Maintenance Therapy with Opium Tincture for Injecting Drug Users; Implications for Prevention from Viral Infections

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Viral infections such as HIV and HCV have a serious negative effect on the health of injecting drug users (IDUs) in Iran (1-4). Two recent studies in Tehran, Iran have shown that HCV prevalence was between 52%-80% among IDUs (5, 6). Furthermore, many IDUs might be infected with HIV and/or HCV in the earlier stages of their injection career , long before reaching therapeutic programs (7). As a result, simultaneous therapy of drug injecting and viral infections among IDUs is a medical priority. Opium tinc-ture is a culturally acceptable alternative to medications such as methadone in some parts of southeast Asia and it is perceived as a traditional medicine for opioid detoxi-fication and relieving opioid withdrawal symptoms. In some countries, however, the cost of methadone maintenance therapy is a barrier to its widespread use. One response to this problem has been the use of opium tinc-ture as a less expensive substitution treatment. In recent years, maintenance therapy with opium tincture has been introduced in Iran as a new strategy to treat drug use problem among IDUs. In Myanmar, opium tincture has been known as an inexpensive pharmaceutical product which is as effective as methadone in treating opioid use problem (8). A study on opium-dependent patients has confirmed long-term positive therapeutic outcomes with opium tincture among opium-dependent patients (9). Somogyi and colleagues (2008) evaluated the clinical effectiveness of using different doses of opium tincture in the management of opioid withdrawal in a sample of 45 opium-dependent subjects and confirmed the effectiveness of opium tincture in the management of opioid withdrawal symptom with minimal adverse effects by using flexible dosing (10). A report by Natpratan (1996) showed that opium tincture was effective in treating opium dependence and contributed to managing drug abuse and HIV infection (8). In a study on a culturally-French environment that methadone was not available, buprenorphine and opium tincture were used in a group of 18 male and female opioid-dependent subjects during 14 months of treatment. The study results showed that body weight, physical and psychological health, socio