy pills, cocaine, and ritalin) (842 [95% ul: 802-879]), heroin/crack (578 [95% ul: 550-607]), and drug injection (459 [95% ul: 438-484]). additionally, we estimated the prevalence of alcohol use as 2797 (95% ul: 2731-2861). on average, substance use was 5.23 times more prevalent among men than women. opium use was more prevalent among individuals aged >50 years old. moreover, alcohol use was more prevalent among participants between 18 and 30 years old (5164 per 100 000 population).conclusion  although opium continues to be the most prevalent illicit drug in iran, the patterns of illicit drug use are heterogeneous among different age groups, genders, and provinces. age-gender specific and culturally appropriate interventions are warranted to meet the needs of people in different subgroups.