Introduction
Drug hangouts are known as open drug scenes (ODS) and places where users and dealers gather to buy, sell, and consume drugs [1]. The spread of infectious diseases, increased overdose and mortality risk, open drug buying and selling, attraction of new drug users (pull effect), and feelings of insecurity among surrounding residents are health and social consequences of the ODS [4]. Research shows that punitive and corrective approaches have had negative health and social impacts [1, 8-11].
The shift in understanding of the substance use issue from an individual to a community problem has been a major factor in changing intervention policies, resulting in the acceptance and development of harm reduction approaches alongside abstinence-based treatment approaches worldwide. However, the impact of this approach on the ODS (drug hangouts) has not been comprehensively evaluated, and the types of interventions related to hangouts have remained controversial. Expert consensus emphasizes the need for balance and interaction between supply reduction strategies, demand reduction, and harm reduction in hangouts [14-16].
The diffuse presence of homeless people and drug users in cities is a cause for concern for authorities. On the other hand, the health, social, and security consequences of arresting and temporarily housing people with addiction are serious. Therefore, implementing interventions with long-term effective results is essential. In this regard, there was a need for research in the field of legal considerations and judicial-regulatory interventions to achieve desirable health and social effects. Since the research in this field is limited, the present qualitative study aimed to explain the legal considerations and law enforcement interventions related to ODS. The results of this study can affect the quality and accessibility of services for drug users and improve the quality of life of drug users, as well as businesses and residents.

Methods
The present research method was a qualitative content analysis conducted in Tehran City, Iran, in 2023 [25]. The statistical population comprised key informants with first-hand information about the topic through work experience related to the subject or study and research in the area under study. In terms of information level, they included local informants like business owners/workers, police officers, residents, and activists in the region, including the city council and service providers, as well as public informants, including experts and officials of transit centers, law enforcement, municipality, and non-governmental organizations.
In this study, purposive and snowball sampling methods were used. In the present study, 13 interviews were conducted with service providers (n=5), heads and anti-narcotics police forces (n=4), lawyers (n=2), and judges (n=2).

The main interview questions were as follows:
1. In addition to the existing services for managing drug scenes, what other services can help reduce the health and social harms of drug scenes? 2. What legal considerations are needed to facilitate the management of drug scenes in terms of health, social, security, and substance use?
Also, focused group discussion sessions were held. In this study, conventional qualitative content analysis was used in an inductive manner [25]. In this analysis method, the analysis steps were carried out by selecting the unit of analysis, determining the semantic units, codes, subcategories, categories, and themes [26]. The in-depth interview texts and focus group discussions were coded with the help of MAXQDA software, version 10.

Results
The findings defined the characteristics of ODS in Iran and the existence of differences in perspective on confronting and managing the ODS. Two perspectives were prominent regarding the ODS. One group was in favor of destroying and eliminating them. The second group, which was the majority, considered eliminating the ODS neither possible nor useful.

Characteristics of drug scenes
The ODS are not simply gathering places for a few people who use or sell drugs. The ODS have a structured community, and individual differences among the hangout members are visible. This community has a range of different populations with specific relationships. Some of the ODS residents are immigrants, some are residents of the hangout, and some visit the ODS temporarily. For some residents, homelessness is a life sentence.
Hangout members have usually experienced a trauma in their lives.
The ODS are places for education and income generation. Specific rules govern drug hangouts, and one of their distinguishing features is their fluidity.

Eliminating drug scenes approach
The group in favor of eliminating drug scenes claimed several reasons, including the global approach to the war on drugs, the prominent criminalization approach in drug laws, the criminalization of establishing places for drug use, the inability to legitimize drug scenes, and the inability to create a tolerable neighborhood for drug scenes.

Managing drug scenes approach
From the perspective of this group (Table 1), in the management of drug scenes, attention should be paid to changing the approach of the police force, changing the laws and distinguishing between hard and soft drugs, developing specific legal guidelines for drug scenes, ensuring proportionality between crime and punishment, balancing power and the attitude of harm reduction officers to consultation, changing the attitude of residents towards vulnerable members of drug scenes, and creating a process-based approach to obtaining support for harm reduction programs.



Conclusions
The findings conclude that although law enforcement measures have some short-term benefits, they ultimately cause the spread and inaccessibility of ODS throughout the cities. This outcome will lead to serious health and security harms. By managing and adopting evidence-based policies, we can address the concerns of those favoring a coercive approach to scenes.
If we prevent the spread of ODS, it will be easier to provide consistent and continuous health care services and reduce harm to the residents. On the other hand, drug dealers will also aggregate in these places instead of wandering around the cities, and will cause less damage to society. As a result, using a tolerance is not legitimizing current problems, but rather managing them. It seems necessary to accept drug scenes as part of society and establish specific rules for them in a way that, if for any reason, people, whether people who deal/use drugs, attempt to violate the laws, they can be referred to correctional or treatment and harm reduction centres. Drug treatment courts should be considered for people who commit unintentional social harms.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the Research Ethics Committee of Iran University of Medical Sciences (cod: IR.IUMS.REC.1400.508).

Funding
The study was funded by the Iran University of Medical Sciences (Grant N: 20832).

Authors contributions
Conceptualization: Sahar Eshrati, Mohammad Baqer Saberi Zafarqandi and, Ali Shafiei; Research and review: Sahar Eshrati and, Mohammad Baqer Saberi Zafarqandi; Supervision, drafting, editing, and finalization: All authors.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
We sincerely appreciate and thank the Faculty of Behavioral Sciences and Mental Health for supporting the implementation of the project, the colleagues of the Anti-narcotics Headquarters Secretariat, the colleagues of the Anti-Narcotics Police, the activists and service providers at the drop-in centers and hangouts, and all the dignitaries who participated in the interview.
 


 

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