Iranian psychiatrists are warning of a sharp rise in acute psychiatric emergencies linked to drug use, particularly among adolescents, raising concerns that the country may face a wave of long-term psychotic disorders if the trend continues.
Doctors working in public and private psychiatric hospitals told Tehran-based daily Etemad that they are seeing growing numbers of patients with no prior mental illness who develop severe psychotic symptoms after using narcotics and synthetic stimulants.
Many require emergency hospitalization, and some go on to develop lasting psychiatric disorders.
A senior psychiatrist at a 100-bed psychiatric hospital in southwest Tehran said that typically 15 to 20 percent of inpatient beds are occupied by patients admitted after drug-induced psychosis.
“Acute symptoms mean a crisis – self-harm, violence toward others, suicidal behavior, severe delusions and hallucinations,” the doctor said, adding that most arrive in an aggressive and disoriented state.
“These patients must often be physically restrained during transfer because they pose an immediate danger to themselves and others,” the psychiatrist said, noting that many families cannot afford private ambulances and that treatment costs are not covered by insurance.
Teens increasingly at risk
The most troubling shift is the age profile, doctors say. While hospitals previously treated mostly adult men, adolescents now make up a growing share of emergency admissions.
“More than half of pediatric psychiatric admissions are teenagers who have used heavy substances,” one psychiatrist said, adding that cannabis derivatives are now “circulating like chewing gum” among youths.
Another doctor described a rise in cases involving homemade drug mixtures and hallucinogens such as LSD and mushrooms. “Some teenagers believe they are entering a spiritual world,” he said. “Instead, they arrive with persistent hallucinations that can last for years.”
A resident psychiatrist at a public hospital said that in the past year, 10–20% of emergency psychiatric visits involved first-time psychosis triggered by drug use. “Some test negative for substances by the time they reach us, yet they are hallucinating and delusional,” he said. “Even if symptoms subside after treatment, continued drug use puts them at high risk of developing chronic disorders.”
Warnings of long-term fallout
Stimulants such as methamphetamine and cocaine sharply increase the risk of severe behavioral changes, Mohammadreza Shalbafan, head of mental health and addiction at the Iranian Ministry of Health told Etemad. “These reactions are not limited to people with a psychiatric history,” he said. “No drug user is immune.”
Toxicologist Kambiz Soltaninejad, speaking at a medical workshop in September 2025, warned that high-potency cannabis strains pose the greatest risk. “With teenage use rising, we should expect a schizophrenia tsunami in the near future,” he said.
Advocacy groups say the warnings confirm what they have long observed. Rising use of hallucinogens has already pushed hospital admissions higher, Tayebeh Dehbashizadeh, head of the Association for the Support of Schizophrenia Patients said.
“Global estimates suggest one percent of any population has schizophrenia,” she said. “In Iran, that number is climbing.”
Doctors caution that hospital data capture only the most severe cases. “We are seeing just the tip of the iceberg,” one psychiatrist said. “Many more are deteriorating quietly at home, unnoticed – until it’s too late.”
Cases that haunt clinicians
Doctors interviewed by Etemad described cases that continue to trouble them years later. One psychiatrist recalled a 27-year-old man who developed vivid, shifting hallucinations after consuming a small amount of psychedelic mushrooms. He remained trapped in a fantasy world for nearly two years before briefly regaining clarity, only to spiral into severe post-traumatic stress and later schizophrenia after renewed stress, requiring lifelong treatment.
Another case involved a 16-year-old girl from a family affected by addiction, who began injecting drugs in early adolescence. She was admitted after fearing a fatal overdose and asking for help but disappeared days after being discharged from a pediatric ward.
“No one knows what happened to her after she walked out of the hospital,” a doctor said.
Clinicians also described patients who returned repeatedly after discharge, only to die from overdoses weeks later. “Some survive the psychosis, but not the next relapse,” one psychiatrist said. “That is the most devastating part.”
The Grand Bazaar, one of Tehran’s most important commercial and historic areas, is facing a crisis that has developed below ground rather than at street level.
Iranian media reported the discovery of excavations beneath the Azadi (Dastmalchi), Ziba and Naderi caravanserais within Tehran’s Grand Bazaar in the capital city's downtown.
Given that the buildings are physically interconnected, damage to one structure can affect the others.
Size and extent of excavations
No official measurements have been released on the length or size of the underground spaces.
Tehran-based Payam-e Ma reported that unknown excavators had dug a deep and narrow tunnel covering about 5,000 square meters beneath the Grand Bazaar, close to the historic core of central Tehran. The report did not cite a source for the figure.
The estimate was attributed elsewhere to a bazaar shopkeeper identified as Mr. Fili, who was quoted by the semi-official ISNA as saying the operation included around 5,000 underground spaces and nearly 12 exit points, making the work easier to conceal.
When did the work begin?
Mohammad Amini, mayor of Tehran’s District 12, said the illegal construction likely began in the mid-2010s and continued until the end of last year.
If accurate, the timeline raises questions about how such large-scale activity could have gone undetected by municipal and oversight bodies for years.
Some Tehran bazaar traders have disputed that assessment.
One long-time shopkeeper told Iran International that continuous police monitoring makes any nighttime activity in the bazaar without official permits effectively impossible.
Another shopkeeper said that due to oversight by municipal authorities, police and cultural heritage bodies, bringing any construction materials into the bazaar — even a single bag of cement — requires official approval.
Amini said no new violations have been reported since the issue was identified sometime between late March and mid-April this year.
It remains unclear why the municipality did not publicly address the issue earlier, despite being aware of the violations since then.
Purpose of the excavations
Officials say the main aim of the excavations was to create a new underground level, likely intended for storage or commercial use outside formal oversight.
Ali Nasiri, head of Tehran’s Crisis Management Organization, said a new level had been created within part of the building foundation without technical feasibility or structural resistance.
The Research Center of the Ministry of Roads, Housing and Urban Development, the body responsible for assessing building safety, said technical inspections showed the caravanserais had become structurally unstable.
Official reports cite damage including distorted ceilings and weakened or warped columns.
The Fire Department and the Crisis Management Organization said about 1,000 shops operate in the affected area, employing roughly 3,000 people on a permanent basis.
Authorities estimate that 5,000 to 6,000 people pass through the area daily and have warned that any incident could lead to a major human disaster.
Who is responsible?
Despite judicial orders and confirmation that violations occurred, authorities have not disclosed the identities of those responsible for the excavations.
City officials say individuals seeking to profit from the project have been identified and the case is under investigation, but no further details have been made public.
Some shopkeepers and experts continue to question how a project of this scale could have continued for months or years in one of Tehran’s busiest areas.
Arash Darbandi, a photographer from Ahvaz in southwestern Iran, told the Ukrainian outlet that he arrived in St. Petersburg on a tourist visa and supported himself by taking photographs of passersby.
“I took photos of anyone who was dressed in colorful clothes. If they liked the photo, they paid me 1,000 rubles ($10-11),” he said.
Although trained as a petroleum engineer, Darbandi said photography had been his main livelihood.
He acknowledged knowing that Russia was at war with Ukraine but said the conflict initially felt distant. That changed after an encounter with police that led to his detention.
According to Darbandi, he was arrested following an altercation with a police officer and taken to a military facility on Ligovsky Prospekt.
He said authorities gave him a stark ultimatum: prison or the battlefield.
“They told me that I either had to go to prison for three to five years, or go to the war for one year,” he said.
When he objected and argued that deportation should be the maximum punishment for a foreigner, he said officers replied: “This is Russia, and you must go to war.”
Iran emerged as one of Russia’s key military backers since Moscow launched its full-scale invasion of Ukraine in February 2022. Tehran has been accused of supplying Russia with hundreds of Shahed-series attack drones, which have been widely used against Ukrainian cities and infrastructure.
Western governments and Kyiv say Iranian-made drones have played a central role in Russia’s aerial campaign, a charge Iran has repeatedly denied or downplayed.
Self-harm to avoid war
Darbandi said he was held in barracks for months before being sent to a training center near Belgorod.
Fearing deployment, he said he deliberately injured himself, breaking his arm, but was still not exempted from service despite Russian law.
“I had never even held a knife,” he said, stressing he had no military background.
He described training as minimal and coercive, saying recruits were treated as expendable.
“They didn’t treat us as humans; they only saw us as expendable and just wanted to send us to the front so that the Russians could live safely,” he said.
Darbandi said foreign nationals—including Iranians, Africans, Arabs, Kenyans, and Colombians—were segregated from Russian soldiers.
“Foreigners have no rights at all; at any moment, they can take whatever they have,” he said.
He said he was later wounded during a Ukrainian drone strike and captured after being left without assistance for days.
Reflecting on his situation, Darbandi said he feels guilt over his forced participation and urged others not to cooperate with governments he accused of exploitation.
“Never help countries like Russia, Iran, and countries that support terrorists. Please stop the war.”
The account has not been independently verified. Iranian, Russian, and Ukrainian officials have not publicly commented on the case.
Recruitment drive in Tehran
Earlier this month, flyers circulated near the Russian Embassy in Tehran that invited men to enlist in the Russian army for promises of dollar payments and contracts “directly under the Ministry of Defense of the Russian Federation.”
The Russian embassy denied any connection to the leaflets.
The flyers targeted men aged 18 to 45 and offered starting bonuses of $15,000 to $18,000 and monthly salaries of $2,500 to $2,800, along with free housing, medical care, and military uniforms.
Tehran-based outlet Rouydad24 said the leaflets directed readers to a Telegram channel that had published multilingual posts in Persian, Russian, Arabic, and English, describing the campaign as a “state-supported initiative.”
The Iranian report compared the flyers to similar alleged recruitment efforts in India, Nepal, Sri Lanka and several African countries, which foreign media have described as part of Moscow’s drive to attract foreign fighters amid heavy losses in Ukraine.
On Wednesday, former Afghan police general Ikramuddin Sari was shot dead by masked assailants near his home in Tehran, according to sources close to him.
He was attacked alongside an associate near their residence in southern Tehran and died while being transferred to hospital, the sources told Afghanistan International.
Sari, a former police commander in Baghlan and Takhar provinces, fled to Iran after the Taliban returned to power in 2021. Reports in recent months had suggested Iranian police had detained and questioned him, though no official explanation was given.
Taliban's 'extraterritorial assassinations'
The killing follows the September shooting of Maroof Ghulami, a political and military figure close to veteran anti-Taliban leader Ismail Khan. He was killed by gunfire in the religious city of Mashhad.
People close to both men have blamed the Taliban for their deaths, according to Afghanistan International.
The attacks, an Afghan military source said, signal the start of what he described as Taliban “extraterritorial assassinations,” adding that the group has repeatedly threatened to target opponents abroad.
Senior Taliban official Mohammad Nabi Omari has previously said the group could kill opponents outside Afghanistan “with as little as 500 Pakistani rupees,” while Saeed Khosti, a former spokesperson for the de facto Taliban Ministry of Interior, warned two years ago that hundreds of volunteers were ready to target critics overseas.
Iranian authorities have remained publicly silent on Sari’s killing. Tehran has also provided no detailed update on the investigation into Ghulami’s death.
Iranian police said in September they arrested three suspects in that case but later released two, offering no clarity on affiliations.
A source familiar with the investigation told Afghanistan International that the remaining suspect was a Taliban operative, a comment not confirmed by Iranian authorities.
Calls for accountability
Sari, originally from Kapisa province, was regarded as a professional officer who served as police commander in Nuristan, Baghlan and Takhar, and as an adviser to Afghanistan’s interior ministry.
In Iran, he acted as an informal representative for former Afghan soldiers, advocating for their rights, opposing deportations and openly criticizing the Taliban.
The National Resistance Front of Afghanistan (NRF), led by Ahmad Massoud, called on Iran to conduct a “transparent, serious and independent” investigation, describing Sari’s killing as a “targeted terrorist act.”
The Jamiat-e Islami Afghanistan, led by Salahuddin Rabbani, also condemned the killing and urged Iranian authorities to identify those responsible.
Iran, which has handed Afghanistan’s embassy in Tehran and the consulate in Mashhad to the Taliban, has faced growing criticism for failing to protect Afghan dissidents on its soil even as it seeks closer ties with the Taliban-led administration.
