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At one of Rebirth's detox and rehab centres for drug addicts, Behza Zarbakhsh, 25, an accountant, and Babak Enayati, 42, a goldsmith, are mid-way through a three-month stint at a valley site on the Verdij River, west of Tehran where they live in dormitories built by addicts.Paul Koring/The Globe and Mail

In the fetid slum of Shoosh, addicts lie comatose in a warren of alleys in one of Tehran's oldest neighbourhoods. Buyers glance nervously at strangers while dealers stash huge stacks of worn bills into bulging pockets of over-large jackets on a hot spring day.

Iran is battling widespread drug abuse, although no one seems to how just how big the problem.

From the southern slums, past the fancy shopping avenues like Vali Asr, where a glassy-eyed young man in expensive clothes is bundled into an ambulance, to the high-end parties behind walls of fancy houses in North Tehran, addiction infests every strata of society. Coping with the massive problem while still denying it poses a serious threat, unmasks the sort of wildly improbable paradox that sometimes seems to define this proud, embattled, society.

"For a long time nobody wanted to admit it but drug abuse was ravaging our society," said Abbas Deylamizade, the managing director of Rebirth, an Iranian non-governmental organization dealing with drug addiction and abuse. "But now the scourge is so bad that we are finally reaching the point where the government is getting really involved."

In Shoosh, for the equivalent of 50 cents or furtive street sex a wretched addict can score a single adulterated dose of heroin from the poppy fields of neighbouring Afghanistan. Uptown, crack, crystal meth and cocaine – "imported" like other desirable designer goods from the West – are the drugs of choice.

Mr. Deylamizade estimates that Iran, with a population of roughly 80 million, may have as many as five million hard-core addicts and millions more occasional users. Drug use sometimes seems endemic among the young. At a stoplight in Tehran, a pair of young women driving a late-model car blithely pulled out a glass pipe and passed it back and forth until the light turned green. "It's so much worse than when I was a teenager," says a young man who works at a central mosque that hosts a self-help group for addicts.

Tall and lean in a blue suit that looks a couple of sizes too big, Mr. Deylamizade, 41, knows what he is talking about. He, too, was an addict, sliding from party use in Shiraz as a youth into long, dark years of addiction. Now he runs the largest drug treatment NGO in the country with more than 140 centres and 600,000 clients.

At one Rebirth street clinic, Fathi, barely out of his teens, shook uncontrollably as other addicts tried to keep his head from smashing the steps in a tiny courtyard.

Some of the Shoosh clinics deal only with women. In a society where public modesty is paramount, female addicts, often reduced to prostitution, are outcasts, even among the underclass of street users. "There is a terrible increase in drug use among women, rich and poor, and it often becomes part of our other 'forbidden' activity, the sex trade," Mr. Deylamizade said.

Yet there are also nascent signs of remarkably progressive, humane treatment. Where once Iran boasted of publicly hanging drug dealers, there are now street clinics offering oral methadone substitution treatment.

A wide array of government, private, community and mosque-based programs are belatedly tackling the problem.

But they can get tangled up in Iran's other problems. For instance, while big businesses and traders seem to have no difficulty moving lots of money in and out of the country despite the sanctions on dealing with Iran's major banks, funding flows to help NGOs have been trapped.

For more than five months, Rebirth has been waiting a stalled €400,000 ($516,000) payment from the European Union. Some smaller drug treatment programs have closed, cut off by sanctions from foreign funding. "The EU won't just hand-carry the money in, which is what businesses do," said Mr. Deylamizade.

Away from the street clinics in Shoosh and the designer drugs at extravagant North Tehran parties (where forbidden alcohol is also the norm) and far to the west of the sprawling capital, a tiny oasis of mutual support and hope hugs the side of a ravine.

Amidst brightly-painted dormitories, built by the addicts themselves, Rebirth runs a three-month detox and rehabilitation centre in one of the wild and remote gullies about 30 kilometres from the city.

Behza Zarbakhsh, 25, a powerfully-built accountant, is on his 67th-day of a three-month stay at the rustic centre built alongside the tiny Verdij River. "For six years I was hooked on crystal meth, and then I quit for 18 months but relapsed," he said. "I realized I was killing myself, so now I hope that being here start a new kind of life."

The centre throws together a wide range of addicts from different backgrounds. Babak Enayati, 42, a goldsmith, lost his partner, his business and his wife to a tangle of drugs and crime and, he says, bad luck. "When I first came here, I told everyone I wasn't really a serious user," he said in a riverside interview. "After about four days, I began to realize just how deep was my trouble."

That may be a useful metaphor for the broader society. Iran is just starting to come to terms with the scale and the seriousness of the endemic drug abuse that threatens it. "My wife says if I can stay clean when I get out of here, then maybe we can reconsider our marriage," Mr. Enayati said with a trace of a smile.

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