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Mansouri B, Azadi N, Drebadami AH, Nakhaee S. Trace element levels: How Substance Use Disorder (SUD) contributes to the alteration of urinary essential and toxic element levels. PLoS One 2024; 19:e0294740. [PMID: 38315674 PMCID: PMC10843129 DOI: 10.1371/journal.pone.0294740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 11/07/2023] [Indexed: 02/07/2024] Open
Abstract
Increasing illicit drug use is one of the main problems in most countries or societies. Monitoring heavy metals and trace elements in this vulnerable group seems to be necessary. Therefore, we assessed the urinary trace element and toxic metals/metalloids concentrations (Zinc (Zn), Iron (Fe), Copper (Cu), Chromium (Cr), Lead (Pb), Cadmium (Cd), Arsenic (As), Nickel (Ni), and Mercury (Hg)) in opium, tramadol, and cannabis users compared to healthy subjects. In this cross-sectional study, patients with substance use disorder (SUD) (n = 74) were divided into four groups: cannabis, tramadol, opium, and mixed (simultaneous use of more than one of the three studied substances), along with a healthy group (n = 60). Urine samples were prepared by dispersive liquid-liquid microextraction method so that heavy metals/metalloids could be measured by ICP-MS. The mean urinary concentration of Cu (48.15 vs. 25.45; 89.2%, p<0.001), Hg (1.3 vs. 0.10; 1200%, p < 0.001), and Zn (301.95 vs. 210; 43.8%, p < 0.001) was markedly lower among patients with SUD. The mean urinary concentration of other elements including As (1.9 vs. 4.1; 115.8%), Cd (0.1 vs. 1.10; 1000%), Cr (6.80 vs. 11.65; 71.3%), Ni (2.95 vs. 4.95; 67.8%), and Pb (1.5 vs. 7.9; 426.6%) were significantly higher among patients with SUD compared to healthy subjects. When sub-groups were compared, no significant differences were observed between their trace element levels (Kruskal-Wallis test, p > 0.05). This can be an indication that regardless of the type of drug, the levels of trace elements are changed with respect to healthy individuals. Our results showed that illicit drug use causes changes in urinary trace element/heavy metal/metalloid levels and highlights the need for monitoring heavy metals and trace elements in individuals with substance use disorder. Assessment of different elements in biological samples of drug dependents may be useful for implementing new prevention and treatment protocols. In case of changes in their levels, complementary recommendations, attention to diet, and periodic assessment of toxic metal levels within treatment programs will be needed.
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Affiliation(s)
- Borhan Mansouri
- Substance Abuse Prevention Research Center, Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nammamali Azadi
- Biostatistics Department, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Arezo Hashemi Drebadami
- State Welfare Organization of Kermanshah, Substance Abuse Prevention Research Center, Research Institute for Health, Kermanshah, Iran
| | - Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Southern Khorasan, Iran
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Pezeshki B, Pourmontaseri H, Homayounfar R, Moghaddam MT, Dehghan A. Thyroid function and opium use disorder: a cross-sectional study on the Fasa adults cohort study (FACS), 2017. BMC Endocr Disord 2023; 23:264. [PMID: 38031024 PMCID: PMC10688461 DOI: 10.1186/s12902-023-01467-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 09/22/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Addiction increases the risk of different lifelong disorders. However, there are limited studies evaluating the effects of opioid use disorder (OUD) on thyroid function. The present study aimed to compare the thyroid function of individuals with and without OUD. METHODS This cross-sectional study was conducted on 700 eligible participants of the Persian Cohort of Fasa, Iran. Pregnant women and participants with false or missing data were excluded from the study. Remained participants were divided into case and control groups based on the recorded history of OUD. Frozen plasma samples of the cohort bank were used to determine the levels of T3, T4, and thyroid-stimulating hormone (TSH). The thyroid function was compared between the two groups using the Mann-Whitney test (P < 0.05). RESULTS The mean age of the final studied population (n = 648) was 54.0 ± 9.8 years, including 336 men (49.1%) and 197 participants with OUD (28.8%). The median levels of TSH, T4, and T3 were 2.91 ± 4.61, 9.26 ± 3.65, and 1.22 ± 0.49, respectively. The case group had significantly higher TSH (3.72 ± 6.2 vs. 2.58 ± 3.75, P < 0.001) and lower T4 (8 ± 3.6 vs. 9.8 ± 3.5, P < 0.001). Also, T3 was slightly lower in the case group (1.1 ± 0.5 vs. 1.3 ± 0.5; P = 0.369), although this association was only significant in female opium users (P < 0.001). CONCLUSIONS The present findings revealed that OUD caused a reduction in T4 while increasing TSH. Therefore, OUD may lead to the development of primary hypothyroidism, which needs to be investigated in future studies.
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Affiliation(s)
- Babak Pezeshki
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Hossein Pourmontaseri
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran.
- USERN Office, Shiraz University of Medical Sciences, Shiraz, Iran.
- Shiraz Nutrition Interest Group, Bitab Enterprise, Shiraz, Iran.
| | - Reza Homayounfar
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
- Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute (WHO Collaborating Center), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Talebi Moghaddam
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Azizallah Dehghan
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
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Ghaderi A, Khoshakhlagh AH, Gruszecka-Kosowska A, Alemi F, Hazegh P, Aghaei Z, Molavi N, Mahdavi M, Vahed N, Dehkohneh SG, Ostadmohammady F, Das D. Blood-lead level in humans and drug addiction: a comprehensive study in Iran. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:112071-112085. [PMID: 37828260 DOI: 10.1007/s11356-023-30179-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
Drug abuse has a high prevalence worldwide and causes many health-related disorders. There are limited human exposure studies on establishing lead exposure levels and their propensity for drug addiction. In the present study, blood samples were tested for lead (Pb) concentrations in illicit drug users together with the related symptoms in comparison with control group of non-drug users. The study was performed on 250 volunteers divided equally in four drug groups, namely, opioids, hashish, methadone, and methamphetamine, and one control group of non-drug users. Participants were recruited from drug addiction clinics and camps in Kashan city, Iran, who were using drugs continuously for more than 1 year. Control group was recruited from companions of the patients with no drug use history. In the investigated groups of drug users, the highest blood-lead level (BLL) concentrations were observed in the opioid group (mean 37.57 µg/dL) with almost 3.7 times higher than in the control group (mean 3.39 µg/dL). In the methamphetamine group, type of occupation had the significant association with BLL concentrations. The positive correlation was revealed in the opioid and methadone groups for BLL concentrations and the duration of drug usage. In the opioid group, the highest BLL concentrations were observed among users who used both methods of drug use: smoking and eating. Also, several behavioral and life-style factors were identified which influence the blood-lead concentration in the drug users. The results of our study revealed that the BLL concentrations in investigated drug users' groups were significantly higher than in the control group (P < 0.001). That can be related with the Pb contents in illicitly used drugs. Apart other adverse health effects, long-term illicit drug use might cause to lead poisoning.
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Affiliation(s)
- Amir Ghaderi
- Department of Addiction Studies, School of Medical and Clinical Research Development Unit-Matini/Kargarnejad Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Amir Hossein Khoshakhlagh
- Department of Occupational Health Engineering, School of Health, Kashan University of Medical Sciences, Kashan, Iran.
| | - Agnieszka Gruszecka-Kosowska
- Department of Environmental Protection, Faculty of Geology, Geophysics and Environmental Protection, AGH University of Krakow, Al. Mickiewicza 30, 30-059, Krakow, Poland
| | - Fatemeh Alemi
- Department of Toxicology and Pharmacology, School of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Pooya Hazegh
- Department of Psychiatry, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Aghaei
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | - Nader Molavi
- Department of Addiction Studies, School of Medical and Clinical Research Development Unit-Matini/Kargarnejad Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Mojtaba Mahdavi
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | - Neda Vahed
- Department of Addiction Studies, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Somayeh Ghadami Dehkohneh
- Department of Pharmacy, Acharya BM Ready College of Pharmacy, Rajive Gandhi University of Health Sciences, Bangalore, Karnataka, India
| | | | - Darpan Das
- Department of Environment and Geography, University of York, York, UK
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Khayat S, Fanaei H. Relationship between lead concentration in maternal and umbilical cord blood and some neonatal outcomes in primiparous opium-dependent mothers in Zahedan, Southeast of Iran in 2022. BMC Pregnancy Childbirth 2023; 23:753. [PMID: 37880654 PMCID: PMC10601093 DOI: 10.1186/s12884-023-06068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/14/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND There are limited studies on maternal and umbilical cord blood lead levels and their relationship with each other and with pregnancy outcomes in women addicted to opium. The present study was conducted with the aim of investigating the relationship between lead concentrations in maternal blood and umbilical cord blood with some neonatal outcomes in primiparous opium-dependent mothers. METHOD The present study is a cross-sectional and analytical research. A total of 35 mothers addicted to opium and 35 women without addiction from Zahedan city of Iran participated in this study in 2022. Convenience sampling was done, lead levels were measured and pregnancy outcomes checked by a checklist to collect information. Data analysis was done by independent t-tests, Pearson's correlation coefficient, Point-Biserial Correlation Coefficient, multivariate linear regression and multivariate logistic regression using SPSS version 26 software. RESULTS There was a significant difference in maternal blood lead levels (24.97 ± 8.45 in addicted mothers and 7.5 ± 4.25 in healthy mothers) and in umbilical cord blood lead concentrations (18.68 ± 6.95 in the addicted group and 5.7 ± 2.84 in the healthy group) between the two groups (P < 0.0001 and P < 0.0001, respectively).The lead concentration of all the samples in the addicted group was higher than the high-risk levels. Birth weight, Apgar score, admission to NICU and need for resuscitation were significantly different between the two groups (P < 0.0001, P < 0.0001, p = 0.03 and p = 0.04, respectively). Based on the results of multivariate linear regression test, only addiction can reversely predict the birth weight (Beta= -0.74, P < 0.0001), 1-minute Apgar score (Beta = -0.47, P = 0.004) and 5th minute (Beta= -0.62, P = 0.001). According to multivariate logistic regression test, OR of none of the predictor variables was significant with the outcomes. Maternal and umbilical cord blood lead concentrations were not predictors of pregnancy outcomes. CONCLUSION The use of opium during pregnancy leads to an increase in the level of lead in maternal blood and umbilical cord blood. Addiction increased adverse pregnancy outcomes but lead concentration did not predict pregnancy complications. It is recommended that the addiction treatment program be included in pre-pregnancy and pregnancy care plans.
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Affiliation(s)
- Samira Khayat
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hamed Fanaei
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
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Rajabi R, Eslami Aliabadi H, Javad Mahdizadeh M, Azzizadeh Forouzi M. A comparative study of religious beliefs, spiritual intelligence and spiritual well-being in two therapies based on education (anonymous drug user) and methadone in drug user in Iran. BMC Res Notes 2023; 16:101. [PMID: 37308965 DOI: 10.1186/s13104-023-06377-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 06/05/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVE Prevention of high-risk behaviors has always been considered; According to the researches, a person's religious attitudes and beliefs and intelligence quotient are associated with the prevention of high-risk behaviors such as drug addiction, and religiosity and spirituality also reduce drug addiction; Therefore, this study was conducted to compare religious beliefs, intelligence and spiritual health in two methods of education-based treatment and methadone in people with addiction. RESULTS A comparative study was performed among 184 people on all drug users admitted to these wards that treated with methadone and participants of meetings of anonymous drug users. Four questionnaires were used to collect information. Mean, and standard deviation were used to describe the demographic characteristics of participants. Chi-square and fisher tests were used to compare demographic information in the two groups. The present study was performed following acquisition of the code of ethics (IR.BUMS.REC.1395.156) from Research Ethics Committee of Birjand University of Medical Sciences.
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Affiliation(s)
- Raheleh Rajabi
- Department of Nursing, Zarand School of Nursing, Kerman University of Medical Sciences, Kerman, Iran
| | - Hassan Eslami Aliabadi
- Nursing midwifery school, Assistant Professor of Nursing, Department of Nursing, Ferdows School of Health and Allied Medical Sciences, Birjand university of Medical Sciences, Birjand, Iran
| | - Mohammad Javad Mahdizadeh
- Instructor of Nursing, Nursing Department, Zarand School of Nursing, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansooreh Azzizadeh Forouzi
- Medical surgical nursing, Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.
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Rodzlan Hasani WS, Robert Lourdes TG, Ganapathy SS, Ab Majid NL, Abd Hamid HA, Mohd Yusoff MF. Patterns of polysubstance use among adults in Malaysia-A latent class analysis. PLoS One 2023; 18:e0264593. [PMID: 36649298 PMCID: PMC9844871 DOI: 10.1371/journal.pone.0264593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 12/04/2022] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Polysubstance use is the use of more than one non-prescribed licit or illicit substance at one time. This is a common phenomenon, but little is known about the severity and the various substances used by adults in Malaysia. OBJECTIVE To determine the pattern of polysubstance use and its associated factors among general adults in Malaysia. METHODOLOGY This was a secondary data analysis from the National Health and Morbidity Survey (NHMS) 2019), a cross-sectional population survey with a two-stage stratified random sampling design. A total of 10,472 Malaysians aged 18 years and above participated in this survey. Polysubstance use was defined as concurrent use of more than one substance, either alcohol, tobacco, or drugs (opioids, marijuana, amphetamine/ methamphetamine or kratom). A latent class analysis (LCA) was used to identify the membership of polysubstance groups. The association of class membership with demographic profiles was examined using Multinomial Logistic Regression analysis. RESULTS Fit indices (AIC = 16458.9, BIC = 16443.6) from LCA supported 3 classes solution: Class 1; "moderate-drug" group primarily combination used of tobacco and alcohol (2.4%), Class 2; "high-drug" group using multiple substance including kratom (0.3%) and Class 3; "low-drug" group reporting minimal alcohol and tobacco use or non-user (97.3%). The multinomial model showed young adults (18-40 years) had a higher likelihood of being polysubstance users both for moderate-drug class (OR = 4.1) and high-drug class (OR = 3.9) compared to older age (≥60 years). Chinese (OR = 18.9), Indian (OR = 23.3), Indigenous Sabah & Sarawak (OR = 34.6) and others ethnicity (OR = 8.9) showed higher odds of being moderate-drug users than Malays. The greater odds of moderate-drug use for males (OR = 35.5), working groups (OR = 1.5) and low education level group (OR = 3.2). CONCLUSION Our study highlights patterns and demographics related to the use of polysubstances among adults in Malaysia. These results would help formulate specific prevention programmes for these high-risk groups.
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Affiliation(s)
- Wan Shakira Rodzlan Hasani
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Selangor, Malaysia.,Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Tania Gayle Robert Lourdes
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Selangor, Malaysia
| | - Shubash Shander Ganapathy
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Selangor, Malaysia
| | - Nur Liana Ab Majid
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Selangor, Malaysia
| | - Hamizatul Akmal Abd Hamid
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Selangor, Malaysia
| | - Muhammad Fadhli Mohd Yusoff
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Selangor, Malaysia
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Bakhshayesh A, Eslami Farsani R, Seyedebrahimi R, Ababzadeh S, Heidari F, Eslami Farsani M. Evaluation of the Negative Effects of Opium Tincture on Memory and Hippocampal Neurons in the Presence of Chicory Extract. Adv Biomed Res 2023; 12:23. [PMID: 36926425 PMCID: PMC10012026 DOI: 10.4103/abr.abr_210_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/15/2021] [Accepted: 08/24/2021] [Indexed: 02/01/2023] Open
Abstract
Background Due to the high prevalence of addiction in society and the need to its attention, various methods are used for addiction withdrawal. The side effects of some methods restrict their use and increase the risk of recurrence. One of the Iranian useful methods is consumption of opium tincture (OT) that may cause brain structure and memory defects. Hence, this study aimed the effects of different doses of OT on memory and hippocampal neurons with the use of an antioxidant such as various concentrations chicory. Materials and Methods In the present study, 70 Wistar rats were randomly divided into 10 groups and the effect of various doses of chicory extract and OT were assessed on memory by the passive avoidance test. The neurons and astrocyte cells numbers in dentate gyrus were investigated, using histological examination. Results In passive avoidance test, the total time in dark compartment was significantly more in groups with 100 and 75 μl OT compared with control and normal saline groups (P < 0.001). Traffic number results showed that there was a significant difference between T100 and control groups (P > 0.05). Moreover, initial latency time was significantly shorter in groups with 75 and 100 μl of OT compared with control and normal saline groups (P < 0.05). However, the presence 250 mg/kg of chicory increases granular layer thickness of dentate gyrus and number of neurons. Conclusion The use of 250 mg/kg of chicory extract may be promising strategy for inducing neurogenesis and this dose could prevent neural damage.
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Affiliation(s)
- Alireza Bakhshayesh
- Department of Psychology and Educational Sciences, Yazd University, Yazd, Iran
| | - Roghayeh Eslami Farsani
- Department of Clinical Psychology, Islamic Azad University, Yazd Branch, Yazd, Iran.,Farsan Health Service System, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | | | - Shima Ababzadeh
- Tissue Engineering Department, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Fatemeh Heidari
- Cellular and Molecular Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Mohsen Eslami Farsani
- Cellular and Molecular Research Center, Qom University of Medical Sciences, Qom, Iran
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Forghani M, Nasr Esfahani M, Vali M. Comparison of the Effect of Intravenous Fentanyl with Low-Dose Ketamine on Pain Relief in Patients Taking Methadone and Suffering from Limb Fractures. Adv Biomed Res 2023; 12:7. [PMID: 36926435 PMCID: PMC10012033 DOI: 10.4103/abr.abr_166_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/15/2021] [Accepted: 01/02/2022] [Indexed: 02/05/2023] Open
Abstract
Background Given the significance of pain control in addicted patients and the prominence of not using opioids due to patient's drug dependence, the present study aimed at comparing and evaluating the effect of intravenous fentanyl with low-dose ketamine on pain relief in patients taking methadone and suffering from limb fractures. Materials and Methods The present double-blind randomized clinical trial was performed on 100 patients taking methadone and suffering from limb fractures. The patients were divided into two groups receiving 1 μg/kg single dose of fentanyl and 0.3 mg/kg single dose of ketamine (low-dose ketamine). Patients' pain scores and the incidence rate of complications were recorded before the intervention, and 15, 30, and 60 min after drug administration and were then compared between the two groups. Results The mean pain score of patients 15 min after the intervention was significantly lower in the low-dose ketamine group with a mean of 2.50 ± 1.34 as compared with the fentanyl group with a mean of 7.10 ± 1.43 (P < 0.001). However, the mean pain score was not significantly different between the two groups 30 and 60 min after the intervention (P > 0.05). In addition, the incidence rate of complications was not significantly different between the two groups (P > 0.05). Conclusion According to the results of this study, low-dose ketamine as compared with fentanyl relieves pain in the mentioned patients with a faster effect and in a shorter time although no difference can be found between the pain scores of the two groups 30 and 60 min after the intervention.
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Affiliation(s)
- Mohsen Forghani
- Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Marzie Vali
- Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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The Effect of 3 Years of Methadone Maintenance Therapy on Biochemical and Biophysical Parameters of Opioid Use Disorder Patients. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00990-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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10
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Farnia V, Nakhaee S, Azadi N, Khanegi M, Ahmadi-Jouybari T, Mansouri B. Comparison of urine trace element levels in tramadol addiction alone and its co-abuse with cigarette and opium in Western Iran. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:77375-77385. [PMID: 35675014 DOI: 10.1007/s11356-022-21271-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
Tramadol is an opioid pain medication used to treat moderate to severe pain. Tramadol consumers tend to co-abuse some other substances such as opium, cigarettes, alcohol, and cannabis and each of these substances may impair trace elements homeostasis in the body. Therefore, this case-control study aimed to compare the urinary concentration of some essential and toxic elements in tramadol addiction alone and its co-abuse with cigarette and opium in Western Iran. For this purpose, urine samples were collected in two groups of tramadol (n = 72) and control subjects (n = 62) from March to November 2020. The case group was divided into three groups: tramadol alone, tramadol + opium, and tramadol + cigarettes. Moreover, ICP-MS (Agilent 7900) was used to measure trace element concentrations in the urine samples. Based on our results, Fe was the only element markedly higher among controls as compared to tramadol users (p < 0.001). Moreover, the concentration levels of As appeared to be the same among both groups, but the levels of other elements including Ca, Cd, Cr, Mn, Cu, Zn, Co, Ni, Se, and Pb were all significantly higher among tramadol users as compared to control group. The rank-based regression analysis illustrated that no contribution of sex and age effect was found by the regression model on the levels of all 12 studied elements. While, smoking was found to affect the levels of Fe (β = 0.163, P = 0.025) and Co (β = 0.411, p < 0.001) so that smoking reduced Fe levels but elevated Co concentration levels. Abuse of tramadol along with cigarettes and opium increased the concentration of some heavy metals in urine samples compared to the control group. However, these results showed no significant effect of age, sex, smoking habit, and amount of tramadol usage on the levels of trace elements.
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Affiliation(s)
- Vahid Farnia
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Nammamali Azadi
- Biostatistics Department, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Khanegi
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Toraj Ahmadi-Jouybari
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Borhan Mansouri
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Sourinejad H, Noroozi M, Taleghani F, Kheirabadi GR. Factors Associated with the Involvement of Women Drug Users in Risky Sexual Behaviors: A Narrative Review. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2022; 27:353-362. [PMID: 36524133 PMCID: PMC9745854 DOI: 10.4103/ijnmr.ijnmr_318_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/12/2021] [Accepted: 04/09/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Drug use is known as an important underlying factor in the occurrence of risky sexual behaviors. The present study was conducted to identify the factors associated with the involvement of women drug users in risky sexual behaviors. MATERIALS AND METHODS This review was conducted by searching databases of ISI Web of Science, Scopus, Science Direct, Cochrane, PubMed, Scientific Information Database (SID), the Iranian Magazine Database (Magiran), the Iranian Research Institute for Information Science and Technology (IranDoc), and the Iranian Medical Articles Database (IranMedex) and searching through the Google Scholar engine. All the articles published in English and Persian using the keywords including substance use, drug users, addiction, substance use disorders, substance-related disorders, sexual risks, high-risk sexual behavior, HIV risk behavior, unsafe sex, unprotected sex, and risky sex were searched from January 2000 to December 2020. After reviewing the articles, out of 110 articles, 21 articles were selected for final evaluation. RESULTS Factors related to the involvement of women drug users in risky sexual behaviors were divided into five categories: individual factors, factors related to drug use, inter-personal relationships, gender discrimination, and socio-economic factors. CONCLUSIONS The results can be used in the field of women's social harms in finding strategies and designing the necessary interventions to prevent risky sexual behaviors in women drug users in different societies and cultural contexts. Also, the results can be used by all researchers who want to study the relationship between these factors and the involvement of women drug users in risky sexual behaviors.
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Affiliation(s)
- Hadis Sourinejad
- Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Noroozi
- Reproductive Sciences and Sexual Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariba Taleghani
- Nursing & Midwifery Care Research Center, Faculty of Nursing & Midwifery, Isfahan University of Medical Sciences, Isfahan-, Iran
| | - Gholam Reza Kheirabadi
- Behavioral Sciences Research Center, Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Sakhaee E, Amirahmadi A, Mahdiani M, Shojaei M, Hassanian‐Moghaddam H, Bauer R, Zamani N, Pakdaman H, Gharagozli K. Developing a novel prediction model in opioid overdose using machine learning; a pilot analytical study. Health Sci Rep 2022; 5:e767. [PMID: 35949676 PMCID: PMC9358662 DOI: 10.1002/hsr2.767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 05/07/2022] [Accepted: 06/16/2022] [Indexed: 12/04/2022] Open
Abstract
Background and Aims The opioid epidemic has extended to many countries. Data regarding the accuracy of conventional prediction models including the Simplified Acute Physiologic Score (SAPS) II and acute physiology and chronic health evaluation (APACHE) II are scarce in opioid overdose cases. We evaluate the efficacy of adding quantitative electroencephalogram (qEEG) data to clinical and paraclinical data in the prediction of opioid overdose mortality using machine learning. Methods In a prospective study, we collected clinical/paraclinical, and qEEG data of 32 opioid-poisoned patients. After preprocessing and Fast Fourier Transform analysis, absolute power was computed. Also, SAPS II was calculated. Eventually, data analysis was performed using SAPS II as a benchmark at three levels to predict the patient's course in comparison with SAPS II. First, the qEEG data set was used alone, secondly, the combination of the clinical/paraclinical, SAPS II, qEEG datasets, and the SAPS II-based model was included in the pool of classifier models. Results Seven out of 32 (22%) died. SAPS II (cut-off of 50.5) had a sensitivity/specificity/positive/negative predictive values of 85.7%, 84.0%, 60.0%, and 95.5% in predicting mortality, respectively. Adding majority voting on random forest with qEEG and clinical data, improved the model sensitivity, specificity, and positive and negative predictive values to 71.4%, 96%, 83.3%, and 92.3% (not significant). The model fusion level has 40% less prediction error. Conclusion Considering the higher specificity and negative predictive value in our proposed model, it could predict survival much better than mortality. The model would constitute an indicator for better care of opioid poisoned patients in low resources settings, where intensive care unit beds are limited.
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Affiliation(s)
- Ehsan Sakhaee
- Brain Mapping Research Center, Department of NeurologyShahid Beheshti University of Medical SciencesTehranIran
| | - Ali Amirahmadi
- Department of Information Technology, School of Electrical and Computer Engineering, University College of EngineeringTehran UniversityTehranIran
- Department of Artificial IntelligenceARIS Intelligent Solutions CompanyTehranIran
| | - Morteza Mahdiani
- Department of Artificial IntelligenceARIS Intelligent Solutions CompanyTehranIran
- Department of Computer EngineeringAmirkabir University of Technology (Tehran Polytechnic)TehranIran
| | - Maziar Shojaei
- Brain Mapping Research Center, Department of NeurologyShahid Beheshti University of Medical SciencesTehranIran
| | - Hossein Hassanian‐Moghaddam
- Department of Clinical Toxicology, Loghman Hakim Hospital, School of MedicineShahid Beheshti University of Medical SciencesTehranIran
- Social Determinants of Health Research Center, Department of Community HealthShahid Beheshti University of Medical SciencesTehranIran
| | - Roman Bauer
- Department of Computer ScienceUniversity of SurreyGuildfordUK
| | - Nasim Zamani
- Department of Clinical Toxicology, Loghman Hakim Hospital, School of MedicineShahid Beheshti University of Medical SciencesTehranIran
- Social Determinants of Health Research Center, Department of Community HealthShahid Beheshti University of Medical SciencesTehranIran
| | - Hossein Pakdaman
- Brain Mapping Research Center, Department of NeurologyShahid Beheshti University of Medical SciencesTehranIran
| | - Kourosh Gharagozli
- Brain Mapping Research Center, Department of NeurologyShahid Beheshti University of Medical SciencesTehranIran
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Bahadori Z, Safaie N, Mirmohammadkhani M. Comparison of psychiatric disorders in addicted patients treated with buprenorphine, methadone, and opium tincture in Iran. MIDDLE EAST CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-022-00224-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The aim of this study was to comparing the complications (depression, anxiety, sleep disorders and sexual dysfunction) of buprenorphine, methadone and opium tincture as an alternative drug treatment in patients referred to the National Center for Addiction Studies of Tehran during 2020–2021. This cross-sectional study was concocted on 197 patients referred to the National Center for Addiction Studies of Tehran who were treated with one of the alternative treatments of opioids buprenorphine (n = 24), methadone (n = 116), and opium tincture (n = 57) during 2020–2021. Three questionnaires were used to assess the side effects of drugs including Anxiety and Depression Hospital Scales (HADS), AIS (Athens insomnia scale) and the International Index of Erectile Function (IIEF). Data were analyzed using Stata 14.0. The multinomial logistic regression model was used in order to compare complications in the three groups and adjusted odds ratio (OR) with 95% confidence interval (CI) were estimated.
Results
The mean age in the buprenorphine, methadone and opium tincture groups were 46.80 ± 9.90, 48.31 ± 13.33 and 55.30 ± 10.34 years, respectively. The numbers of men were 17 (70.80), 90 (77.60), and 50 (78.70); respectively. Multinomial logistic regression model showed OR = 0.73 (95% CI 0.61–0.88) for anxiety in the methadone group in compared to buprenorphine. Likewise, OR = 1.22 (95% CI 1.001–1.48) and OR = 1.34 (95% CI 1.10–1.63) was observed for sleep disorder in the methadone and opium tincture groups in compared to buprenorphine; respectively.
Conclusions
Sleep disturbance in buprenorphine group is less than opium tincture and methadone. Also, anxiety in the methadone group was lower than the buprenorphine, however, there was no significant difference between the three groups in term of sexual function and depression. In addition to control measures for sleep disorders in receiving methadone and buprenorphine, the cohort studies with a higher sample size are recommended.
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14
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López-Lázaro M. Opium, street opium and cancer risk. Curr Pharm Des 2022; 28:2039-2042. [PMID: 35674306 DOI: 10.2174/1381612828666220607104805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022]
Abstract
Opium is defined as the air-dried latex obtained by incision from the unripe capsules of Papaver somniferum L. Opium is a complex mixture that contains approximately 10% morphine and 2% codeine. It is commonly used to prepare opium tinctures for people with chronic diarrhea. Morphine and related opioids are powerful but highly addictive analgesics; designing less addictive opioids is an active area of pharmaceutical research that may lead to significant improvements in chronic pain management. Recently, the International Agency for Research on Cancer (IARC) classified opium consumption as carcinogenic to humans (Group 1) based on sufficient evidence of carcinogenicity in human studies. However, all human studies analyzed by the IARC Working Group included participants who consumed opium that was mixed, adulterated, and/or contaminated with known and probable human carcinogens (e.g., tarry residues of combusted opium, arsenic, lead, and chromium). The Working Group considered that these carcinogens were part of the complex mixture that opium is, rather than co-exposure or confounders. No evidence of carcinogenicity was available for pure opium in human, animal, or mechanistic studies. To avoid confusion and concern in health professionals and patients using medicinal opium preparations, and in scientists involved in the design and development of new opium derivatives, opium should be classified in Group 3 (not classifiable as to its carcinogenicity to humans). The term 'street opium' could be used to refer to opium that probably contains human carcinogens not present in pure opium, and should remain in Group 1 (carcinogenic to humans).
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Affiliation(s)
- Miguel López-Lázaro
- Department of Pharmacology, Faculty of Pharmacy, University of Seville, Sevilla, Spain
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15
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Etemadi A, Hariri S, Hassanian-Moghaddam H, Poustchi H, Roshandel G, Shayanrad A, Kamangar F, Boffetta P, Brennan P, Dargan PI, Dawsey SM, Jones RL, Freedman ND, Malekzadeh R, Abnet CC. Lead poisoning among asymptomatic individuals with a long-term history of opiate use in Golestan Cohort Study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 104:103695. [PMID: 35472727 PMCID: PMC9133202 DOI: 10.1016/j.drugpo.2022.103695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/29/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent reports of lead poisoning suggest that people who use opium may be exposed to high amounts of lead. Here, we investigate the association between opium use and blood lead levels (BLL) in a population-based cohort study. METHODS In 2017, we studied a random sample of 410 people who currently (both within the past year and the past month) used opium and 104 who did not from participants of the Golestan Cohort Study in northeast Iran. Participants were stratified by sex and tobacco use history, completed a comprehensive opiate and tobacco use questionnaire and provided blood. BLL was measured by Lead Care® II Blood Lead Test Kit, validated by inductively coupled plasma triple quadrupole mass spectrometry. BLL was categorized as "<5 µg/dL", "elevated" (5-10 µg/dL), "high" (10-50 µg/dL), and "very high" (above 50 µg/dL). To assess the association between BLL categories and opiate use, route of consumption and weekly use, we used ordered logistic regression models, and report OR (odds ratio) and 95% CI (confidence interval) adjusted for age, sex, place of residence, education, occupation, household fuel type, and tobacco use. RESULTS In the cohort, participants used only raw (teriak) or refined (shireh) opium, which were smoked (45%, n = 184), taken orally (46%, n = 189), or both (9%, n = 37), for a mean duration of 24.2 (standard deviation: 11.6) years. The median BLL was significantly higher in people who currently used opium (11.4 µg/dL; IQR: 5.2-23.4) compared with those who did not (2.3 µg/dL; IQR: 2.3-4.2), and the highest median BLL was seen in oral use (21.7 µg/dL; IQR: 12.1-34.1). The BLL was <5 µg/dL among 79.8% of people with no opiate use, compared with only 22.7% in those using opium. BLL was elevated in 21.7%, high in 50.5% and very high in 5.1% of people using opium. About 95% of those with oral (180/189) or dual use (35/37) and 55% (102/184) of those who smoked opium had levels of blood lead above 5 µg/dL. The OR for the association between any opium use and each unit of increase in BLL category was 10.5 (95%CI: 5.8-19.1), and oral use of opium was a very strong predictor of increasing BLL category (OR=74.1; 95%CI: 35.1-156.3). This odds ratio was 38.8 (95%CI: 15.9-95.1) for dual use and 4.9 (95%CI: 2.6-9.1) for opium smoking. There was an independent dose-response association between average weekly dose and BLL among people using opium, overall and when stratified by route of use. CONCLUSION Our results indicate that regular use of lead-adulterated opium can expose individuals to high levels of lead, which may contribute to mortality and cancer risks associated with long-term opium use.
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Affiliation(s)
- Arash Etemadi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA.
| | - Sanam Hariri
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Liver and Pancreaticobilliary Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hossein Poustchi
- Liver and Pancreaticobilliary Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Amaneh Shayanrad
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, USA
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | - Paul I Dargan
- Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Sanford M Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Robert L Jones
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Christian C Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA
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Rahimi M, Kargar A, Hazegh Fetratjoo D, Hosseini SM, Mahdavinejad A, Shadnia S. Demographic and Clinical Characteristics of 907 Cases with Naltrexone Intoxication; a 14-Year Cross-Sectional Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e34. [PMID: 35765606 PMCID: PMC9187130 DOI: 10.22037/aaem.v10i1.1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Opioids have been the leading cause of death from poisoning in Iran for several years. This study aimed to evaluate the clinical and para-clinical presentations of naltrexone intoxication, its toxic dose, and its epidemiological properties. METHODS This retrospective cross-sectional study was conducted on medical records of patients presenting to Toxicology Department of Loghman Hakim Hospital, Tehran, Iran, following naltrexone intoxication, from 2002 to 2016. Patients' demographic and laboratory data, clinical signs, supposed ingested dose, and intent of naltrexone consumption were collected, analyzed, and then interpreted. RESULTS 907 patients with the mean age of 36.6 ±11.7 years were evaluated (94.3% male). The mean amount of naltrexone consumed by the intoxicated patients reported in the medical records was 105.8 ± 267.8 mg. One hundred thirty patients (14.3%) used naltrexone to treat substance use disorder. Two hundred eighty-seven poisoned patients (31.6%) were current opium users who intentionally or unintentionally used naltrexone concomitantly. The most common symptoms observed in these patients were agitation (41.8%), vomiting (16.4%), and nausea (14.8%). Among patients with naltrexone poisoning, 25 patients were intubated (2.8%), and three passed away. Aspartate aminotransferase (AST) levels were significantly higher in patients intoxicated with naltrexone who needed intubation (p = 0.02). CONCLUSION The probability of intubation of cases with naltrexone intoxication was associated with AST elevation. It seems that, the number of intensive care unit (ICU) admissions and mortality rates are not high among these patients.
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Affiliation(s)
- Mitra Rahimi
- Toxicological Research Center, Excellence Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Kargar
- Student Research Committee, Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Delara Hazegh Fetratjoo
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Sayed Masoud Hosseini
- Toxicological Research Center, Excellence Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arezou Mahdavinejad
- Toxicological Research Center, Excellence Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Shadnia
- Toxicological Research Center, Excellence Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Corresponding Author: Shahin Shadnia; Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail: , https://orcid.org/0000-0002-9401-0781, Tel/Fax: +98-21-55424041
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Hassanpour N, Zamani N, Akhgari M, Salimi A, Ahangar H, Phillips S, Hedayatshodeh M, Hassanian-Moghaddam H. Post-mortem blood lead analysis; a comparison between LeadCare II and graphite furnace atomic absorption spectrometry analysis results. J Forensic Leg Med 2022. [DOI: https://doi.org/10.1016/j.jflm.2022.102317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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18
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Azadi N, Nakhaee S, Farnia V, Pirsaheb M, Mansouri B, Ahmadi-Jouybari T, Khanegi M. Multivariate statistical evaluation of heavy metals in the urine of opium individuals in comparison with healthy people in Western Iran. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:8232-8241. [PMID: 34482458 DOI: 10.1007/s11356-021-16271-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
The current study aimed to evaluate the levels of some toxic and essential elements (Pb, Cd, Cu, Ti, Ni, Cr, Co, Fe, Ca, Hg, Mn, Se, and Zn) in the urine of opium-addicted compared to non-addicted cases. In this study, 126 participants were recruited and their fasting urine samples were collected (63 opium-addicted and 63 non-addicted subjects served as the reference group). ICP-MS was utilized to detect the concentration of trace elements. Results exhibited that the concentration of all elements than Ni, Cu, and Zn was markedly different between the addicted and non-addicted groups. Compared to controls, the Cd, Cr, Co, Hg, Mn, Pb, Se, and Ti levels were higher among opium-addicted cases (p < 0.05) whereas the Fe and Ca concentrations were higher among controls (p < 0.05). Robust regression analysis showed no statistically significant effect of gender on element levels. It revealed that age was associated with the levels of Ni and Cu only and also the route of administration was related to the urinary levels of Co, Cr, Hg, and Mn. In conclusion, results confirmed that it is opium consumption that affects the concentration levels of most elements.
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Affiliation(s)
- Nammamali Azadi
- Biostatistics Department, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Vahid Farnia
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Meghdad Pirsaheb
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Borhan Mansouri
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Toraj Ahmadi-Jouybari
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Khanegi
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Hassanpour N, Zamani N, Akhgari M, Salimi A, Ahangar H, Phillips S, Hedayatshodeh M, Hassanian-Moghaddam H. Post-mortem blood lead analysis; a comparison between LeadCare II and graphite furnace atomic absorption spectrometry analysis results. J Forensic Leg Med 2022; 86:102317. [DOI: 10.1016/j.jflm.2022.102317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/25/2022]
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20
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Vafaeinasab M, Zare H, Dehghani A, Malek S, Dehghani-Tafti M, Sarebanhassanabadi M. Comparison of Lapse Rate in Drug Dependent Patients in 2 Methods of Methadone Maintenance Treatment and Buprenorphine Maintenance Treatment. Subst Abuse 2022; 16:11782218221112502. [PMID: 35903309 PMCID: PMC9315257 DOI: 10.1177/11782218221112502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/21/2022] [Indexed: 11/17/2022]
Abstract
Background: Lapse has been one of the major challenges in the treatment of drug dependence sometimes leading to its relapse. Objectives: The aim of this study was to determine the lapse rate in drug dependent patients as for the 2 methods of methadone maintenance treatment (MMT) and buprenorphine maintenance treatment (BMT) in Yazd city. Methods: In this cross-sectional study, 626 female and male patients who had referred to 5 SUD treatment centers in Yazd and had been treated with methadone and buprenorphine maintenance were studied. Participants were divided into 2 groups of MMT and BMT and were evaluated based on lapse within 6 months. Results: In this study, 60.9% of patients were treated with methadone but the rest were treated with buprenorphine. Overall, 33.1% of patients lapsed (35.2% for methadone and 29.8%for buprenorphine). Lapse in methadone treatment was correlated with age, occupational status, and duration of treatment ( P < .05); it failed to correlated with any other demographic and clinical characteristics ( P > .05). Lapse rate in buprenorphine treatment was also related to marital status and the drug used ( P < .05). The mean dose of buprenorphine consumed showed no significant relationship with lapse ( P > .05). The results demonstrated that given the low dose, lapse stood higher in the buprenorphine group than the methadone group; however, as to high dose, the buprenorphine group showed lower lapse than the other group. Conclusions: In regard with the high rate of lapse, it is recommended to consider the factors related to the 2 methods of treatments, and provide counseling and training programs to lower lapse in the patients. Ethics Committee (REC) approval code: IR.SSU.REC.1394.158.
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Affiliation(s)
- Mohammadreza Vafaeinasab
- Physical Medicine and Rehabilitation, Non-communicable Diseases Research Institue, Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hamidreza Zare
- General practitioner, Addiction Therapists Association, Fajr Addiction Treatment Center, Yazd, Iran
| | - Ali Dehghani
- Epidemiology, Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyedehzahra Malek
- Social Science, Addiction Therapists Association, Fajr Addiction Treatment Center, Yazd, Iran
| | - Maryam Dehghani-Tafti
- Geriatric Nursing, Non-communicable Diseases Research Institue, Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammadtaghi Sarebanhassanabadi
- Epidemiology, Non-communicable Diseases Research Institue, Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Hosseini A, Fayaz A, Hassanian-Moghaddam H, Zamani N, Hadeiy SK, Gholami N, Dara N, Khatami K, Rohani P, Phillips S. Blood lead concentrations among pediatric patients with abdominal pain: a prospective cross-sectional study. BMC Gastroenterol 2021; 21:493. [PMID: 34930142 PMCID: PMC8690485 DOI: 10.1186/s12876-021-02023-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 11/11/2021] [Indexed: 12/04/2022] Open
Abstract
Background Lead exposure is one of the most menacing of environmental exposures, particularly in children. Children are more susceptible to the effects of lead which manifest in many organ systems, including interference with mental and motor development. Lead poisoning can cause colicky abdominal pain. In this study, the authors sought to evaluate the prevalence of elevated blood lead level (BLL) and its contributing factors among pediatric patients presenting with abdominal pain. An epidemic of lead poisoning in adults was previously uncovered, and thus a concern for pediatric lead poisoning was raised. Methods Pediatric patients presenting to two pediatric clinics in Tehran with abdominal pain were eligible for enrollment in a descriptive prospective cross-sectional study. A predesigned questionnaire was filled for each patient by their consenting parents. The questionnaire queried demographic information, environmental, social, and other relevant parameters for lead exposure. After completion of the questionnaire, biometrics were obtained, and a blood sample was taken from each patient for measurement of BLL and complete blood count. Results A total of 187 patients were enrolled in the study. Of them, almost 20% had BLL ≥ 5 µg/dL. Univariate analysis showed that age (p = 0.002, OR 3.194, CI 95% 1.504–6.783), weight (p = 0.009, OR 2.817, CI 95% 1.266–6.269), height (p = 0.003, OR 3.155, CI 95% 1.443–6.899), and playing with both plastic and cotton toys (p = 0.03, OR 2.796, CI 95% 1.072–7.295) were significant predictors of high BLLs. Maternal level of education correlated with blood lead concentrations (p = 0.048, OR 2.524, CI 95% 1.006–6.331). Conclusions A clinically significant number of cases of abdominal pain may have high BLLs. Specific attention should be paid to children presenting with abdominal pain, especially due to the detrimental effects of lead on their mental and motor development.
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Affiliation(s)
- Amirhossein Hosseini
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anahita Fayaz
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, South Karegar Street, Tehran, Iran.
| | - Nasim Zamani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, South Karegar Street, Tehran, Iran
| | - Seyed Kaveh Hadeiy
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narges Gholami
- Department of Pediatrics, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Naghi Dara
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Katayoun Khatami
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pejman Rohani
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Scott Phillips
- Washington Poison Center, University of Colorado Anchutz Medical Campus, Rocky Mountain Poison & Drug Safety, Denver, CO, Seattle, WA, USA
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22
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Vahabzadeh M, Balali-mood M, Banagozar Mohammadi A, Moshiri M. Efficacy and expenses of succimer vs. d-penicillamine plus garlic in the treatment of lead poisoning: a retrospective cross-sectional study. Daru 2021; 29:477-481. [PMID: 34313939 PMCID: PMC8602534 DOI: 10.1007/s40199-021-00407-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 07/08/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Lead Poisoning is a major health problem in Iran. We aimed to compare efficacy of a standard regimen (Succimer) with that of a low-priced combination of D-penicillamine and Garlic in outpatients with lead poisoning. METHODS In this retrospective cross-sectional study, year-long clinical files of outpatients with lead poisoning in two referral toxicology clinics in Mashhad, Iran were reviewed. A total of 79 patients (all men), received either Succimer or a combination of D-penicillamen plus garlic (DPN + Gar), for 19 and 30 days, respectively. Clinical and laboratory data, including blood lead level (BLL), were analyzed and treatment expanses were compared between the two regimens. RESULTS Of 79 male patients, 42 were treated by DPN + Gar and 37 received Succimer. Mean BLL of DPN + Gar group before treatment (965.73 ± 62.54 µg/L) was higher than that of the Succimer group (827.59 ± 24.41) (p < 0.001). After treatment, BLL in both groups significantly reduced to 365.52 ± 27.61 µg/L and 337.44 ± 26.34 µg/L, respectively (p < 0.001). The price of a 19-day treatment with Succimer was approximately 28.6 times higher than a one-month course of treatment with garlic plus DPN. None of the treatments caused serious side effects in the patients. CONCLUSION Combination therapy with DPN + Gar is as effective as Succimer in Pb poisoning, while treatment with Succimer is significantly more expensive.
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Affiliation(s)
- Maryam Vahabzadeh
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Balali-mood
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Ali Banagozar Mohammadi
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Moshiri
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Clinical Toxicology and Poisoning, Imam Reza (P) Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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23
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Mohaddes Ardabili H, Akbari A, Rafei P, Butner J, Khan R, Khazaal Y, Arab AZ, Qazizada MR, Al-Ansari B, Baldacchino AM. Tramadol, captagon and khat use in the Eastern Mediterranean Region: opening Pandora's box. BJPsych Int 2021; 19:58-62. [PMID: 36287793 PMCID: PMC9540563 DOI: 10.1192/bji.2021.53] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/05/2021] [Accepted: 08/15/2021] [Indexed: 12/12/2022] Open
Abstract
As defined by the World Health Organization, the Eastern Mediterranean Region (EMR), given its special geopolitical situation and internal/external conflicts, faces an increase in illegal activities such as drug production and trafficking, highlighting the need for a comprehensive understanding of the substance use situation. On the basis of a review of published papers between 2015 and 2021 we briefly review substance use in the EMR with special focus on the emerging drugs pertinent to this region, namely tramadol, captagon and khat.
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24
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Tabrizi R, Sarihi S, Moazzen F, Hosseini-Bensenjan M, Malekpour F, Asadikaram G, Momeni-Moghaddam MA, Akbari H. A Systematic Review and Meta-analysis on Blood Lead Level in Opium Addicts: an Emerging Health Threat. Biol Trace Elem Res 2021; 199:3634-3641. [PMID: 33244670 DOI: 10.1007/s12011-020-02504-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022]
Abstract
This meta-analysis was conducted aiming to summarize the results obtained from the previous studies so that the effect of opium on blood lead levels (BLLs) can be investigated. Scopus, Embase, PubMed, and Web of Science (ISI) were systematically searched up to June 2020. Heterogeneity of the included studies was evaluated using Cochrane's Q test and the I2 statistic. A random-effects model was used to pool the weighted mean differences (WMDs) and their 95% confidence intervals (CIs). Out of a total of 2372 citations, eleven articles with 916 participants (487 opium addicts and 429 controls) were included in the study. The meta-analysis results showed that there were higher lead levels (WMD = 14.59 μg/dL, 95% CI = 11.59 to 17.92, Z = 8.60, P < 0.001) in opium addicts than in the control group. The degree of heterogeneity observed (P < 0.001, I2 = 98.1%) might be mainly the result of the type of sampling and of consumption. Moreover, the findings of meta-regression analyses indicated that publication year (β = 1.23, P = 0.287), total sample size (β = 0.05, P = 0.728), and quality scores (β = - 2.91, P = 0.546) had no effects on lead levels in opium addicts. In the sensitivity analysis, it was found that the pooled WMDs remained stable after excluding one by one study. Oral opium consumption increased the amount of lead in the bloodstream, and the measurement of lead levels in opium addicts' blood may be regarded as a useful test to diagnosis and prognosis of disorders that may lead poisoning causes.
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Affiliation(s)
- Reza Tabrizi
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sorour Sarihi
- Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Moazzen
- Department of Hematology, Faculty of Allied Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | | | - Fatemeh Malekpour
- Family Medicine Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamreza Asadikaram
- Department of Biochemistry, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Amin Momeni-Moghaddam
- Department of Nutrition and Biochemistry, Faculty of Medicine, Social Determinants of Health Research Center, Gonabad University of Medical Science, Gonabad, Iran.
| | - Hamed Akbari
- Department of Biochemistry, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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25
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Adult Lead Poisoning Caused by Contaminated Opium: A Two-Year Longitudinal Follow-Up Study. Ann Glob Health 2021; 87:89. [PMID: 34567981 PMCID: PMC8428290 DOI: 10.5334/aogh.3420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: A major episode of lead poisoning caused by lead-adulterated opium occurred in Iran in 2016. Patients were removed from exposure and treated with chelating agents. A subset of those patients was evaluated in this follow-up study to evaluate treatment efficacy in relation to patient outcome. Methods: Between March 2016 and December 2017, thirty-five male cases of lead poisoning due to ingestion of lead-adulterated opium were followed for two years. There are three patient groups: 1) those who abstained from opium use; 2) those who continued to use potentially contaminated opium; and 3) those who abstained from opium and were placed on maintenance therapy. Maintenance therapy included: methadone and opium tincture, offered by the Opioid Maintenance Therapy (OMT) clinics. Amongst the three patient groups Blood Lead Levels (BLL), complete blood count, and kidney and liver function tests were compared. Findings: The results of BLL, hemoglobin, hematocrit, and aspartate aminotransferase were significantly different between the admission time and follow-up. Of the three patient groups, no difference was detected in these measures. Conclusions: Treatment of lead poisoning combined with OMT proved an effective method to prevent recurrent lead poisoning.
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26
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Suleman F, Shoukat K, Arshad A, Khan NU, Sheikh U. Lead encephalopathy in an adult opioid abuser. BMJ Case Rep 2021; 14:e240977. [PMID: 34544696 PMCID: PMC8454275 DOI: 10.1136/bcr-2020-240977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 11/04/2022] Open
Abstract
A 38-year-old man presented at the emergency department with abdominal pain, vomiting, generalised weakness and altered consciousness. He had been ingesting opioids for over 5 years and had several past hospital admissions for abdominal pain. His investigations showed deranged liver function tests, anaemia and basophilic stippling on the peripheral blood smear. Further investigations revealed a significant increase in the serum lead level. We started chelation with peroral penicillamine 250 mg every 6 hours for 2 days and switched to intramuscular dimercaprol 4 mg/kg every 12 hours and intravenous calcium ethylenediamine tetraacetic acid 50 mg/kg in two divided doses daily for the next 5 days. We then discharged him home; he had become clinically stable by that time. We repeated his lead level and followed him up in the clinic. In this report, we emphasise the consideration of lead toxicity in opioid abusers and bring to attention a rare way of lead chelation in resource-limited settings.
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Affiliation(s)
| | - Karima Shoukat
- Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Ainan Arshad
- Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Usman Sheikh
- Department of Haematology, Aga Khan University Hospital, Karachi, Pakistan
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27
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Noroozi A, Conigrave KM, Mirrahimi B, Bastani P, Charkhgard N, Salehi M, Narenjiha H, Vaziri A, Kebriaeezadeh A. Factors influencing engagement and utilisation of opium tincture-assisted treatment for opioid use disorder: A qualitative study in Tehran, Iran. Drug Alcohol Rev 2021; 41:419-429. [PMID: 34309108 DOI: 10.1111/dar.13357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/02/2021] [Accepted: 07/03/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In response to a high burden of opioid use disorder (OUD), Iran established a network of opioid agonist treatment (OAT) centres beginning in 2002. To increase treatment diversity, particularly for patients who use opium as their drug of choice, opium tincture (OT)-assisted treatment was introduced to the network. This study aimed to explore factors influencing OT-assisted treatment selection for OUD in Tehran, Iran. METHODS We conducted 54 in-depth interviews with patients with OUD (n = 33), family members of patients (n = 9) and drug treatment providers (n = 12). Participants were recruited from 12 drug treatment centres across Tehran, between September and November 2019. All interviews were audio-recorded, transcribed and coded in OpenCode 4.02 software and analysed using thematic analysis. RESULTS Study participants more commonly reported individual-level factors as facilitators (e.g. to reduce harms associated with illicit opioid use, achieve recovery through a gradual dose reduction regimen combined with Congress 60 recovery program) and structural level factors (e.g. low adoption by OAT system and lack of familiarity of treatment providers) as barriers for utilisation of OT-assisted treatment regimens. OT was perceived to produce lower levels of physiological dependence than methadone, but the requirement for twice supervised dosing was restrictive. Low familial and community acceptance were also seen as barriers to access. DISCUSSION AND CONCLUSIONS This research identified a range of perceived benefits for OT-assisted treatment ranging from harm reduction to an intermediate step to achieve recovery. However, several structural-, individual-, familial- and community-level barriers impede its availability and acceptability.
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Affiliation(s)
- Alireza Noroozi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Katherine M Conigrave
- Addiction Medicine, Sydney School of Medicine (Central Clinical School), The University of Sydney, Sydney, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Bahareh Mirrahimi
- Department of Pharmacoeconomics and Pharmaceutical Management, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Parsa Bastani
- Department of Anthropology, Brown University, Providence, USA
| | - Nader Charkhgard
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.,Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Salehi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.,Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooman Narenjiha
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Alaleh Vaziri
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Kebriaeezadeh
- Department of Pharmacoeconomics and Pharmaceutical Management, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Pharmaceutical Management and Economic Research Center, Tehran University of Medical Sciences, Tehran, Iran
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28
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The effects of drug addiction treatment methods on families' behaviors: The Congress 60 treatment method. J Subst Abuse Treat 2021; 131:108564. [PMID: 34389185 DOI: 10.1016/j.jsat.2021.108564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 06/06/2021] [Accepted: 07/04/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND When a family member who uses drugs begins drug abstinence, this change can cause a great deal of tension within a family. Although family members are willing to help drug users overcome their addiction, they sometimes disrupt the treatment process and, in many cases, resist change altogether. METHOD This qualitative research study uses grounded theory to study the factors that contribute to positive family change and changes in the family system throughout the treatment process. The study selected 39 participants from among the clients at Congress 60 Human Revivification Society using purposive sampling until the study reached data saturation. The study collected information from participants during semistructured interviews. The participants consisted of 18 men who used drugs and 21 individuals from their families who had undergone one year of treatment at Congress 60. RESULTS & DISCUSSION The findings of the current study show that peace in the family is an influential factor that helps drug users overcome their addiction. Clear boundaries, detachment, and reduced emotional distance were the major structural changes that participating families exhibited after educational interventions, positive family support, and they gained trust in the treatment method.
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29
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Kamali M, Kamali H, Doustmohammadi M, Sheikhbardsiri H, Moghadari M. Treatment of opium addiction in persian medicine: A review study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:157. [PMID: 34222532 PMCID: PMC8224515 DOI: 10.4103/jehp.jehp_5_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 01/27/2021] [Indexed: 06/13/2023]
Abstract
Drug abuse is one of the most important threats to human beings today, leading to disability and even early death. In the past, opium had only therapeutic uses, but now, drug addiction is one of the major public health problems in Iran. Opium and its derivatives are the most commonly used illicit drugs in this country. Therefore, this study was conducted to evaluate the treatment strategies of opium addiction from the perspective of Persian medicine. In this narrative review, the search was conducted using appropriate keywords in the authoritative books of Persian medicine documentations of databases of PubMed, Google Scholar, PsycINFO, American Academy of Medical Sciences, United Nations Office on Drugs and Crimes with keywords of opioid and opium since 2000 AD. In Persian medicine books, "Afioon" means poppy plant (Papaver somniferum), which is called opium in English and "Theriac" in Persian. To quit, they should be gradually reduced and replaced with appropriate spices such as henbane (Hyoscyamus niger) seeds or mandrake (Mandragora officinarum) fruit or root or poppy (P. somniferum) seeds or poppy shell or Lettuce (Lactuca sativa) seeds, or castor testis or nutmeg (Myristans fragrans) fruit or ajwain (Trachyspermum copticum) seeds or baked bread. Opioid quit should be gradual and delayed in time of consumption and gradual reduction of opium levels, and bodies that have become lean for a long time will gradually recover with adequate nutrition over time.
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Affiliation(s)
- Mohadese Kamali
- Neurosciences Research Center, Institute of Neuropharmacology and Department of Traditional Medicine, Faculty of Persian Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Hoda Kamali
- Neurosciences Research Center, Institute of Neuropharmacology and Department of Neurology, Shafa Hospital, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammadmahdi Doustmohammadi
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hojjat Sheikhbardsiri
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Masoud Moghadari
- Neurosciences Research Center, Institute Of Neuropharmacology and Department of Traditional Medicine, Faculty of Persian Medicine, Kerman University of Medical Sciences, Kerman, Iran
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30
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Investigating the CYP2B6 rs3745274 and rs3211371 polymorphisms in Methadone-Responder and Non-Responder Addicts in Iran. IRANIAN BIOMEDICAL JOURNAL 2021. [PMID: 33546554 PMCID: PMC8183388 DOI: 10.52547/ibj.25.3.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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31
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Sattler S, Zolala F, Baneshi MR, Ghasemi J, Amirzadeh Googhari S. Public Stigma Toward Female and Male Opium and Heroin Users. An Experimental Test of Attribution Theory and the Familiarity Hypothesis. Front Public Health 2021; 9:652876. [PMID: 33959582 PMCID: PMC8096178 DOI: 10.3389/fpubh.2021.652876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
Drug abuse and addiction exist around the world. People addicted to drugs such as opium or heroin often encounter dehumanizing discriminatory behaviors and health-care systems that are reluctant to provide services. Experiencing discrimination often serves as a barrier to receiving help or finding a home or work. Therefore, it is important to better understand the mechanisms that lead to the stigmatization of drug addiction and who is more prone to stigmatizing behaviors. There is also a dearth of research on whether different patterns of stigma exist in men and women. Therefore, this study investigated factors affecting gender-specific stigmatization in the context of drug addiction. In our vignette study (N Mensample = 320 and N Womensample = 320) in Iran, we experimentally varied signals and signaling events regarding a person with drug addiction (i.e., N Vignettes = 32 per sample), based on Attribution Theory, before assessing stigmatizing cognitions (e.g., blameworthiness), affective responses (e.g., anger), and discriminatory inclinations (e.g., segregation) with the Attribution Questionnaire. We also tested assumptions from the Familiarity Hypothesis by assessing indicators of respondents' familiarity with drug addiction (e.g., knowledge about addiction). Results, for example, show higher stigma if the person used "harder" drugs, displayed aggressive behavior, or had a less controllable drug urge. Self-attributed knowledge about addiction or prior drug use increased some forms of stigma, but diminished others. These findings only partially converged between men and women. We suggest that anti-stigma initiatives should consider information about the stigmatized person, conditions of the addiction, and characteristics of stigmatizers.
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Affiliation(s)
- Sebastian Sattler
- Institute for Sociology and Social Psychology, University of Cologne, Cologne, Germany.,Institut de Recherches Cliniques de Montréal, Montréal, QC, Canada
| | - Farzaneh Zolala
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Reza Baneshi
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Javad Ghasemi
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Saber Amirzadeh Googhari
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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32
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Hadeiy SK, Parhizgar P, Hassanian-Moghaddam H, Zamani N, Khoshkar A, Kolahi AA, Amirabadizadeh A, Rezaei O. Trends of acute drug and chemical toxicities in adults and adolescents in Tehran, Iran between 2012 and 2018: a retrospective chart review. Drug Chem Toxicol 2021; 45:2039-2048. [PMID: 33858280 DOI: 10.1080/01480545.2021.1903486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Poisoning is among the top three common causes of suicidal deaths in Iran. We aimed to evaluate the epidemiologic trend of poisoning and its mortality rate in the largest tertiary toxicology referral center in Iran between 2012 and 2018. A total of 84,242 patients were hospitalized or died due to poisoning in this center during the study period, of whom 2114 (2.5%) died. The most frequent poisonings were those with antiepileptics, sedativehypnotics, and antiparkinson medications (T42) followed by narcotics and psychodysleptics (T40). Psychodysleptics had the highest mortality rate (684; 32.4% of the deaths). Among drugs of abuse, methadone was the most common cause of admission reported in 10,398 cases (12.3%). In conclusion, suicidal or recreational methadone poisoning is becoming the most common cause of admission to poisoning referral wards in Iran. Rigorous supervision of daily dosing at opioid maintenance clinics as well as efforts to control the black-market offering methadone are needed to prevent further methadone-related acute poisonings and deaths.
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Affiliation(s)
- Seyed Kaveh Hadeiy
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parinaz Parhizgar
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasim Zamani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Khoshkar
- Department of Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Amirabadizadeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Omidvar Rezaei
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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33
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Nalini M, Shakeri R, Poustchi H, Pourshams A, Etemadi A, Islami F, Khoshnia M, Gharavi A, Roshandel G, Khademi H, Zahedi M, Abedi-Ardekani B, Vedanthan R, Boffetta P, Dawsey SM, Pharaoh PD, Sotoudeh M, Abnet CC, Day NE, Brennan P, Kamangar F, Malekzadeh R. Long-term opiate use and risk of cardiovascular mortality: results from the Golestan Cohort Study. Eur J Prev Cardiol 2021; 28:98-106. [PMID: 33624066 PMCID: PMC8133380 DOI: 10.1093/eurjpc/zwaa006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/16/2020] [Accepted: 07/09/2020] [Indexed: 12/28/2022]
Abstract
AIMS Tens of millions of people worldwide use opiates but little is known about their potential role in causing cardiovascular diseases. We aimed to study the association of long-term opiate use with cardiovascular mortality and whether this association is independent of the known risk factors. METHODS AND RESULTS In the population-based Golestan Cohort Study-50 045 Iranian participants, 40-75 years, 58% women-we used Cox regression to estimate hazard ratios and 95% confidence intervals (HRs, 95% CIs) for the association of opiate use (at least once a week for a period of 6 months) with cardiovascular mortality, adjusting for potential confounders-i.e. age, sex, education, wealth, residential place, marital status, ethnicity, and tobacco and alcohol use. To show independent association, the models were further adjusted for hypertension, diabetes, waist and hip circumferences, physical activity, fruit/vegetable intake, aspirin and statin use, and history of cardiovascular diseases and cancers. In total, 8487 participants (72.2% men) were opiate users for a median (IQR) of 10 (4-20) years. During 548 940 person-years-median of 11.3 years, >99% success follow-up-3079 cardiovascular deaths occurred, with substantially higher rates in opiate users than non-users (1005 vs. 478 deaths/100 000 person-years). Opiate use was associated with increased cardiovascular mortality, with adjusted HR (95% CI) of 1.63 (1.49-1.79). Overall 10.9% of cardiovascular deaths were attributable to opiate use. The association was independent of the traditional cardiovascular risk factors. CONCLUSION Long-term opiate use was associated with an increased cardiovascular mortality independent of the traditional risk factors. Further research, particularly on mechanisms of action, is recommended.
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Affiliation(s)
- Mahdi Nalini
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Imam Ali Hospital, Shahid Beheshti Boulevard, Kermanshah, Iran
| | - Ramin Shakeri
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran
| | - Akram Pourshams
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran
| | - Arash Etemadi
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Farhad Islami
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Masoud Khoshnia
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Abdolsamad Gharavi
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Gholamreza Roshandel
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Hooman Khademi
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran
| | - Mahdi Zahedi
- Ischemic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Behnoush Abedi-Ardekani
- Section of Genetics, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Paolo Boffetta
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sanford M Dawsey
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Paul D Pharaoh
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Masoud Sotoudeh
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran
| | - Christian C Abnet
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Nicholas E Day
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Paul Brennan
- Section of Genetics, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University Portage Avenue Campus, Room 103, Baltimore, MD 21251, USA
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran
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Aghabozorg Afjeh SS, Boshehri B, Hamednia S, Asmaolhosna A, Mashayekhi P, Omrani MD. Investigating the CYP2B6 rs3745274 and rs3211371 polymorphisms in Methadone-Responder and Non-Responder Addicts in Iran. IRANIAN BIOMEDICAL JOURNAL 2021; 25:220-5. [PMID: 33546554 PMCID: PMC8183388 DOI: 10.29252/ibj.25.3.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/12/2021] [Indexed: 10/31/2022]
Abstract
Background Methadone therapy is a major protocol in opioid addiction cases in many health care systems. Population-based studies have shown that in addicted people, the genetic profile affects their response to methadone therapy. Therefore, this study designed to examine the frequency of two SNPs of the CYP2B6 gene (rs3745274 and rs3211371) in addicted cases in two methadone-responders and methadone non-responders groups. Methods A total of 199 opioid-addicted individuals and 117 unaffected control subjects were genotyped for rs3745274 and rs3211371 polymorphisms of the CYP2B6 gene using the tetra-primer amplification refractory mutation system-polymerase chain reaction. Results Results of this study revealed the significant association of rs3745274 GG (p < 0.001; OR = 0.027; 95% CI = 0.14-0.49) and GT (p < 0.001; OR = 4.04; 95% CI = 2.26-7.21) genotypes with the risk of addiction in methadone-responders. Also, a significant association between rs3745274 GG (p < 0.001; OR = 0.28; 95% CI = 0.15-0.51) and GT (p < 0.001; OR = 5.1; 95% CI = 2.8-5.28) genotypes and addiction relapse was found in methadone non-responders. Conclusion Based on our findings, we can conclude that rs3745274 variant of CYP2B6 gene could serve as a potential biomarker, to evaluate the prognosis of addicted people fate under treatment with methadone.
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Affiliation(s)
| | - Behzad Boshehri
- Department of Forensic Medicine and Toxicology, Urmia University of Medical Sciences, Urmia, Iran
| | - Safar Hamednia
- Department of Psychiatry, Urmia University of Medical Sciences, Urmia, Iran
| | | | | | - Mir Davood Omrani
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Farnia V, Pirsaheb M, Azadi NA, Mansouri B, Radmehr F. Blood lead concentration among oral/inhaled opium users: systematic review and meta-analysis. Crit Rev Toxicol 2021; 51:24-35. [PMID: 33528296 DOI: 10.1080/10408444.2020.1864722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Lead is a poisonous heavy metal with various known side effects. The effect of opium on raising blood lead concentration (BLC) has been investigated with no general agreement. In Iran, the number of lead poisoning cases has raised among the opium-addicted population. This systematic review and meta-analysis aim to combine the results of previous studies with the Iranian population to investigate the effect of opium on BLC. In this systematic review, PubMed/Medline, Web of Sciences, Embase, and Scopus were searched for studies using the Iranian population to compare the BLC of opium-addicted cases and non-addicted controls till January 2020. A random-effects model was used to pool the results. I-square test was used to assess the heterogeneity of the studies. The effect sizes were standardized mean differences (proxied by Hedges' g) followed by a 95% confidence interval. Of 417 initial articles, 13 studies met the inclusion criteria to be considered in the meta-analysis. The sample size of eligible studies ranged from 40 to 131 (mean 81.83, SD 27.6). All studies were focused on adults with mean age ranged from 33.5 to 65.15 years old (overall mean 49.0, SD 7.66). There were 13 studies included with 18 Hedges' g effect sizes. Using a random effect model, the pooled effect size was gw = 2.48 (95% CI: 1.58-3.39) and statistically significant in favor of opium-addicted participants. Moreover, heterogeneity was 96.6% (I2=96.6, Q(17) = 504.95, p < 0.001). For studies with large Hedges' g effect sizes (> 4) identified as outliers and removed from meta-analysis. The pooled Hedges' g effect size reduced to 1.39 (95% CI: 0.94-1.85), still highly significant in favor of higher levels of lead in the opium-addicted group. The funnel plot appeared symmetrical confirmed by Egger's test (t = 1.87, p = 0.088), indicating no publication bias present.
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Affiliation(s)
- Vahid Farnia
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maghdad Pirsaheb
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Namam Ali Azadi
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Borhan Mansouri
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farnaz Radmehr
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Affiliation(s)
- Samantha Young
- From the British Columbia Centre on Substance Use (S.Y.), and the Department of Medicine (S.Y.), the Division of Hematology (L.C.), the Centre for Health Education Scholarship (L.C.), and the Division of Critical Care (J.W.), University of British Columbia, Vancouver, the Department of Emergency Medicine (W.P.) and the Department of Internal Medicine Section of Critical Care (J.W.), University of Manitoba, Winnipeg, and the Department of Pathology and Laboratory Medicine, Richmond General Hospital, Richmond, BC (P.W.) - all in Canada
| | - Luke Chen
- From the British Columbia Centre on Substance Use (S.Y.), and the Department of Medicine (S.Y.), the Division of Hematology (L.C.), the Centre for Health Education Scholarship (L.C.), and the Division of Critical Care (J.W.), University of British Columbia, Vancouver, the Department of Emergency Medicine (W.P.) and the Department of Internal Medicine Section of Critical Care (J.W.), University of Manitoba, Winnipeg, and the Department of Pathology and Laboratory Medicine, Richmond General Hospital, Richmond, BC (P.W.) - all in Canada
| | - Wesley Palatnick
- From the British Columbia Centre on Substance Use (S.Y.), and the Department of Medicine (S.Y.), the Division of Hematology (L.C.), the Centre for Health Education Scholarship (L.C.), and the Division of Critical Care (J.W.), University of British Columbia, Vancouver, the Department of Emergency Medicine (W.P.) and the Department of Internal Medicine Section of Critical Care (J.W.), University of Manitoba, Winnipeg, and the Department of Pathology and Laboratory Medicine, Richmond General Hospital, Richmond, BC (P.W.) - all in Canada
| | - Patrick Wong
- From the British Columbia Centre on Substance Use (S.Y.), and the Department of Medicine (S.Y.), the Division of Hematology (L.C.), the Centre for Health Education Scholarship (L.C.), and the Division of Critical Care (J.W.), University of British Columbia, Vancouver, the Department of Emergency Medicine (W.P.) and the Department of Internal Medicine Section of Critical Care (J.W.), University of Manitoba, Winnipeg, and the Department of Pathology and Laboratory Medicine, Richmond General Hospital, Richmond, BC (P.W.) - all in Canada
| | - Justin Wong
- From the British Columbia Centre on Substance Use (S.Y.), and the Department of Medicine (S.Y.), the Division of Hematology (L.C.), the Centre for Health Education Scholarship (L.C.), and the Division of Critical Care (J.W.), University of British Columbia, Vancouver, the Department of Emergency Medicine (W.P.) and the Department of Internal Medicine Section of Critical Care (J.W.), University of Manitoba, Winnipeg, and the Department of Pathology and Laboratory Medicine, Richmond General Hospital, Richmond, BC (P.W.) - all in Canada
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The effect of methadone on blood glucose, lipids and glucose-modulating hormones in methadone-dependent Wistar rats. Toxicol Res 2020; 36:221-226. [PMID: 32685426 DOI: 10.1007/s43188-019-00019-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/12/2019] [Accepted: 06/17/2019] [Indexed: 10/24/2022] Open
Abstract
A growing body of evidence indicates that opioids regulate mechanisms activated during the stress response. This study was aimed to investigate the effect of methadone dependency on blood glucose, lipids and glucose-modulating hormones in male and female Wistar rats.This study was performed on 40 Wistar rats weighing 150-350 g, in four methadone exposure and control groups of both males and females. All rats were weighed at the beginning and end of the study and their fasting blood glucose was measured using a glucometer. In order to induce addiction, methadone was injected intraperitoneal for 10 consecutive days at 5 mg/kg dose. The control group received the same volume of only normal saline. At the end of the study, the rats were sacrificed and their blood serum collected to measure cortisol, glucagon, adrenaline and lipid profile levels.There was a significant decrease in the mean final blood glucose of methadone-treated versus control male rats (p = 0.02). There was no significant glucose difference, however, in female rats. Furthermore, a decrease in the mean serum levels of triglyceride, cortisol, and adrenaline occurred in male rats of methadone-dependent compared with control animals, but there was no significant difference in these values in female rats. Our results showed that methadone significantly reduced serum glucose as well as triglyceride levels only in male rats, this being associated with a reduction in the level of counter-regulating hormones of carbohydrate metabolism. Changes in lipid profiles, however, occurred independently of gender.
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Zamani N, Mehrpour O, Hassanian-Moghaddam H, Jalali M, Amirabadizadeh A, Samie S, Sabeti S, Kolahi AA. A Preliminary Report on the Largest Ongoing Outbreak of Lead Toxicity in Iran. Sci Rep 2020; 10:11797. [PMID: 32678122 PMCID: PMC7367297 DOI: 10.1038/s41598-020-64859-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 04/23/2020] [Indexed: 11/09/2022] Open
Abstract
No countrywide data exists on the patients' characteristics of lead exposure in Iran. We aimed to evaluate the demographic characteristics and blood lead level (BLL) of these patients in the country scale during five consecutive years, including the epidemic outbreak year (2016). Between 2014 and 2018, records of all patients who had referred to two reference laboratories in Tehran, Iran, to check BLL were evaluated. Of 58,642 patients, 48,589 were male. Mean age was 44.9 ± 20.7 years. Males had higher BLLs and were significantly older. Median BLL was 16 µg/dL (0.3 to 263 µg/dL). Median BLL was significantly higher in 45- to 60-year-old patients. The highest median BLL was reported in May 2016 confirming our records about the peak of the epidemic. Although the frequency of high BLL declined after 2016, it never returned to the measures before that. Considering the ongoing high prevalence of increased BLLs after 2016 and similar environmental and occupational exposures as before, lead-contaminated opium still seems to persist in the Iranian opium black market. Substitution of this lead-contaminated opium by Opioid Maintenance Therapy (OMT)-prescribed opium tincture is recommended.
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Affiliation(s)
- Nasim Zamani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran.,Rocky Mountain Poison and Drug Center, Denver, Colorado, USA
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Jalali
- Clinical Biochemistry Founder and Director of Noor Pathobiology Lab, Tehran, Iran
| | | | - Saeed Samie
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shahram Sabeti
- Department of Pathology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Shirinbayan P, Salavati M, Soleimani F, Saeedi A, Asghari-Jafarabadi M, Hemmati-Garakani S, Vameghi R. The Psychometric Properties of the Drug Abuse Screening Test. ADDICTION & HEALTH 2020; 12:25-33. [PMID: 32582412 PMCID: PMC7291903 DOI: 10.22122/ahj.v12i1.256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Substance abuse is a critical problem in most countries, especially in developing ones. Early detection is the pre-requisite of early control, for which reliable and valid tools are required. In the present study, we aimed at measuring the psychometric properties of the 10-item Drug Abuse Screening Test (DAST-10) in Iranian individuals. Methods After translation and back-translation of the questionnaire, 244 adults were recruited from Tehran Megacity, Iran, and completed the questionnaires. Participants were recruited by a multistage randomized cluster sampling method. Reliability was determined by Cronbach’s alpha. Also, construct validity was evaluated using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Findings The internal consistency using Cronbach's alpha coefficients for the total score of the Persian version of DAST-10 was 0.93. EFA evoked only one factor for DAST-10. The CFA for 1-factor models for DAST-10 indicated an acceptable fit for the proposed models. Conclusion The results prove desirable reliability and validity of the Persian version of the DAST which can be utilized as a screening instrument for drug abuse among Iranian adults.
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Affiliation(s)
- Peymaneh Shirinbayan
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahyar Salavati
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Farin Soleimani
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ahmad Saeedi
- Institute for Research and Planning in Higher Education, Tehran, Iran
| | - Mohammad Asghari-Jafarabadi
- Road Traffic Injury Research Center AND Department of Statistics and Epidemiology, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sahel Hemmati-Garakani
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Roshanak Vameghi
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Rahimi M, Eshraghi MA, Shadnia S. Lead Contamination in Opium, Opium Tincture, and Methadone Oral Solution, in Iran. ADDICTION & HEALTH 2020; 12:34-39. [PMID: 32582413 PMCID: PMC7291899 DOI: 10.22122/ahj.v12i1.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background The present study is conducted with the aim to assess the lead contamination in opium tincture, methadone oral solution, and opium. Methods 10 samples from each of the matters of opium tinctures, methadone oral solutions, and opium (provided by the Law Enforcement Force of the Islamic Republic of Iran) were collected. Then, an atomic absorption spectrophotometer (AAS) was used to measure lead concentration in each of the samples. Data were analyzed using the SPSS software. A P value of 0.05 or less was considered to be statistically significant (Two-tailed). Findings In this study, the amount of lead measured in all samples was equal or less than 5 parts per million (ppm) and the only exception was the lead level of 5.6 ppm in one of the opium tincture samples, which was slightly higher than the standard lead level. Conclusion The results of the current study showed that lead was present in opium tincture, methadone oral solution, and opium, but it was not in toxic levels. It is reasonable for opium derived medicinal products, but the low levels of lead in opium may need to be addressed at different times in different regions of the country.
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Affiliation(s)
- Mitra Rahimi
- Toxicology Research Center, Excellence Center of Clinical Toxicology AND Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Eshraghi
- Toxicology Research Center, Excellence Center of Clinical Toxicology AND Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Shadnia
- Toxicology Research Center, Excellence Center of Clinical Toxicology AND Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Moghadam AT, Bahreini M, Anzali BC. Opium-Related Lead Toxicity: An Integrative Review and Case Series. J Emerg Med 2020; 59:33-45. [PMID: 32414545 DOI: 10.1016/j.jemermed.2020.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 03/31/2020] [Accepted: 04/08/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Restrictive regulations and the increased price of opioids have resulted in the addition of impurities to illicit opioids by drug dealers. Among the adulterants, lead salts are optimal agents to make packages heavier. Consequently, lead toxicity has emerged in the opioid-user population. OBJECTIVES Our goal was to review the related literature and describe patients with common presentations of opioid-related lead poisoning to provide a basis to prepare optimal management. METHODS A narrative review was performed aiming to study opioid lead poisoning. PubMed and Google Scholar databases were explored with two Medical Subject Heading terms, lead poisoning and substance-related disorders to find a broad but relevant spectrum of articles. Then, the reference lists within those articles were checked to upgrade our literature pool on this issue. RESULTS Ultimately, among English-language articles, 16 were case series and case reports of patients with lead intoxication after opioid consumption. Data pertaining to disease characteristics, diagnosis, and treatment protocols were extracted. CONCLUSIONS The clinical presentation of opioid lead intoxication can vary from rather asymptomatic to severely debilitating gastrointestinal or neurologic symptoms. The diagnosis is made by checking lead blood levels after obviating other critical diagnoses and should be considered in each drug user in endemic regions of opioid addiction, such as the Middle East. Management protocols are suggested to cover both features of opioid-related complications and lead toxicity.
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Affiliation(s)
- Ali Tafazoli Moghadam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Bahreini
- Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Background Abdominal pain may be a presenting symptom of lead poisoning and is often difficult to diagnose. This study aimed to determine the prevalence of abdominal pain in patients seen in the Laghman Hakim Hospital ED and GI clinic who were lead-intoxicated, with or without opiate use disorder. Methods Between July 2017 and January 2018, patients seen in the ED and GI clinic of Loghman Hakim Hospital with unexplained abdominal pain or abdominal pain resistant to treatment were enrolled. Informed consent was obtained from potential enrollees. For standardization, a pre-designed data collection tool was developed for uniform data acquisition. Opiate use was determined historically. For this study, lead poisoning was defined as a blood lead level (BLL) greater than or equal to 30 μg/dL (1.45 μmol/L) with concomitant GI symptoms. Results Of 125 patients admitted, 28 (22.4%) had BLLs higher than 30 μg/dL. None of the patients had signs and symptoms of opioid withdrawal syndrome during evaluation. Elevated BLLs were significantly correlated with oral opium use/abuse, history of addiction for over the preceding 12 years. The daily opium use was more than 2.75 g. There was a statistical correlation between lead toxicity and abdominal pain consistency and intensity, constipation, and paresthesias. Anemia, leukocytosis, and abnormal liver enzyme tests were laboratory findings associated with lead toxicity. Four patients died, one of whom was diagnosed with lead toxicity. Conclusion Lead toxicity should be considered in the potential differential diagnosis of severe and resistant abdominal pain in patients referring to general EDs or GI clinics if a positive history of opium abuse exists.
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Haghighi-Morad M, Zamani N, Hassanian-Moghaddam H, Shojaei M. Encephalopathy following ingestion of Lead-contaminated opium; magnetic resonance imaging findings. BMC Neurol 2020; 20:166. [PMID: 32357843 PMCID: PMC7195795 DOI: 10.1186/s12883-020-01750-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Encephalopathy is an uncommon but serious presentation of lead toxicity. Objective We aimed to determine and follow-up the brain magnetic resonance imaging (MRI) abnormalities in the patients with lead encephalopathy due to ingestion of lead contaminated opium. Methods In a cross-sectional study during lead-contaminated opium outbreak, all lead-poisoned patients with any signs/symptoms of encephalopathy were included. Results Of 19 patients with lead encephalopathy, five died early and other five could not be sent to MRI during their hospitalization period. Mean age was 51 ± 11 years and males were dominant (89%). Median [IQR] blood lead level (BLL) was 101 [81, 108] μg/dL (range; 50 to 200 μg/dL). There was no correlation between MRI findings and signs/symptoms. MRI was normal in six and abnormal in three. Bilateral symmetric involvement of parieto-occipital lobes was observed. Gray matter, gray-white matter junction, and subcortical white matter were also affected. Follow-up MRI was performed in two with abnormal MRI which showed complete and near complete resolution of the abnormalities after cessation of opium use and treatment. Conclusion: There was no correlation between MRI findings and BLL. Complete recovery of brain MRI lesions was detected after cessation of opium use.
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Affiliation(s)
- Maryam Haghighi-Morad
- Department of Radiology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasim Zamani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maziar Shojaei
- Department of Neurology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mayel M, Hamzeh S, Rabori SS, Ghasemirad S, Zamani N, Hassanian-Moghaddam H. Intravenous calcium Gluconate alleviates Lead-induced abdominal pain, a randomized clinical trial. BMC Pharmacol Toxicol 2020; 21:23. [PMID: 32188492 PMCID: PMC7079520 DOI: 10.1186/s40360-020-00403-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2016, in a lead poisoning outbreak in Iran, physicians reported thousands of opium users who presented to emergency departments (EDs) with intractable severe abdominal pain which did not respond to any narcotic medication. During the same period of time, we investigated the efficacy of intravenous calcium gluconate in alleviating lead-induced abdominal pain. METHODS In a single-center, single blinded, randomized controlled trial, a convenient sample of adult opium-addicted patients who presented to an academic ED with abdominal pain and had an initial diagnosis of lead poisoning were included and randomly subjected to two treatment groups receiving conventional treatment (morphine 0.1 mg/kg + normal saline; group 1) and conventional treatment plus 1 g of intravenous calcium gluconate (group 2) to alleviate their abdominal pain. The visual analogue scale (VAS) was determined by each patient (0 to 100 mm) before treatment, and 15, 30, and 60 min after intervention. RESULTS A total of 50 patients (25 in each group) were enrolled. Blood lead levels, VAS scores before treatment, and mean administered dose of morphine were similar between the two groups. After treatment, mean VAS score dropped to 64.7± 10.4 vs. 67.1± 10.9 at 15 min (P = 0.437), 64.6± 10.9 vs. 58.0 ± 11.2 at 30 min (P = 0.041), and 63.8± 10.7 vs. 53.6± 10.9 at 60 min (P = 0.002) in groups 1 and 2, respectively. CONCLUSION Intravenous calcium gluconate administration along with morphine can improve abdominal pain in lead poisoning due to the ingestion of lead-contaminated opium. Further interventional studies are recommended to see if response to calcium salts in suspected lead-induced abdominal pain can rule in lead toxicity. TRIAL REGISTRATION IRCT20171009036661N2. Registered 27 May 2018 - Retrospectively registered.
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Affiliation(s)
- Masoud Mayel
- Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Saleh Hamzeh
- Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Salile Shahabi Rabori
- Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Sareh Ghasemirad
- Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Nasim Zamani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, South Karegar Street, Tehran, Iran
- Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, South Karegar Street, Tehran, Iran.
- Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Okhovat AA, Ansari B, Basiri K, Fatehi F. Neuromuscular manifestations of lead poisoning in opium and herbal users in Iran. Rev Neurol (Paris) 2020; 176:856-863. [PMID: 32139183 DOI: 10.1016/j.neurol.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/11/2019] [Accepted: 12/13/2019] [Indexed: 11/17/2022]
Abstract
Opium sale is prohibited in Iran, and sellers mix it with lead to increase the weight. Herein, we describe neuromuscular findings in nine patients who developed lead poisoning due to opium/drug consumption. The mean age of patients was 53±3.5 years and their mean blood lead level was 122.6±20.8μg/dL. Most of the patients had an acute/subacute course presenting as axonal or demyelinating sensorimotor polyneuropathy, motor neuron disease, and multiple mononeuropathies with favorable response to the chelation therapy. Lead poisoning should be considered in patients with a history of opium use and neuromuscular symptoms.
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Affiliation(s)
- A A Okhovat
- Faculty of Medicine, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Street, Tehran, Iran
| | - B Ansari
- Department of Neurology, Isfahan University of Medical Sciences, Alzahra Hospital, Isfahan, Iran
| | - K Basiri
- Department of Neurology, Isfahan University of Medical Sciences, Alzahra Hospital, Isfahan, Iran
| | - F Fatehi
- Faculty of Medicine, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Street, Tehran, Iran; CNRS (UMR 7339), centre de résonance magnétique biologique et médicale, faculté de médecine, Aix Marseille University, 27, boulevard J. Moulin, 13005 Marseille, France.
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Jahani MA, Ebadi F, Abdi M, Ghaffari F, Mahmoudi G. The Effect of Methadone Maintenance Treatment Method on Mental Health and Quality of Life in People With Opioid Addiction: A Longitudinal Study in Iran. ADDICTIVE DISORDERS & THEIR TREATMENT 2020. [DOI: 10.1097/adt.0000000000000176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Wong J, Bourke E, Roberts V, Lim SM, Johnson D, Hamblin PS, Karunajeewa H, Greene S. Lead poisoning associated with illicit opium use. Intern Med J 2020; 50:239-242. [PMID: 32037702 DOI: 10.1111/imj.14729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 11/26/2022]
Abstract
Lead poisoning is an uncommon and challenging diagnosis to make. In 2018, The Victorian Department of Health issued a health warning following four cases of lead poisoning associated with illicit opium use in Melbourne, Australia. We present these cases to highlight clinical features and the relevant investigations leading to diagnosis. All cases occurred in recent immigrants to Australia, who had access to non-traditional sources of opioids. Health care professionals should consider lead poisoning in patients with appropriate symptoms and a history of illicit opium use.
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Affiliation(s)
- Joshua Wong
- Department of General Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Elyssia Bourke
- Austin Clinical Toxicology Service, Austin Health, Melbourne, Victoria, Australia
| | - Vanessa Roberts
- General Medicine Unit, Western Health, Melbourne, Victoria, Australia
| | - Seok M Lim
- Department of General Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Douglas Johnson
- Department of General Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Peter S Hamblin
- Endocrinology and Diabetes Unit, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne - Western Precinct, Melbourne, Victoria, Australia
| | - Harin Karunajeewa
- General Medicine Unit, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne - Western Precinct, Melbourne, Victoria, Australia
| | - Shaun Greene
- Austin Clinical Toxicology Service, Austin Health, Melbourne, Victoria, Australia
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Zamani N, Hassanian-Moghaddam H, Bahrami-Motlagh H, Ahmadi S, Phillips S. Lead poisoning due to ingestion of lead-contaminated opium: A diagnostic study on patients' imaging findings. J Trace Elem Med Biol 2019; 55:26-32. [PMID: 31345361 DOI: 10.1016/j.jtemb.2019.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Our study attempts to determine if for patients following ingestion of lead-contaminated opium, radiographs [plain X-ray (KUB)] or unenhanced computed tomography (CT scan) of the abdomen may be predictive of lead poisoning. METHODS Our study is concerned with patients of >21 years with elevated lead concentrations, who had undergone KUB or CT. Patients with other toxicities who had undergone similar imaging profiles but who had low blood lead level (BLL) were enrolled as controls. RESULTS We evaluated a total of 79 cases and 79 controls with median [IQR] BLLs of 126 [97.4, 160] μg/dL and 8.7 [5.5, 15] μg/dL. All cases and eleven controls (13.9%) were addicted to oral opium, and of these cases, anemia (94.9%) and abdominal pain (92.4%) were the two most common clinical manifestations. Two radiologists reviewed the X-ray and non-contrast CTs. Fifty (63.3%) and 53 (67.1%) cases and controls underwent CT scanning with 34 (68%) vs. 6 (11.3%) positive CTs (P < 0.001) while 43 (54.4%) and 39 (43.3%) underwent X-rays with 21 (48.8%) vs. 4 (11.8%) positive X-rays, respectively (P < 0.001). Positive CT is associated with BLL between 10 and 45 μg/dL with a specificity of 96.9%, 88.7% and positive predictive value of 97.5% and 85% respectively. CONCLUSIONS In suspected cases of lead exposure due to ingested opium, and if BLL is not readily available, a positive imaging result may guide radiologists and physicians to consider lead poisoning.
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Affiliation(s)
- Nasim Zamani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hooman Bahrami-Motlagh
- Department of Radiology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Ahmadi
- Department of Radiology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Khazaee-Pool M, Pashaei T, Nouri R, Taymoori P, Ponnet K. Understanding the relapse process: exploring Iranian women's substance use experiences. Subst Abuse Treat Prev Policy 2019; 14:27. [PMID: 31215472 PMCID: PMC6582531 DOI: 10.1186/s13011-019-0216-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 06/07/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Relapse is one of the main challenges that must be tackled in the drug addiction treatment. Different factors contribute to the relapse process but it remains unclear how relapse occursin women. Describing the relapse phenomenon in women might be of interest to practitioners and academics. The aim of this study was to explore the relapse experiences of Iranian women with a substance use disorder. METHODS Qualitative in-depth interviews were conducted with women with a substance use disorder. The interviews contained open-ended questions regarding relapse experiences during previous treatment. Interviews were digitally recorded. Data were analyzed using the content analysis method. RESULTS In total, 20 women who use drugs took part in the study. The mean age of the women was 34.57 (age range = 9.6 years), and the minimum age of participants was 23 years. The following five main themes were explored: socioeconomic backgrounds, physical complications of drug withdrawal, psychological burden of drug withdrawal, family atmosphere, and cultural factors. The findings highlighted the different treatment needs in women with a substance use disorder. CONCLUSIONS Based on the interviews, it seems necessary to develop female-specific comprehensive treatment programs by putting more emphasis on pain treatment intervention, relapse prevention, the diagnosis and treatment of mental disorders, couples counseling, and financial support. Furthermore, policymakers should be committed to providing a nonjudgmental social environment to remove or reduce stigma of women with drug use problems.
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Affiliation(s)
- Maryam Khazaee-Pool
- Department of Public Health, School of Health, Mazandaran University of Medical Sciences, Sari, Iran
- Health Sciences Research Center, Addiction Research Institutes, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Pashaei
- Environmental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
- Department of public health,Faculty of Health, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Roghayeh Nouri
- Environmental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Parvaneh Taymoori
- Department of public health,Faculty of Health, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Koen Ponnet
- Department of Communication Sciences, imec-mict-Ghent University, Ghent, Belgium
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Gholamhossenian A, Shahouzehi B, Shokoohi M, Najafipour H. B12 and Folate Concentrations in Opium Addicts Compared to Healthy Subjects: A Case Control Study from Kerman Coronary Artery Disease Risk Study. ADDICTION & HEALTH 2019; 10:198-204. [PMID: 31105918 PMCID: PMC6511400 DOI: 10.22122/ahj.v10i3.547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Opium addiction is a global problem which has implicated many societies. Opium addiction and drug abuse is related to harmful consequences which affect life style, biochemical factors, and vitamins values, and also is considered as a risk for heart diseases. Folate and B12 levels are related to homocysteine and studies about their levels in opium addicts are controversial; therefore, we designed this study to evaluate B12 and folate values in opium addicts. Methods From the Kerman Coronary Artery Disease Risk Study (KERCADRS) which is a population-based study, we randomly selected 340 men and entered them into two groups: case (n = 170) and control group (n = 170). Then vitamin B12 and folate levels were measured. Findings Opium addiction did not change B12 and folate levels significantly in opium addicts compared to non-addict control subjects. However, only some variables including blood pressure (BP) and diabetes positively and cigarette smoking, triglyceride (TG), alcohol, and cardiovascular disease (CVD) history negatively affected folate, and none of clinical and demographic variables influenced the B12 levels (P > 0.050). TG had significant effects on B12 and folate levels although opium addiction did not show any impact. Conclusion High TG levels were accompanied by low levels of B12 and folate. Reduced B12 and folate values are accompanied by serum homocysteine elevation. As TG elevates in opium addicts, it can be considered as an important factor which affects vitamins levels and reduces their absorption. Opium addiction elevates homocysteine level, since we can conclude that homocysteine elevation in opium addicts is independent of B12 and folate levels.
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Affiliation(s)
- Ahmad Gholamhossenian
- Professor, Physiology Research Center, Institute of Basic and Clinical Physiology Sciences AND Department of Clinical Biochemistry, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Beydolah Shahouzehi
- Assistant Professor, Cardiology Research Center, Institute of Basic and Clinical Physiology Sciences AND Department of Clinical Biochemistry, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mostafa Shokoohi
- Assistant Professor, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Najafipour
- Professor, Physiology Research Center AND Department of Physiology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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