Iranian Psychiatrists’ Attitudes toward Methamphetamine Use Disorder and Prescribing Patterns: A Cross-Sectional Survey

Shiva  Soraya; Maryam  Rafieian; Kaveh  Alavi; Elham  Shirazi; Sahar  SadatSharifi

doi:10.18502/jimc.v9i3.21824

Shiva Soraya Research Center for Addiction and Risky Behaviors, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Maryam Rafieian Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Kaveh Alavi Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Elham Shirazi Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Sahar SadatSharifi Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jimc.v9i3.21824

Keywords: Benzodiazepines, Buprenorphine, Methamphetamine, Prescriptions, Psychiatrists, Psychotherapy, Substance-related disorders

Abstract

Background: Methamphetamine Use Disorder (MUD) has emerged as a major public health concern in Iran, driven by a shift in substance use patterns from opioids to methamphetamine. Despite its rising prevalence, there is scarce data on Iranian psychiatrists’ therapeutic approaches. This study evaluated their prescribing practices and attitudes toward managing MUD.

Methods: This cross-sectional study was conducted in 2024 among 150 practicing Iranian psychiatrists, recruited via convenience sampling through social media platforms until the target sample size was reached. The participants completed a researcher-made, structured questionnaire featuring four clinical scenarios representing MUD cases (methamphetamine-induced psychosis, intoxication, craving, and recurrent psychosis). Scenarios were developed by a panel of four psychiatrist faculty members with ≥3 yr. of experience, based on DSM-IV-TR and DSM-5 criteria, and refined by a separate panel of five experts for clarity and relevance. Responses, collected via Google Forms, were analyzed using SPSS v26.

Results: For methamphetamine-induced psychosis, 88% prescribed medications, primarily atypical antipsychotics (55.3%). For aggression, 50% prescribed adjunctive medications, predominantly sedatives (28%) and mood stabilizers (20%). Craving management involved pharmacotherapy in 66.7% of the cases, with bupropion (50%) and pregabalin/gabapentin (27.9%) most frequently prescribed. Half prescribed medication for intoxication, primarily benzodiazepines (28%). For recurrent psychosis, 80% recommended combining psychotherapy with pharmacotherapy, while 35.3% prescribed long-acting antipsychotics.

Conclusion: While prescription of atypical antipsychotics (for psychosis) and bupropion (for craving) align with partial evidence, underutilization of medications like mirtazapine and buprenorphine highlights knowledge-practice gaps. Findings emphasize the need for regional treatment guidelines, targeted educational interventions addressing evidence-practice discrepancies, and further research to optimize therapeutic strategies.