Dear Editor:
After the Islamic Revolution in Iran, the consumption of alcoholic beverages was declared illegal, making it difficult to estimate the burden of alcohol-related disease (Amin-Esmaeili et al., 2018). Therefore, very accurate statistics on the extent of alcohol consumption are not available for Iran (Amin-Esmaeili et al., 2018; Samadi et al., 2017). Despite such severe restrictions, the mean age of onset of alcohol consumption is 16.7 years, and the main alcoholic beverage is a homemade drink (Samadi et al., 2017). According to data from the Global Burden of Disease study (GBD 2010), the mortality rate (per 100,000 people) attributed to alcohol use disorders was 0.16 in men and 0.02 in women (Moazen et al., 2015). It seems that any alcoholic beverage that is easier to acquire is consumed more in our country due to legal and religious restrictions on alcohol consumption (Samadi et al., 2017). Therefore, mortality from poisoning is caused by drinking harmful homemade alcohol used in Iran to produce low-cost alcoholic beverages (Rostami & Rezaeian, 2019; Samadi et al., 2017). Homemade alcohol that may include high levels of methanol is common in Iran, mostly because of the high cost of illegally purchased alcohol (Hassanian-Moghaddam et al., 2015). Consequently, methanol poisoning could be a threat for Iran’s health-care system (Hassanian-Moghaddam et al., 2015; Samadi et al., 2017).
After the first official death from coronavirus disease (COVID-19) on February 19, 2020, was reported by the Iranian government, data from the Iranian Legal Medicine Organization (LMO) dated from February 20, 2020, through April 7, 2020, showed that more than 700 deaths in cases referred to this organization during this period were caused by alcohol poisoning (Iranian legal medicine organization, 2020 [access date: April 20, 2020]). The majority of deaths evidenced methanol intoxication (Iranian legal medicine organization, 2020 [access date: April 20, 2020]). The total number of deaths due to alcohol consumption in the same period of the previous year (March and April 2019) was 66 cases nationwide (Iranian legal medicine organization, 2020 [access date: April 20, 2020]). This means that an alarming number of alcohol-poisoning cases have been reported in Iran. Alcohol poisoning and its potentially deadly consequences have become a public health challenge in Iran. It is beyond the scope of this letter to discuss possible causes of this disaster in Iran, but some reasons have been identified and discussed elsewhere (Shalbafan & Khademoreza, 2020). In line with the World Health Organization recommendations (Al-Ansari et al., 2019) and in response to recent increases in alcohol consumption and related harm, policymakers should consider measures to educate the public about the negative consequences of drinking and health impact of illicit alcohol on Iranian society, especially men.
In parallel with the increased number of COVID-19 cases in Iran, the rapid increase of alcohol-related deaths can imply several important points. It shows the lack of adequate knowledge and information about the risks associated with alcohol use in the general population (Shalbafan & Khademoreza, 2020). Also, the stigma associated with alcohol consumption poses challenges for implementing alcohol screening in primary health care (Al-Ansari et al., 2019). Considering the conservative context of Iranian society, most existing studies on alcohol use are based on self-reporting by participants who might be prone to underreporting (Amin-Esmaeili et al., 2018; Rostami & Rezaeian, 2019). These may indicate that the national burden of disease due to alcohol is underestimated. Further research is needed to gain a better estimate of the prevalence of this condition.
Acknowledgments
The author would like to thank Dr. Mostafa Shokoohi (Dalla Lana School of Public Health, University of Toronto, Canada) for his useful comments.
Footnotes
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
ORCID iD: Mehran Rostami 
https://orcid.org/0000-0001-5155-962X
References
- Al-Ansari B., Thow A.-M., Mirzaie M., Day C. A., Conigrave K. M. (2019). Alcohol policy in Iran: Policy content analysis. International Journal of Drug Policy, 73(11), 185–198. [DOI] [PubMed] [Google Scholar]
- Amin-Esmaeili M., Motevalian A., Hajebi A., Sharifi V., Stockwell T., Rahimi-Movaghar A. (2018). Methods for calculation of per capita alcohol consumption in a Muslim majority country with a very low drinking level: Findings from the 2011 Iranian mental health survey. Drug and Alcohol Review, 37(7), 874–878. [DOI] [PubMed] [Google Scholar]
- Hassanian-Moghaddam H., Nikfarjam A., Mirafzal A., Saberinia A., Nasehi A. A., Masoumi Asl H., Memaryan N. (2015). Methanol mass poisoning in Iran: role of case finding in outbreak management. Journal of Public Health (Oxford), 37(2), 354-359. [DOI] [PubMed] [Google Scholar]
- Iranian Legal Medicine Organization. (2020. [Access date: April 20, 2020]). Referral of more than 700 deaths due to alcohol poisoning. https://www.lmo.ir/news/95987; [Language: Persian]
- Moazen B., Shokoohi M., Noori A., Rahimzadeh S., Saeedi Moghaddam S., Rezaei F., Lotfizadeh M., Kazemi M. R., Jamshidi H. R., Pazhuheian F., Rabbani S., Naderimagham S. (2015). Burden of drug and alcohol use disorders in Iran: findings from the Global Burden of Disease Study 2010. Archives of Iranian Medicine, 18(8), 480–485. [PubMed] [Google Scholar]
- Rostami M., Rezaeian S. (2019). Challenges of substance use disorders in Iran: A letter to the editor. International Journal of High Risk Behaviours and Addiction, 8(3), e95534. [Google Scholar]
- Samadi S., Baneshi M. R., Haghdoost A. A. (2017). Pattern of alcohol consumption among men consumers in Kerman, Iran. Addiction and Health, 9(3), 139–145. [PMC free article] [PubMed] [Google Scholar]
- Shalbafan M., Khademoreza N. (2020). What we can learn from COVID-19 outbreak in Iran about the importance of alcohol use education. The American Journal of Drug and Alcohol Abuse, 46(3), 385–386. [DOI] [PubMed] [Google Scholar]