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Background  Crystal (methamphetamine) is a strong stimulant of addictive substances that affects the central nervous system. The consumption of this substance is increasing among teenagers and adult young people in the country. In this matter, one of the practical and important ways to its control is to identify the factors leading to its first use. Thus this paper, explores the factors related to the first crystal use in Golestan province, Iran.    Methods  In a qualitative study, 19 crystal users were recruited in the study conducted in Golestan province by snowball sampling from DIC (Drop-In Center) in addiction treatment centers. The interviews were mostly carried out individually with the participants; only one interview was conducted in an addiction treatment camp in the form of a group-focused discussion. Data analysis was implemented through content analysis in MAXQDA 10 software.    Results  The mean age of the participants was 35.05 ± 6.06 years with a range of 23–46 years. Meanwhile, the mean of crystal use period was 7.42 (SD: 3.61) and a range of 1–14 years. Based on the obtained data, the reasons for first crystal use could be categorized in six; 1: “crystal use to other drugs rehabilitation”; 2: “Lack of awareness of the addictive nature of crystal”; 3: “stimulating curiosity in public with crystal-use friends”, 4: affordable and convenient use”, 5: “anti-sleeping effects and increasing work efficiency”, and 6: “therapeutic and other misconceptions”“.    Conclusions  The results indicated that crystal is mostly abused to opium rehabilitation. The lack of awareness and misconceptions about this substance can lead people to crystal use. Therefore, designing public health interventions to increase awareness about negative consequences of crystal use is fundamental to prevent people from abusing it. We suggest designing public health program to promote awareness about health risks of crystal and modifying related misconceptions. Finally, the government can establish policies to mandate sale tax for crystal producers and reduce easy access to crystal especially among youth.

A qualitative exploration of the factors associated with initiation to methamphetamine use in Iran