Norjizak Injection: A Critical Risk for Transmitting Blood-Borne Infectious Diseases

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Infectious diseases including HIV and viral hepatitis constitute a major health concern with high prevalences among injecting drug users (IDUs) in Iran (1, 2). IDUs that share needles and syringes and practice sexual behaviors are at risk groups for being infected with blood-borne infectious diseases such as HCV (3). The recent increasing use of opioids in Iran has been strongly associated with health-related harms (4) including transmitting HIV, HCV, and HBV infections (5-9). In 2005, a new illicit opioid, named as Norjizak, was introduced in Iran's illicit drug market and it gained popularity in a short period of time and contributed to transmitting blood-borne infectious diseases. Norjizak which is also written as Norjizac, Norgesic, and Norchizack in Iran is a narcotic drug which is a combination of several opioids with Dexamethason or Benzodiazepines (10). Its main route of administration is injection. Norjizak is also used intramuscularly and/or subcutaneously. Its injection is associated with several medical complications including abscess formation, development of septic emboli and soft tissue infections in IDUs, but a few studies have focused on Norjizak injection and its health-related problems in Iran (11). A recent study on the patterns of pre-treatment drug abuse, drug treatment history, and characteristics of 810 drug dependent-patients at drug use treatment clinics in Tehran, Iran showed that Norjizak injecting was prevalent as a main drug of abuse among 0.5% of the sample before entry to Methadone maintenance treatment (12). In another study on hospitalized drug users in Loghman Hakim and Imam Hussein hospitals in southern Tehran, a total of 221 patients were studied. The study results showed that 5.4% included injecting Norzijak users (INUs) (13). A research study on 18 male Norjizak-dependent patients with a mean age of 29.8 years who volunteered for treatment at a drug use treatment clinic showed various psychological and physical impacts associated with Norjizak injecting such as striae, weakness, high systolic blood pressure, moon face, hirsutism, extensive dermal infection, gyne