Iran has the highest nonmedical opium use globally and has faced the adverse effects of US and UN sanctions, intensified in 2018, for four decades. It was among the first to report COVID-19 and has experienced five pandemic waves.

Substance use is a major health issue in Iran, with opium, shireh, crystal methamphetamine, hashish, and heroin use rates at 150, 660, 590, 470, and 350 per 100,000 people, respectively. Substance use disorder is among the top four health burdens in the country.

Addressing this health crisis requires legalizing various treatments, enabling domestic production of affordable opioid medications, and providing online self-help groups, while fostering coordination among government, private healthcare, and NGOs.