The need for a comprehensive opioid overdose prevention program in Iran

It is estimated that at least one million people in Iran are affected by opioid use disorders [1-3]. Opioid overdose remains a serious yet overlooked issue in Iran. Alarming numbers of opioid-related fatalities have been reported [4]. A recent national survey showed that 3.8% of those who had used opiates in the past year had experienced opioid overdose during the same year [3]. A considerable number of substance users in Iran have either experienced an overdose personally or have witnessed overdose incidents among their friends and family, often resulting in fatalities [5]. A large number of individuals with opioid use disorder seek treatment in abstinence-based residential facilities or face arrest and imprisonment for various reasons. Both situations increase their risk of opioid overdose during the immediate post-release phase. Despite the seriousness of this issue, Iran lacks an overdose prevention program. Naloxone, an opioid antagonist, can reverse overdose and save lives. Making naloxone available in injectable and nasal spray forms, along with proper education, is essential to prevent overdose deaths [6]. In the past decade, community-based overdose prevention programs have gained recognition globally. The World Health Organization guideline emphasizes naloxone availability and ensuring potential witnesses are prepared to respond [7]. Over the past two decades, Iran has expanded drug treatment and harm reduction facilities. Opioid agonist treatment with methadone and buprenorphine, needle and syringe programs, along with screening, diagnosis and treatment for HIV/AIDS are widely available for individuals who use drugs. Nevertheless, the concern regarding non-infectious health issues affecting these individuals remains minimal [8]. Injectable naloxone is manufactured in Iran, and the price of a single dose vial (0.4 mg/mL) is approximately 0.30 USD, however, it is only available in the emergency rooms, ambulances and specialized drug treatment centers. There is no program for the prevention and management of opioid overdose in the communities. Naloxone nasal sprays are neither manufactured nor imported. This gap significantly hampers the country's ability to address its high overdose mortality rate. The country's extensive drug treatment and harm reduction services can significantly contribute to the program on naloxone distribution and promotion, helping to reduce opioid overdoses. Pooneh Malekifar: Writing—original draft; writing—review and editing. Afarin Rahimi-Movaghar: Conceptualization; writing—original draft; writing—review and editing. None. None.