Estimating opium use prevalence at the national and provincial levels in Iran: a modelling study

Authors

Saeed Nemati 1 2, Mehdi Hatami Goloujeh 2, Hossein Poustchi 3, Maryam Hadji 4, Hamideh Rashidian 2, Farhad Pourfarzi 5, Ali Fakhari Dehkharghani 6 7, Mehdi Shahmoradi 8, Farhad Moradpour 9, Mojtaba Farjam 10, Mohammadreza Naghipour 11, Nader Saki 12, Mohammad Reza Fattahi 13, Farid Najafi 14, Abbas Rezaianzadeh 15, Parvin Khalili 16, Fereshteh Ghorat 17, Moluk Hadi Alijanvand 18, Mahmood Moosazadeh 19, Rahim Khalilzadeh 20, Javad Harooni 21, Hossein Fallahzadeh 22, Nour Mohammad Bakhshani 23, Ali Akbar Haghdoost 24, Afarin Rahimi-Movaghar 25, Farin Kamangar 26, Reza Malekzadeh 27, Mahdi Sheikh 1, Kazem Zendehdel 2

  1. 1Early Detection, Prevention, and Infections Branch, International Agancy for Research on Cancer (IARC – WHO), 25 avenue Tony Garnier, Lyon, 69007, France.
  2. 2Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
  3. 3Liver and Pancreatobiliary Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
  4. 4Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland.
  5. 5Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
  6. 6Liver and Gastrointestinal Diseases Research center, Tabriz university of Medical Sciences, Tabriz, Iran.
  7. 7Research Center of Psychiatry and Behavioral Sciences, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
  8. 8Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
  9. 9Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
  10. 10Noncommunicable diseases research center, Fasa University of medical sciences, Fasa, Iran.
  11. 11Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
  12. 12Hearing Research Center, Clinical Sciences Research Institute, Department of Otolaryngology, Head and Neck Surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
  13. 13Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
  14. 14Research Center for Environmental Determinants of Health (RCEDH), Nutritional Sciences Department, Kermanshah University of Medical Sciences, Kermanshah, Iran.
  15. 15Colorectal Research Center, Shiraz University of Medical Sciences, Fars, Iran.
  16. 16Non-Communicable Diseases Research Center, Rafsanjanm University of Medical Sciences, Rafsanjan, Iran.
  17. 17Department of Traditional Medicine, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
  18. 18Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
  19. 19Psychosomatic Research Center, Non-communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran.
  20. 20Departement of Psychiatry, Urmia University of Medical sciences, Urmia, Iran.
  21. 21Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.
  22. 22Research Center of Prevention & Epidemiology of Non-Communicable Disease, Department of Biostatistics and epidemiology, Shahid Sadoughi University of medical sciences, Yazd, Iran.
  23. 23Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran.
  24. 24HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
  25. 25Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.
  26. 26Department of Biology, School of Computer, Mathematical and Natural Sciences, Morgan State University, Baltimore, MD, USA.
  27. 27Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Opium consumption was recently classified as carcinogenic to humans by the International Agency for Research on Cancer (IARC). With Iran having the highest global prevalence of opium consumption, understanding the national and provincial prevalence of opium use is critical for cancer control efforts. This study integrated multiple data sources to estimate the prevalence of opium use across Iran. Using population-based cohorts and case-control studies we calculated opium use prevalence for 17 provinces of Iran. A regression model was then developed to explain geographical variation in opium use prevalence, incorporating demographic, socioeconomic, and opium-related national enforcement variables. The model was trained and validated using leave-one-out cross-validation for the 17 provinces with individual-level data, and was subsequently used to predict prevalence in the 14 remaining provinces lacking individual-level data. The age-standardized predicted prevalence of opium use among Iranian adults aged > 30 years was estimated at 5.93% (95% CI 2.76–8.20%), with a significant difference between men [10.40% (95% CI 4.69–14.30%)], and women [1.46% (95% CI 0.83–2.09%)]. Older age, lower socioeconomic status, unemployment, and higher quantities of seized opium were associated with higher opium use prevalence at provincial levels (all P-values < 0.05). Significant geographical variations in opium use prevalence were observed, with the highest rates estimated for the eastern provinces bordering Afghanistan, the world’s largest producer of opium, and the lowest rates in the northwestern provinces. The highest rates were calculated for Sistan and Baluchestan (15.00%), Golestan (13.43%), and Qom (13.07%), while the lowest were in Markazi (1.30%), Ilam (1.30%), and Zanjan (1.32%). Although the overall prevalence differed substantially between men and women, the geographic distribution patterns were similar for both. Opium consumption is highly prevalent among Iranian men and in populations residing in the eastern and southeastern provinces. Targeted public health interventions are urgently needed to reduce opium use, particularly in high-risk regions. These efforts should be integrated into national cancer control programs to effectively address the associated health burden.

Supplementary Information: The online version contains supplementary material available at 10.1038/s41598-026-38294-0.

Keywords: Addiction; Dependency; Opiate; Opioids; Prediction.

How to Cite

Nemati S, Hatami Goloujeh M, Poustchi H, Hadji M, Rashidian H, Pourfarzi F, Dehkharghani AF, Shahmoradi M, Moradpour F, Farjam M, Naghipour M, Saki N, Fattahi MR, Najafi F, Rezaianzadeh A, Khalili P, Ghorat F, Alijanvand MH, Moosazadeh M, Khalilzadeh R, Harooni J, Fallahzadeh H, Bakhshani NM, Haghdoost AA, Rahimi-Movaghar A, Kamangar F, Malekzadeh R, Sheikh M, Zendehdel K. Estimating opium use prevalence at the national and provincial levels in Iran: a modelling study. Sci Rep. 2026 Mar 9;16(1):8430. doi: 10.1038/s41598-026-38294-0. PMID: 41803187; PMCID: PMC12972347.

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Estimating opium use prevalence at the national and provincial levels in Iran: a modelling study