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Khameneh Bagheri R, Mousavi SH, Mehrad‐Majd H, Jamili MJ, Nasimi Shad A, Baradaran Rahimi V. Evaluating the association between opium abuse, blood lead levels, and the complexity of coronary artery disease. Physiol Rep 2024; 12:e15975. [PMID: 38480374 PMCID: PMC10937294 DOI: 10.14814/phy2.15975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/02/2024] [Accepted: 03/02/2024] [Indexed: 03/17/2024] Open
Abstract
Opium abuse and exposure to heavy metals elevate the risk of coronary artery disease (CAD). Therefore, we aimed to determine the association between opium abuse and blood lead levels (BLLs) and the CAD complexity. We evaluated patients with acute coronary symptoms who underwent coronary angiography, and those with >50% stenosis in at least one of the coronary arteries were included. Furthermore, Synergy between PCI with Taxus and Cardiac Surgery I (SYNTAX I) score and BLLs were measured. Based on the opium abuse, 95 patients were subdivided into opium (45) and control (50) groups. Differences in demographics and CAD risk factors were insignificant between the two groups. The median BLLs were remarkably higher in the opium group than in controls (36 (35.7) and 20.5 μg/dL (11.45), respectively, p = 0.003). We also revealed no significant differences in SYNTAX score between the two groups (15.0 (9.0) and 17.5 (14.0), respectively, p = 0.28). Additionally, we found no significant correlation between BLLs and the SYNTAX scores (p = 0.277 and r = -0.113). Opium abuse was associated with high BLLs. Neither opium abuse nor high BLLs were correlated with the complexity of CAD. Further studies are warranted to establish better the relationship between opium abuse, BLLs, and CAD.
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Affiliation(s)
- Ramin Khameneh Bagheri
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Seyed Hadi Mousavi
- Medical Toxicology Research CenterMashhad University of Medical SciencesMashhadIran
| | - Hassan Mehrad‐Majd
- Clinical Research Development Unit, Ghaem HospitalMashhad University of Medical SciencesMashhadIran
| | - Mohammad Javad Jamili
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Arya Nasimi Shad
- Student Research Committee, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Vafa Baradaran Rahimi
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
- Pharmacological Research Center of Medicinal PlantsMashhad University of Medical SciencesMashhadIran
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Sharafi A, Ghaderi A, Shahbazi P, Ghaseminejad‐Raeini A, Ramezani A, Soleimani M, Talebiyan P, Shafiei SH. Illicit drug abuse and complexity of tibial shaft fracture based on AO/OTA classification: Is there any connection? J Exp Orthop 2024; 11:e12003. [PMID: 38455452 PMCID: PMC10903434 DOI: 10.1002/jeo2.12003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 12/25/2023] [Indexed: 03/09/2024] Open
Abstract
Purpose Illicit drug abuse is a global epidemic afflicting millions worldwide. Several studies have investigated the contribution of this dependence as a risk factor for fracture, but its impacts on fracture severity have been rarely studied. The present study primarily aims to determine the relationship between illicit drug abuse and the severity of tibial shaft fractures. Methods This retrospective study consecutively included patients aged ≥18 years with tibial shaft fracture who attended Sina Tertiary Hospital, Tehran, Iran, between 2016 and 2021. The fracture patterns were assessed according to the Arbeitsgemeinschaft für Osteosynthesefragen Foundation/Orthopaedic Trauma Association classification. Participants were divided into three individual specialists into groups: simple (A), wedge (B) and multifragmentary (C) fractures. The association of illicit drug abuse and other recorded variables, including age, sex, body mass index (BMI), comorbidities, physical activity, smoking habits and mechanism of injury, was also examined and assessed in multivariate logistic regression. Results Of 219 patients, 26 were drug abusers, and 193 had no history of use. A total of 20 out of 26 drug abusers experienced a complex fracture, yielding a rate of 76.9%, while this rate for nonusers was 50.3% (97 out of 193), indicating a statistically significant difference between the two subgroups (p = 0.011). The smoking history also influenced the fracture pattern (p = 0.027) based on univariate analysis; however, using adjusted multivariate analysis yielded only illicit drug abuse (odds ratio = 3.495; confidence interval = 1.144-10.680) as a risk factor for more complex fractures. Conclusion The evidence from this study suggests that complexity and fracture patterns can depend on illicit drug abuse history. Level of Evidence Level III.
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Affiliation(s)
- Amirmohammad Sharafi
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University HospitalTehran University of Medical SciencesTehranIran
| | - Ali Ghaderi
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University HospitalTehran University of Medical SciencesTehranIran
| | - Parmida Shahbazi
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University HospitalTehran University of Medical SciencesTehranIran
| | - Amirhossein Ghaseminejad‐Raeini
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University HospitalTehran University of Medical SciencesTehranIran
| | - Akam Ramezani
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University HospitalTehran University of Medical SciencesTehranIran
| | - Mohammad Soleimani
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University HospitalTehran University of Medical SciencesTehranIran
| | - Parham Talebiyan
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University HospitalTehran University of Medical SciencesTehranIran
| | - Seyyed Hossein Shafiei
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University HospitalTehran University of Medical SciencesTehranIran
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Ahmadi J, Mansoori A, Mosavat SH, Bazrafshan A. Comparison of ketamine with buprenorphine as adjunctive therapy in the treatment of comorbid major depressive disorder and opium use disorders: A randomized controlled trial. Int J Psychiatry Med 2023:912174231225087. [PMID: 38140979 DOI: 10.1177/00912174231225087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
BACKGROUND Comorbid major depressive disorder (MDD) and opium use disorder (OUD) are known to increase the risk of suicide. The purpose of this study was to compare the efficacy and safety of adjunctive therapy with either ketamine or buprenorphine as a fast-acting treatment in patients with comorbid MDD and OUD. METHODS This was a randomized double-blind controlled trial in adults admitted to a hospital in Iran. Sixty-six participants were enrolled and received ketamine or buprenorphine, along with current antidepressant therapy. The primary outcome was change in depressive symptoms assessed using Beck Depression Inventory (BDI) after 2 hours, 24 hours, and 7 days. Secondary outcomes included changes in suicidal ideation, evaluated by the Beck Scale for Suicidal Ideation (BSSI). RESULTS Both groups experienced a significant decrease in the severity of depression compared to before the study (P < .05). However, there was no significant difference in the between-group comparison (P > .05). Both groups also exhibited a significant reduction in suicidal ideation compared to before the study, with the severity of this decrease being over 85% in both groups (P < .05). CONCLUSION Both ketamine and buprenorphine appear to be equally effective in reducing symptoms of depression and suicidal ideation among individuals with MDD and OUD.
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Affiliation(s)
- Jamshid Ahmadi
- Substance Abuse Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- IMCES (Institute for Multicultural Counseling and Educational Services), Los Angeles, CA, USA
| | - Arash Mansoori
- Research Center for Psychiatry and Behavioral Science, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Hamdollah Mosavat
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Bazrafshan
- Substance Abuse Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Hadji M, Marzban M, Rashidian H, Naghibzadeh-Tahami A, Gholipour M, Mohebbi E, Safari-Faramani R, Seyyedsalehi MS, Hosseini B, Alizadeh-Navaei R, Rezaianzadeh A, Moradi A, ShahidSales S, Najafi F, Moazed V, Haghdoost AA, Rahimi-Movaghar A, Etemadi A, Malekzadeh R, Boffetta P, Weiderpass E, Kamangar F, Zendehdel K, Pukkala E. Opium use and risk of colorectal cancer: a multi-center case-referent study in Iran. Acta Oncol 2023; 62:1661-1668. [PMID: 37934078 DOI: 10.1080/0284186x.2023.2276326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Opium use has been associated with an increased risk of cancers of the lung, oesophagus, and pancreas, and it was recently classified by the International Agency for Cancer Research as carcinogenic to humans. It is not clear whether opium also increases the risk of colorectal cancer (CRC). The aim of our study was to assess the association between various metrics of opium use and the risk of CRC. METHODS This case-referent study from seven provinces in Iran comprised 848 CRC cases and 3215 referents. Data on opium use (duration, amount, frequency) and potential confounders were collected by trained interviewers. Multivariable unconditional logistic regression models were used to measure odds ratios (OR) adjusted for age, gender, province, marital status, family history of CRC-linked cancers, consumption of red meat, fruits and vegetables, body shape, occupational physical activity, and socioeconomic status. RESULTS Regular opium consumption was not associated with the risk of CRC (OR 0.9, 95% confidence interval, CI: 0.7, 1.2) compared to subjects who never used opium. However, frequent opium use more than twice a day was associated with an increased risk of CRC compared to non-users of opium (OR: 2.0, 95% CI: 1.1, 3.8; p for quadratic trend 0.008). CONCLUSION There seems to be no overall association between opium use and CRC, but the risk of CRC might be increased among persons who use opium many times a day.
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Affiliation(s)
- Maryam Hadji
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Marzban
- Department of Public Health, School of Public Health, Bushehr University of Medical Science, Bushehr, Iran
- Clinical Research Development Center, The Persian Gulf Martyrs, Bushehr University of Medical Science, Bushehr, Iran
| | - Hamideh Rashidian
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Naghibzadeh-Tahami
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Regional Knowledge HUB for HIV/AIDS Surveillance, Research Centre for Modelling in Health, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahin Gholipour
- Metabolic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Elham Mohebbi
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Safari-Faramani
- Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah Medical Sciences University, Kermanshah, Iran
| | | | - Bayan Hosseini
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
- International Agency for Research on Cancer, Lyon, France
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Rezaianzadeh
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolvahab Moradi
- Metabolic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Farid Najafi
- International Agency for Research on Cancer, Lyon, France
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Vahid Moazed
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoost
- Regional Knowledge HUB for HIV/AIDS Surveillance, Research Centre for Modelling in Health, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Etemadi
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, USA
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cancer Biology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Eero Pukkala
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Finnish Cancer Registry - Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
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Liu CM, Jia W, Liu XY, Du Y, Hua ZD. Geographical classification of opium samples from Myanmar and Afghanistan by NMR profiling and chemometrics. Drug Test Anal 2023. [PMID: 37997567 DOI: 10.1002/dta.3613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/24/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
This study presents a new strategy to discriminate between opium samples obtained from different geographical regions. Nuclear magnetic resonance (NMR) profiling and chemometrics were applied to geographical classification of opium originating from Myanmar and Afghanistan, which are two major opium producing countries in the world. A total of 50 Myanmar and 46 Afghanistan authentic opium samples were analyzed by 1 H-NMR, and the chemical profiles were characterized. Different sample preparation procedures, data processing methods, and chemometrics were compared to obtain the best classification effect. It was found that drying and the addition of buffer solutions were unnecessary for classification purposes; thus, the gum opium samples were extracted directly with CD3 OD, which shortened sample preparation time. A full discrimination between the two geographical origins was achieved by 1 H-NMR profiling and orthogonal partial least squares discriminant analysis. All 30 opium samples were classified correctly by the developed orthogonal partial least squares discriminant analysis model. Compared with traditional chromatography and mass spectrometry profiling methods, the 1 H-NMR profiling method was faster (with instrument analysis time of less than 3 min) and reproducible. This study provides new insights into the applying of NMR profiling and chemometrics to rapid drug profiling analysis.
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Affiliation(s)
- Cui-Mei Liu
- Key Laboratory of Drug Monitoring and Control, Drug Intelligence and Forensic Center of Ministry of Public Security, Beijing, China
| | - Wei Jia
- Key Laboratory of Drug Monitoring and Control, Drug Intelligence and Forensic Center of Ministry of Public Security, Beijing, China
| | - Xue-Yan Liu
- School of pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yu Du
- School of pharmacy, China Pharmaceutical University, Nanjing, China
| | - Zhen-Dong Hua
- Key Laboratory of Drug Monitoring and Control, Drug Intelligence and Forensic Center of Ministry of Public Security, Beijing, China
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Nalini M, Poustchi H, Roshandel G, Kamangar F, Khoshnia M, Gharavi A, Brennan P, Boffetta P, Dawsey SM, Abnet CC, Malekzadeh R, Etemadi A. Association Between Incident Type 2 Diabetes and Opium Use: Mediation by Body Mass and Adiposity. Am J Epidemiol 2023; 192:2050-2062. [PMID: 37552966 PMCID: PMC10691200 DOI: 10.1093/aje/kwad166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/26/2023] [Accepted: 08/03/2023] [Indexed: 08/10/2023] Open
Abstract
Opiates can affect glucose metabolism and obesity, but no large prospective study (to our knowledge) has investigated the association between long-term opium use, body mass index (BMI; weight (kg)/height (m)2), and incident type 2 diabetes mellitus (T2DM). We analyzed prospective data from 50,045 Golestan Cohort Study participants in Iran (enrollment: 2004-2008). After excluding participants with preexisting diseases, including diabetes, we used adjusted Poisson regression models to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for T2DM in opium users compared with nonusers, using mediation analysis to assess the BMI-mediated association of opium use with incident T2DM. Of 40,083 included participants (mean age = 51.4 (standard deviation, 8.8) years; 56% female), 16% were opium users (median duration of use, 10 (interquartile range), 4-20) years). During follow-up (until January 2020), 5,342 incident T2DM cases were recorded, including 8.5% of opium users and 14.2% of nonusers. Opium use was associated with an overall decrease in incident T2DM (IRR = 0.83, 95% CI: 0.75, 0.92), with a significant dose-response association. Most (84.3%) of this association was mediated by low BMI or waist circumference, and opium use did not have a direct association with incident T2DM (IRR = 0.97, 95% CI: 0.87, 1.08). Long-term opium use was associated with lower incidence of T2DM, which was mediated by low body mass and adiposity.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Reza Malekzadeh
- Correspondence to Dr. Arash Etemadi, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850 (e-mail: ); or Dr. Reza Malekzadeh, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran (e-mail: )
| | - Arash Etemadi
- Correspondence to Dr. Arash Etemadi, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850 (e-mail: ); or Dr. Reza Malekzadeh, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran (e-mail: )
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Fairbanks CA, Peterson CD. The opioid receptor: emergence through millennia of pharmaceutical sciences. Front Pain Res (Lausanne) 2023; 4:960389. [PMID: 38028425 PMCID: PMC10646403 DOI: 10.3389/fpain.2023.960389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Throughout history humanity has searched for an optimal approach to the use of opioids that maximizes analgesia while minimizing side effects. This review reflects upon the conceptualization of the opioid receptor and the critical role that the pharmaceutical sciences played in its revelation. Opium-containing formulations have been delivered by various routes of administration for analgesia and other therapeutic indications for millennia. The concept of a distinct site of opium action evolved as practitioners developed innovative delivery methods, such as intravenous administration, to improve therapeutic outcomes. The introduction of morphine and synthetic opioids engendered the prevalent assumption of a common opioid receptor. Through consideration of structure-activity relationships, spatial geometry, and pharmacological differences of known ligands, the idea of multiple opioid receptors emerged. By accessing the high-affinity property of naloxone, the opioid receptor was identified in central and peripheral nervous system tissue. The endogenous opioid neuropeptides were subsequently discovered. Application of mu-, delta-, and kappa- opioid receptor-selective ligands facilitated the pharmacological characterization and distinctions between the three receptors, which were later cloned and sequenced. Opioid receptor signal transduction pathways were described and attributed to specific physiological outcomes. The crystal structures of mu, delta, kappa, and nociceptin/orphanin FQ receptors bound to receptor-selective ligands have been elucidated. Comparison of these structures reveal locations of ligand binding and engagement of signal transduction pathways. Expanding knowledge regarding the structure and actions of the opioid receptor fuels contemporary strategies for driving the activity of opioid receptors toward maximizing therapeutic and minimizing adverse outcomes.
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Affiliation(s)
- Carolyn A. Fairbanks
- Department of Pharmaceutics, University of Minnesota, Minneapolis, MN, United States
- Department of Pharmacology, University of Minnesota, Minneapolis, MN, United States
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
| | - Cristina D. Peterson
- Department of Pharmaceutics, University of Minnesota, Minneapolis, MN, United States
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
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Burgess A, Craig J, Miller EN, Clear B, Weiner SG. Treatment of poppy seed tea misuse with buprenorphine in a telehealth practice: a case series. J Addict Dis 2023:1-6. [PMID: 37909343 DOI: 10.1080/10550887.2023.2273191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND Poppy seed tea (PST) is a legally obtainable source of opiates made from the seeds of the opium poppy. Our large telehealth opioid use disorder (OUD) provider group has treated several patients with PST misuse. METHODS We retrospectively identified patients with primary PST use disorder treated with buprenorphine in a telehealth-only practice with first visits between January 2021 and December 2022. Patients were identified by having the word "poppy" in their enrollment note, and then charts were reviewed to determine which patients had primary PST misuse. Demographics, buprenorphine doses, and retention in treatment were recorded. RESULTS We identified 18 patients treated for PST use disorder. Fifteen (83.3%) identified as male, mean age was 40.4 (standard deviation 8.8) years, and patients resided in 10 different U.S. states. Median starting buprenorphine dose was 2 mg (interquartile range (IQR) 2-2.5 mg). Median stabilizing dose of buprenorphine was 16 mg daily (IQR 15-20.5 mg). As of June 2023, 5 patients (27.8%) were still in active treatment. Two patients (11.1%) had completed a planned, elective taper. Ten patients (55.6%) had unplanned discontinuation from treatment, and 3 patients (16.7%) discontinued for other reasons. CONCLUSIONS To our knowledge, this is the largest case series describing PST misuse in the U.S., and the first to demonstrate its treatment in the telehealth setting. PST use disorder is treatable with buprenorphine with doses similar to treatment of other opioid use disorders. Clinicians who treat patients with OUD should be aware of PST use disorder and its treatment.
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Affiliation(s)
- Amelia Burgess
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Julie Craig
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily N Miller
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian Clear
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott G Weiner
- Bicycle Health Medical Group, Boston, MA, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
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9
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Rostamipoor Z, Nazemi-Rafi M, Mirafzal A, Ilka S, Hosseininasab M. Effect of oral clonidine on pain reduction in patients with opioid use disorder in the emergency department: A randomized clinical trial. Br J Clin Pharmacol 2023. [PMID: 37908055 DOI: 10.1111/bcp.15948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/07/2023] [Accepted: 10/23/2023] [Indexed: 11/02/2023] Open
Abstract
AIMS Pain can create physical and psychosocial discomfort. Pain management of patients with opioid misuse history can be challenging, in part due to their tolerance to opioids. Clonidine is an alpha-2 agonist that has been used for the reduction of anxiety and pain. The aim of this study was to investigate the effect of oral clonidine on pain outcomes in patients with a history of opioid use disorder presenting with orthopaedic fractures in the emergency room. METHODS In this blinded clinical trial in the emergency department, 70 opioid-dependent patients with orthopaedic fractures were divided into a control group of 35 and an intervention group of 35 subjects. Initially, 0.2 mg of oral clonidine was given to the intervention group and the control group received placebo tablets. Pain levels were recorded based on the Numerical Rating Scale rating before intervention, at 30 min, 1 h after intervention and at disposition from the emergency room (3-6 h after intervention). The total morphine requirement was also recorded. RESULTS The pain score of the clonidine group was significantly lower than that of the control group at 1 h and at disposition time. The amount of morphine required was significantly reduced in the clonidine group (P < 0.05). Oral clonidine had no significant effect on pulse rate. Oral clonidine was more effective for pain reduction in lower limb injuries. CONCLUSION Oral clonidine significantly reduced pain and the need for morphine in opioid-dependent patients with orthopaedic fractures.
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Affiliation(s)
- Zahra Rostamipoor
- Department of Emergency Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Masoomeh Nazemi-Rafi
- Department of Emergency Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Amirhossein Mirafzal
- Department of Emergency Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahab Ilka
- Department of Orthopedics, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Masumeh Hosseininasab
- Department of Clinical Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences, Kerman University of Medical Sciences, Kerman, Iran
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Zhang M, Hashibe M, Rao JY, Jung SY, Tashkin DP, Morgenstern H, Zhang ZF. Opium, phencyclidine, and crack cocaine smoking associations with lung and upper aerodigestive tract cancers: exploratory findings from a case-control study in Los Angeles County. Am J Drug Alcohol Abuse 2023; 49:440-449. [PMID: 37433108 PMCID: PMC10540566 DOI: 10.1080/00952990.2023.2220875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/18/2023] [Accepted: 05/28/2023] [Indexed: 07/13/2023]
Abstract
Background: Illicit drug use has become a global epidemic, yet it is unclear if drug smoking increases the risk of tobacco-related cancers.Objectives: We aimed to evaluate hypothesized associations between smoking three drugs - opium, phencyclidine (PCP) and crack cocaine and lung and upper aerodigestive tract (UADT) cancers.Methods: A population-based case-control study with 611 lung cancer cases (50% male), 601 UADT cancers cases (76% male), and 1,040 controls (60% male) was conducted in Los Angeles County (1999-2004). Epidemiologic data including drug smoking histories were collected in face-to-face interviews. Associations were estimated with logistic regressions.Results: Adjusting for potential confounders, ever vs. never crack smoking was positively associated with UADT cancers (aOR = 1.56, 95% CI: 1.05, 2.33), and a dose-response relationship was observed for lifetime smoking frequency (p for trend = .024). Heavy (> median) vs. never crack smoking was associated with UADT cancers (aOR = 1.81, 95% CI: 1.07, 3.08) and lung cancer (aOR = 1.58, 95% CI: 0.88, 2.83). A positive association was also observed between heavy PCP smoking and UADT cancers (aOR = 2.29, 95% CI: 0.91, 5.79). Little or no associations were found between opium smoking and lung cancer or UADT cancers.Conclusion: The positive associations between illicit drug use and lung and/or UADT cancers suggest that smoking these drugs may increase the risk of tobacco-related cancers. Despite the low frequency of drug smoking and possible residual confounding, our findings may provide additional insights on the development of lung and UADT cancers.
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Affiliation(s)
- Mingyan Zhang
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Mia Hashibe
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jian-Yu Rao
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Su Yon Jung
- Translational Sciences Section, UCLA Jonsson Comprehensive Cancer Center and UCLA School of Nursing, Los Angeles, CA, USA
| | - Donald P Tashkin
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Hal Morgenstern
- Departments of Epidemiology and Environmental Health Sciences, School of Public Health and Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Zuo-Feng Zhang
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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11
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Hessami K, Welch J, Frost A, AlAshqar A, Arian SE, Gough E, Borahay MA. Perioperative opioid dispensing and persistent use after benign hysterectomy: a systematic review and meta-analysis. Am J Obstet Gynecol 2023; 229:23-32.e3. [PMID: 36539027 PMCID: PMC10276170 DOI: 10.1016/j.ajog.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/29/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This meta-analysis was conducted to (1) assess the quantity and dose of perioperatively dispensed opioids for benign hysterectomy by procedure route and (2) identify the predictors of persistent opioid use after the procedure. DATA SOURCES PubMed, Web of Science, and Embase were systematically searched from study inception to 25 March 2022. STUDY ELIGIBILITY CRITERIA Studies reporting data on opioid dispensing among patients undergoing benign hysterectomy were considered eligible. The primary outcome was the dosage of opioids dispensed perioperatively (from 30 preoperative days to 21 postoperative days). The secondary outcome was the predictors of persistent opioid use after benign hysterectomy (from 3 months to 3 years postoperatively). Total opioid dispensing was measured in morphine milligram equivalents units. METHODS The random-effects model was used to pool the mean differences or odds ratios and the corresponding 95% confidence intervals. RESULTS A total of 8 studies presenting data on 377,569 women undergoing benign hysterectomy were included. Of these women, 83% (95% confidence interval, 81-84) were dispensed opioids during the perioperative period. The average amount of perioperatively dispensed opioids was 143.5 morphine milligram equivalents (95% confidence interval, 40-247). Women undergoing vaginal hysterectomy were dispensed a significantly lower amount of opioids than those undergoing laparoscopic or abdominal hysterectomies. The overall rate of persistent opioid use after benign hysterectomy was 5% (95% confidence interval, 2-8). Younger patient age (odds ratio, 1.38; 95% confidence interval, 1.17-1.63), smoking history (odds ratio, 1.87; 95% confidence interval, 1.67-2.10), alcohol use (odds ratio, 3.16; 95% confidence interval, 2.34-4.27), back pain (odds ratio, 1.50; 95% confidence interval, 1.10-2.05), and fibromyalgia (odds ratio, 1.60; 95% confidence interval, 1.39-1.83) were significantly associated with a higher risk of persistent opioid use after benign hysterectomy. However, there was no significant effect of hysterectomy route and operative complexity on persistent opioid use postoperatively. CONCLUSION Perioperative opioid dispensing was significantly dependent on the route of hysterectomy, with the lowest dispensed morphine milligram equivalents of opioids for vaginal hysterectomy and the highest for abdominal hysterectomy. Nevertheless, hysterectomy route did not significantly predict persistent opioid use postoperatively, whereas younger age, smoking, alcohol use, back pain, and fibromyalgia were significantly associated with persistent opioid use.
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Affiliation(s)
- Kamran Hessami
- Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Jennifer Welch
- Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Anja Frost
- Department of Gynecology and Obstetrics, Johns Hopkins, Baltimore, MD
| | - Abdelrahman AlAshqar
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Sara E Arian
- Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Ethan Gough
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD
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12
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Constance JE, McFarland MM, Casucci T, Deininger MW, Enioutina EY, Job K, Lemons RS, Lim CS, Ward RM, Yellepeddi V, Watt KM. Mapping the Evidence for Opioid-Mediated Changes in Malignancy and Chemotherapeutic Efficacy: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12:e38167. [PMID: 37213193 PMCID: PMC10242459 DOI: 10.2196/38167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 03/19/2023] [Accepted: 04/05/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Numerous reports contend opioids can augment or inhibit malignancy. At present, there is no consensus on the risk or benefit posed by opioids on malignancy or chemotherapeutic activity. Distinguishing the consequences of opioid use from pain and its management is challenging. Additionally, opioid concentration data is often lacking in clinical studies. A scoping review approach inclusive of preclinical and clinical data will improve our understanding of the risk-benefit relationship concerning commonly prescribed opioids and cancer and cancer treatment. OBJECTIVE The aim of the study is to map diverse studies spanning from preclinical to clinical regarding opioids with malignancy and its treatment. METHODS This scoping review will use the Arksey six stages framework to (1) identify the research question; (2) identify relevant studies; (3) select studies meeting criteria; (4) extract and chart data; (5) collate, summarize, and report results; and (6) conduct expert consultation. An initial pilot study was undertaken to (1) parameterize the extent and scale of existing data for an evidence review, (2) identify key factors to be extracted in systematic charting efforts, and (3) assess opioid concentration as a variable for its relevance to the central hypothesis. Six databases will be searched with no filters: MEDLINE, Embase, CINAHL Complete, Cochrane Library, Biological Sciences Collection, and International Pharmaceutical Abstracts. Trial registries will include ClinicalTrials.gov, Cochrane CENTRAL, International Standard Randomised Controlled Trial Number Registry, European Union Clinical Trials Register, and World Health Organization International Clinical Trials Registry. Eligibility criteria will include preclinical and clinical study data on opioids effects on tumor growth or survival, or alteration on the antineoplastic activity of chemotherapeutics. We will chart data on (1) opioid concentration from human subjects with cancer, yielding a "physiologic range" to better interpret available preclinical data; (2) patterns of opioid exposure with disease and treatment-related patient outcomes; and (3) the influence of opioids on cancer cell survival, as well as opioid-related changes to cancer cell susceptibility for chemotherapeutics. RESULTS This scoping review will present results in narrative forms as well as with the use of tables and diagrams. Initiated in February 2021 at the University of Utah, this protocol is anticipated to generate a scoping review by August 2023. The results of the scoping review will be disseminated through scientific conference proceedings and presentations, stakeholder meetings, and by publication in a peer-reviewed journal. CONCLUSIONS The findings of this scoping review will provide a comprehensive description of the consequences of prescription opioids on malignancy and its treatment. By incorporating preclinical and clinical data, this scoping review will invite novel comparisons across study types that could inform new basic, translational, and clinical studies regarding risks and benefits of opioid use among patients with cancer. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/38167.
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Affiliation(s)
- Jonathan E Constance
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Mary M McFarland
- Spencer S. Eccles Health Science Library, University of Utah, Salt Lake City, UT, United States
| | - Tallie Casucci
- J Willard Marriott Library, University of Utah, Salt Lake City, UT, United States
| | - Michael W Deininger
- Versiti Blood Research Institute, Milwaukee, WI, United States
- Division of Hematology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Elena Y Enioutina
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Kathleen Job
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Richard S Lemons
- Division of Hematology and Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Carol S Lim
- Department of Molecular Pharmaceutics, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Robert M Ward
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Venkata Yellepeddi
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Kevin M Watt
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
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13
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Ranjit YS, Davis WM, Fentem A, Riordan R, Roscoe R, Cavazos-Rehg P. Text Messages Exchanged Between Individuals With Opioid Use Disorder and Their mHealth e-Coaches: Content Analysis Study. JMIR Hum Factors 2023; 10:e37351. [PMID: 36897632 PMCID: PMC10039403 DOI: 10.2196/37351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 11/30/2022] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Opioid use disorder (OUD) has affected 2.2 million people in the United States. About 7.2 million people reported using illicit drugs in 2019, which contributed to over 70,000 overdose deaths. SMS text messaging interventions have been shown to be effective in OUD recovery. However, the interpersonal communication between individuals in OUD treatment and a support team on digital platforms has not been well examined. OBJECTIVE This study aims to understand the communication between participants undergoing OUD recovery and their e-coaches by examining the SMS text messages exchanged from the lens of social support and the issues related to OUD treatment. METHODS A content analysis of messages exchanged between individuals recovering from OUD and members of a support team was conducted. Participants were enrolled in a mobile health intervention titled "uMAT-R," a primary feature of which is the ability for patients to instantly connect with a recovery support staff or an "e-coach" via in-app messaging. Our team analyzed dyadic text-based messages of over 12 months. In total, 70 participants' messages and 1196 unique messages were analyzed using a social support framework and OUD recovery topics. RESULTS Out of 70 participants, 44 (63%) were between the ages of 31 and 50 years, 47 (67%) were female, 41 (59%) were Caucasian, and 42 (60%) reported living in unstable housing conditions. An average of 17 (SD 16.05) messages were exchanged between each participant and their e-coach. Out of 1196 messages, 64% (n=766) messages were sent by e-coaches and 36% (n=430) by participants. Messages of emotional support occurred the most, with 196 occurrences (n=9, 0.8%) and e-coaches (n=187, 15.6%). Messages of material support had 110 occurrences (participants: n=8, 0.7%; e-coaches: n=102, 8.5%). With OUD recovery topics, opioid use risk factors appeared in most (n=72) occurrences (patient: n=66, 5.5%; e-coach: n=6, 0.5%), followed by a message of avoidance of drug use 3.9% (n=47), which occurred mainly from participants. Depression was correlated with messages of social support (r=0.27; P=.02). CONCLUSIONS Individuals with OUD who had mobile health needs tended to engage in instant messaging with the recovery support staff. Participants who are engaged in messaging often engage in conversations around risk factors and avoidance of drug use. Instant messaging services can be instrumental in providing the social and educational support needs of individuals recovering from OUD.
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Affiliation(s)
- Yerina S Ranjit
- Department of Communication, University of Missouri, Columbia, MO, United States
| | - Warren M Davis
- Department of Communication, University of Missouri, Columbia, MO, United States
| | - Andrea Fentem
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, MO, United States
| | - Raven Riordan
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, MO, United States
| | - Rikki Roscoe
- Department of Communication, University of Missouri, Columbia, MO, United States
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, MO, United States
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14
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Sheikh M, Brennan P, Mariosa D, Robbins HA. Opioid medications: an emerging cancer risk factor? Br J Anaesth 2023; 130:e401-e403. [PMID: 36682937 DOI: 10.1016/j.bja.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
- Mahdi Sheikh
- Genomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
| | - Paul Brennan
- Genomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Daniela Mariosa
- Genomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Hilary A Robbins
- Genomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
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15
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Mehmandoost S, Sharifi A, Tohidinik HR, Shafa S, Hayati N, Sharifi M, McFarland W, Sharifi H. Opium Use and the Risk of Cataract: a Hospital-based, Group-matched, Case-control Study in Iran. Ophthalmic Epidemiol 2023; 30:66-73. [PMID: 35081859 DOI: 10.1080/09286586.2022.2028296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Cataract is the most prevalent cause of reversible blindness worldwide. Although studies have identified risk factors for cataract, its association with opium use has not been studied. This study aimed to evaluate the association between opium use and cataract in Iran in 2020. METHODS In a hospital-based, group-matched case-control study in Kerman, a city in southeast Iran, 160 new cases of cataract and 320 controls without cataract underwent ophthalmological examination and were interviewed. Logistic regression models tested the association between cataract and history of opium use, adjusting for demographic characteristics and history of hypertension, coronary heart disease, renal disease, smoking, alcohol use, and unprotected sun exposure. RESULTS After controlling for potential confounders, opium use increased the odds of cataract, exhibiting a dose-response relationship. The adjusted odds ratio (aOR) for mild use was 1.44 (95% confidence intervals [CI] 0.80-2.58), and 2.10 (95% CI 1.04-4.25) for heavy use. Exposure to opium juice use further increased the odds of cataract (aOR 2.24, 95% CI 1.00-5.10). Other significant associations with cataract were lower education level (aOR 5.46, 95% CI 2.45-11.29), being unmarried (aOR 2.88, 95% CI 1.65-5.00), both underweight (BMI <18.5, aOR 5.27, 95% CI 2.02-13.70) and overweight (BMI >25, aOR 1.82, 95% CI 1.15-2.87), and family history of cataract (aOR 2.07, 95% CI 1.32-3.23). CONCLUSION Our study provides evidence that opium use could increase the odds of cataract. Results also support the association of cataract with other modifiable risk factors, such as very low and high BMI and unprotected sun exposure.
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Affiliation(s)
- Soheil Mehmandoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, and Institute for Futures Studies in Health, Kerman University of Medical Sciences, Bristol, United Kingdom
| | - Ali Sharifi
- Department of Ophthalmology, Shafa Hospital, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Reza Tohidinik
- Centre for Academic Child Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Shahriyar Shafa
- Department of Ophthalmology, Shafa Hospital, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Neda Hayati
- Department of Ophthalmology, Shafa Hospital, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Sharifi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Willi McFarland
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, and Institute for Futures Studies in Health, Kerman University of Medical Sciences, Bristol, United Kingdom
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16
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Nikoo M, Kianpoor K, Nikoo N, Javidanbardan S, Kazemi A, Choi F, Vogel M, Gholami A, Tavakoli S, Wong JSH, Moazen-Zadeh E, Givaki R, Jazani M, Mohammadian F, Moghaddam NM, Schütz C, Jang K, Akhondzadeh S, Krausz M. Opium tincture versus methadone for opioid agonist treatment: a randomized controlled trial. Addiction 2023; 118:284-294. [PMID: 35971297 DOI: 10.1111/add.16030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/03/2022] [Indexed: 01/05/2023]
Abstract
AIM To test if opium tincture (OT) was non-inferior to methadone in retaining participants in opioid agonist treatment (OAT). DESIGN A Phase III, multi-centre, parallel-group, non-inferiority, double-blind randomized controlled trial with an allocation ratio of 1:1. Participants were provided treatment and followed for a period of 85 days. SETTING Four OAT clinics in Iran. PARTICIPANTS Two hundred and four participants with opioid use disorder [mean age (standard deviation) = 37.4 (9.3); female 11.3%] recruited between July 2017 and January 2018. INTERVENTIONS Participants were assigned to either OT (102) or methadone (102) using a patient-centred flexible dosing strategy. MEASUREMENTS Treatment retention over 85 days was the primary outcome. Self-reported opioid use outside treatment and occurrence of adverse events (AEs) were the secondary outcomes. FINDINGS Remaining in treatment at the end of the follow-up were 68.6% in the methadone arm and 59.8% in the OT arm. The relative retention rate of methadone to OT was 1.15 (0.97, 1.36) in both intent-to-treat and per-protocol analyses; non-inferiority was not supported statistically, as the upper bound of the confidence interval exceeded our pre-specified non-inferiority margin (1.25). Opioid use outside treatment was reported by 30.3% of OT (n = 152) and 49.4% of methadone (n = 168) patients, a difference in proportions of -19%: 90% confidence interval (-28%, -10%). The total count of AEs in the OT arm (22 among nine individuals) was significantly higher (P = 0.04) than that in the methadone arm (three among two individuals). Nausea was the most common side effect. CONCLUSION While this study could not conclude the non-inferiority of opium tincture (OT) to methadone for retaining patients in opioid agonist treatment, OT retained 60% of participants to end of follow-up (85 days) and was superior to methadone in reducing self-reported opioid use outside treatment.
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Affiliation(s)
- Mohammadali Nikoo
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kiana Kianpoor
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nooshin Nikoo
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Alireza Kazemi
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Fiona Choi
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marc Vogel
- Division of Substance Use Disorders, Psychiatric Services of Thurgovia, Münsterlingen, Switzerland.,Division of Substance Use Disorders, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Ali Gholami
- Kian Methadone Maintenance Treatment Clinic, Private Practice, Sari, Mazandaran, Iran
| | - Saeed Tavakoli
- Rooz-e-No, Methadone Maintenance Treatment Clinic (Private Practice), Shiraz, Fars, Iran
| | - James S H Wong
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Complex Pain and Addiction Consult Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - Ehsan Moazen-Zadeh
- Addiction Institute of Mount Sinai, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Reza Givaki
- Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Jazani
- Sales, Marketing, Export and Medical Department, Darou Pakhsh Pharmaceutical Manufacturing Company, Tehran, Iran
| | - Fatemeh Mohammadian
- Sales, Marketing, Export and Medical Department, Darou Pakhsh Pharmaceutical Manufacturing Company, Tehran, Iran
| | - Nader Markazi Moghaddam
- Department of Health Management and Economics, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Christian Schütz
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kerry Jang
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Department of Psychiatry, Faculty of Medicine, Tehran University of Medical Sciences, Iran
| | - Michael Krausz
- Institute of Mental Health, Centre for Health Evaluation and Outcome Sciences, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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17
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Rashidian H, Hadji M, Gholipour M, Naghibzadeh-Tahami A, Marzban M, Mohebbi E, Safari-Faramani R, Bakhshi M, Sadat Seyyedsalehi M, Hosseini B, Alizadeh-Navaei R, Emami H, Haghdoost AA, Rezaianzadeh A, Moradi A, Ansari-Moghaddam A, Nejatizadeh A, ShahidSales S, Rezvani A, Larizadeh MH, Najafi F, Poustchi H, Mohagheghi MA, Brennan P, Weiderpass E, Schüz J, Pukkala E, Freedman ND, Boffetta P, Malekzadeh R, Etemadi A, Rahimi-Movaghar A, Kamangar F, Zendehdel K. Opium use and risk of lung cancer: A multicenter case-control study in Iran. Int J Cancer 2023; 152:203-213. [PMID: 36043555 DOI: 10.1002/ijc.34244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 11/11/2022]
Abstract
Opium use was recently classified as a human carcinogen for lung cancer by the International Agency for Research on Cancer. We conducted a large, multicenter case-control study evaluating the association between opium use and the risk of lung cancer. We recruited 627 cases and 3477 controls from May 2017 to July 2020. We used unconditional logistic regression analyses to estimate the odds ratios (OR) and 95% confidence intervals (CI) and measured the association between opium use and the risk of lung cancer. The ORs were adjusted for the residential place, age, gender, socioeconomic status, cigarettes, and water pipe smoking. We found a 3.6-fold risk of lung cancer for regular opium users compared to never users (95% CI: 2.9, 4.6). There was a strong dose-response association between a cumulative count of opium use and lung cancer risk. The OR for regular opium use was higher for small cell carcinoma than in other histology (8.3, 95% CI: 4.8, 14.4). The OR of developing lung cancer among opium users was higher in females (7.4, 95% CI: 3.8, 14.5) than in males (3.3, 95% CI: 2.6, 4.2). The OR for users of both opium and tobacco was 13.4 (95% CI: 10.2, 17.7) compared to nonusers of anything. The risk of developing lung cancer is higher in regular opium users, and these results strengthen the conclusions on the carcinogenicity of opium. The association is stronger for small cell carcinoma cases than in other histology.
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Affiliation(s)
- Hamideh Rashidian
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Hadji
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Mahin Gholipour
- Metabolic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ahmad Naghibzadeh-Tahami
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Marzban
- Clinical Research Development Center, The Persian Gulf Martyrs, Bushehr University of Medical Science, Bushehr, Iran
- Department of Public Health, School of Public Health, Bushehr University of Medical Science, Bushehr, Iran
| | - Elham Mohebbi
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
- Pathology and Stem Cell Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Roya Safari-Faramani
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahdieh Bakhshi
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Monireh Sadat Seyyedsalehi
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Bayan Hosseini
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
- International Agency for Research on Cancer, Lyon, France
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Habib Emami
- National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Haghdoost
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman, Iran
- Regional Knowledge HUB for HIV/AIDS Surveillance, Research Centre for Modelling in Health, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Rezaianzadeh
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolvahab Moradi
- Metabolic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Azim Nejatizadeh
- Tobacco and Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | - Alireza Rezvani
- Hematology Research Center, Shiraz University of Medical Science, Fars, Iran
| | - Mohammad Hasan Larizadeh
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Farid Najafi
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mohagheghi
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | | | - Joachim Schüz
- International Agency for Research on Cancer, Lyon, France
| | - Eero Pukkala
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Finnish Cancer Registry-Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Neal D Freedman
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
| | - Reza Malekzadeh
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Etemadi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, Maryland, USA
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cancer Biology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
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18
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Guan Q, Velho RV, Sehouli J, Mechsner S. Endometriosis and Opioid Receptors: Are Opioids a Possible/Promising Treatment for Endometriosis? Int J Mol Sci 2023; 24:ijms24021633. [PMID: 36675147 PMCID: PMC9864914 DOI: 10.3390/ijms24021633] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/17/2023] Open
Abstract
Endometriosis (EM), defined as the presence of endometrial-like tissue with surrounding smooth muscle cells outside the uterus, is a disregarded gynecological disease reported to affect 6-10% of women of reproductive age, with 30-50% of them suffering from chronic pelvic pain and infertility. Since the exact pathogenic mechanisms of EM are still unclear, no curative therapy is available. As pain is an important factor in EM, optimal analgesia should be sought, which to date has been treated primarily with non-steroidal anti-inflammatory drugs (NSAIDs), metamizole or, in extreme cases, opioids. Here, we review the pain therapy options, the mechanisms of pain development in EM, the endogenous opioid system and pain, as well as the opioid receptors and EM-associated pain. We also explore the drug abuse and addiction to opioids and the possible use of NOP receptors in terms of analgesia and improved tolerability as a target for EM-associated pain treatment. Emerging evidence has shown a promising functional profile of bifunctional NOP/MOP partial agonists as safe and nonaddictive analgesics. However, until now, the role of NOP receptors in EM has not been investigated. This review offers a thought which still needs further investigation but may provide potential options for relieving EM-associated pain.
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19
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Sheikhy A, Fallahzadeh A, Nayebirad S, Nalini M, Sadeghian S, Pashang M, Shirzad M, Salehi-Omran A, Mansourian S, Bagheri J, Hosseini K. Opium consumption and long-term outcomes of CABG surgery in patients without modifiable risk factors. Front Surg 2023; 10:1047807. [PMID: 36874455 PMCID: PMC9982127 DOI: 10.3389/fsurg.2023.1047807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 01/30/2023] [Indexed: 02/19/2023] Open
Abstract
Background The question about the significance of opium consumption as a coronary artery disease (CAD) risk factor still remains open. The present study aimed to evaluate the association between opium consumption and long term outcomes of coronary artery bypass grafting (CABG) in patients without standard modifiable CAD risk factors (SMuRFs; hypertension, diabetes, dyslipidemia, and smoking). Methods In this registry-based design, we included 23,688 patients with CAD who underwent isolated CABG between January 2006 to December 2016. Outcomes were compared in two groups; with and without SMuRF. The main outcomes were all-cause mortality, fatal and nonfatal cerebrovascular events (MACCE). Inverse probability weighting (IPW) adjusted Cox's proportional hazards (PH) model was used to evaluate the effect of opium on post-op outcomes. Results During 133,593 person-years of follow-up, opium consumption was associated with increased risk of mortality in both patients with and without SMuRFs (weighted Hazard Ratio (HR)s: 1.248 [1.009, 1.574] and 1.410 [1.008, 2.038], respectively). There was no association between opium consumption and fatal and non-fatal MACCE in patients without SMuRF (HR = 1.027 [0.762-1.383], HR 0.700 [0.438-1.118]). Opium consumption was associated with earlier age of CABG in both groups; 2.77 (1.68, 3.85) years in SMuRF-less and 1.70 (1.11, 2.38) years in patients with SMuRFs. Conclusion Opium users not only undergo CABG at younger ages but also have a higher rate of mortality regardless of the presence of traditional CAD risk factors. Conversely, the risk of MACCE is only higher in patients with at least one modifiable CAD risk factor.
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Affiliation(s)
- Ali Sheikhy
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Aida Fallahzadeh
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepehr Nayebirad
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Nalini
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran.,Cardiovascular Research Center, Kermanshah University of Medical Sciences, Imam Ali Hospital, Shahid Beheshti Boulevard, Kermanshah, Iran
| | - Saeed Sadeghian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Pashang
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Shirzad
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Salehi-Omran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Mansourian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamshid Bagheri
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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20
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Pakmanesh H, Anvari O, Forey N, Weiderpass E, Malekpourafshar R, Iranpour M, Shahesmaeili A, Ahmadi N, Bazrafshan A, Zendehdel K, Kannengiesser C, Ba I, McKay J, Zvereva M, Hosen MI, Sheikh M, Calvez-Kelm FL. TERT Promoter Mutations as Simple and Non-Invasive Urinary Biomarkers for the Detection of Urothelial Bladder Cancer in a High-Risk Region. Int J Mol Sci 2022; 23:14319. [PMID: 36430798 PMCID: PMC9696845 DOI: 10.3390/ijms232214319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/31/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022] Open
Abstract
Bladder cancer (BC) is the 10th most common cancer in the world. While there are FDA-approved urinary assays to detect BC, none have demonstrated sufficient sensitivity and specificity to be integrated into clinical practice. Telomerase Reverse Transcriptase (TERT) gene mutations have been identified as the most common BC mutations that could potentially be used as non-invasive urinary biomarkers to detect BC. This study aims to evaluate the validity of these tests to detect BC in the Kerman province of Iran, where BC is the most common cancer in men. Urine samples of 31 patients with primary (n = 11) or recurrent (n = 20) bladder tumor and 50 controls were prospectively collected. Total urinary DNA was screened for the TERT promoter mutations (uTERTpm) by Droplet Digital PCR (ddPCR) assays. The performance characteristics of uTERTpm and the influence by disease stage and grade were compared to urine cytology results. The uTERTpm was 100% sensitive and 88% specific to detect primary BC, while it was 50% sensitive and 88% specific in detecting recurrent BC. The overall sensitivity and specificity of uTERTpm to detect bladder cancer were 67.7% and 88.0%, respectively, which were consistent across different tumor stages and grades. The most frequent uTERTpm mutations among BC cases were C228T (18/31), C250T (4/31), and C158A (1/31) with mutant allelic frequency (MAF) ranging from 0.2% to 63.3%. Urine cytology demonstrated a similar sensitivity (67.7%), but lower specificity (62.0%) than uTERTpm in detecting BC. Combined uTERTpm and urine cytology increased the sensitivity to 83.8%, but decreased the specificity to 52.0%. Our study demonstrated promising diagnostic accuracy for the uTERTpm as a non-invasive urinary biomarker to detect, in particular, primary BC in this population.
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Affiliation(s)
- Hamid Pakmanesh
- Department of Urology, School of Medicine, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman 7616913555, Iran
| | - Omid Anvari
- Department of Urology, School of Medicine, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman 7616913555, Iran
| | - Nathalie Forey
- International Agency for Research on Cancer (IARC), Genomic Epidemiology Branch, 69008 Lyon, France
| | - Elisabete Weiderpass
- International Agency for Research on Cancer (IARC), Genomic Epidemiology Branch, 69008 Lyon, France
| | - Reza Malekpourafshar
- Department of Pathology, Pathology and Stem Cell Research Center, Kerman University of Medical Sciences, Kerman 7616913555, Iran
| | - Maryam Iranpour
- Department of Pathology, Pathology and Stem Cell Research Center, Kerman University of Medical Sciences, Kerman 7616913555, Iran
| | - Armita Shahesmaeili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman 7616913555, Iran
| | - Nahid Ahmadi
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman 7616913555, Iran
| | - Azam Bazrafshan
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman 7616913555, Iran
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran 1419733133, Iran
| | | | - Ibrahima Ba
- Department of Genetics, Bichat Claude Bernard Hospital, 75108 Paris, France
| | - James McKay
- International Agency for Research on Cancer (IARC), Genomic Epidemiology Branch, 69008 Lyon, France
| | - Maria Zvereva
- Chair of Chemistry of Natural Compounds, Department of Chemistry, Lomonosov Moscow State University, 119991 Moscow, Russia
| | - Md Ismail Hosen
- Department of Biochemistry and Molecular Biology, Faculty of Biological Sciences, University of Dhaka, Dhaka 1000, Bangladesh
| | - Mahdi Sheikh
- International Agency for Research on Cancer (IARC), Genomic Epidemiology Branch, 69008 Lyon, France
| | - Florence Le Calvez-Kelm
- International Agency for Research on Cancer (IARC), Genomic Epidemiology Branch, 69008 Lyon, France
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21
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Hadji M, Rashidian H, Marzban M, Naghibzadeh-Tahami A, Gholipour M, Mohebbi E, Safari-Faramani R, Seyyedsalehi MS, Hosseini B, Bakhshi M, Alizadeh-Navaei R, Ahmadi L, Rezaianzadeh A, Moradi A, Ansari-Moghaddam A, Nejatizadeh A, ShahidSales S, Zohrabi F, Mohammadi R, Nowroozi MR, Poustchi H, Nasrollahzadeh D, Najafi F, Haghdoost AA, Rahimi-Movaghar A, Etemadi A, Mohagheghi MA, Malekzadeh R, Brennan P, Schüz J, Boffetta P, Weiderpass E, Kamangar F, Zendehdel K, Pukkala E. Opium use and risk of bladder cancer: a multi-centre case-referent study in Iran. Int J Epidemiol 2022; 51:830-838. [PMID: 35244716 PMCID: PMC9189939 DOI: 10.1093/ije/dyac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/04/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bladder cancer (BC) is the 10th most common type of cancer worldwide and the fourth most common type of cancer in Iran. Opium use is considered as one of the risk factors for BC. We aim to assess the association between various parameters of opium use, which in Iran is mainly ingested or smoked in various forms, and the risk of BC. METHOD In this multi-centre case-referent study in Iran, 717 BC cases and 3477 referents were recruited to the study from May 2017 until July 2020. Detailed histories of opium use (duration, amount, frequency) and potential confounders were collected by trained interviewers. Multivariable unconditional logistic regression models were used to measure adjusted odds ratio (OR) and 95% confidence intervals (CI). The ORs were adjusted for age, gender, place of residence and pack-years of cigarette smoking. RESULTS Regular opium consumption was associated with an increased risk of BC (OR 3.5, 95% CI: 2.8, 4.3) compared with subjects who never used opium. Compared with continuous users, the risk decreased to one-third for those who stopped opium more than 10 years ago. The adjusted OR for those who used both crude opium (teriak) and opium juice was 7.4 (95% CI: 4.1, 13.3). There was a joint effect of opium and tobacco (OR for users of both opium and tobacco 7.7, 95% CI: 6.0, 9.7). CONCLUSIONS Regular opium use is associated with an approximately 4-fold risk for BC. The OR decreases along with the increasing time since stopping opium use.
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Affiliation(s)
- Maryam Hadji
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamideh Rashidian
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Marzban
- Department of Public Health, School of Public Health, Bushehr University of Medical Science, Bushehr, Iran
- Clinical Research Development Center, Persian Gulf Martyrs, Bushehr University of Medical Science, Bushehr, Iran
| | - Ahmad Naghibzadeh-Tahami
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Biostatistics and Epidemiology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahin Gholipour
- Metabolic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Elham Mohebbi
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
- Pathology and Stem Cell Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Roya Safari-Faramani
- Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah Medical Sciences University, Kermanshah, Iran
| | | | - Bayan Hosseini
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
- International Agency for Research on Cancer, Lyon, France
| | - Mahdieh Bakhshi
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Lida Ahmadi
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rezaianzadeh
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolvahab Moradi
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Azim Nejatizadeh
- Tobacco and Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | - Farshad Zohrabi
- Department of Urology, School of Medicine, Busher University of Medical Science, Bushehr, Iran
| | - Reza Mohammadi
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
- Department of Urology, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farid Najafi
- Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah Medical Sciences University, Kermanshah, Iran
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Akbar Haghdoost
- Department of Biostatistics and Epidemiology, Kerman University of Medical Sciences, Kerman, Iran
- Regional Knowledge HUB for HIV/AIDS Surveillance, Research Centre for Modelling in Health, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Etemadi
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Mohammad Ali Mohagheghi
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Malekzadeh
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | - Joachim Schüz
- International Agency for Research on Cancer, Lyon, France
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, USA
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cancer Biology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Eero Pukkala
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
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22
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Khosravi M. Increasing opium use in Iran in response to unsubstantiated rumors that it protects against COVID-19. Addiction 2022; 117:1173-1174. [PMID: 34605101 PMCID: PMC8652596 DOI: 10.1111/add.15706] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Mohsen Khosravi
- Department of Psychiatry and Clinical PsychologyZahedan University of Medical SciencesZahedanIran
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23
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Song MJ, Westenberg JN, Kianpoor K, Nikoo M, Kazemi A, Schuetz C, Jang K, Gholami A, Akhondzadeh S, Krausz M. Substance of choice, impact of heroin or opium on treatment retention in a multicentre randomised controlled trial in Iran. Drug Alcohol Rev 2022; 41:895-901. [PMID: 35170124 DOI: 10.1111/dar.13445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/23/2021] [Accepted: 01/13/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In the Middle East and Asia, illicit opioid use exists across a spectrum between heroin and opium. The impact of primary opioid of choice on opioid agonist treatment retention has not been well evaluated previously, especially for opium tincture, an increasingly popular form of opioid agonist treatment in Iran. This study investigates the relationship between primary opioid of choice, namely heroin or opium, and retention in opium tincture and methadone treatment. METHODS Participants with opioid use disorder (n = 204) were randomised to receive opium tincture or methadone. All participants were categorised as mainly using opium or heroin. Bivariate analyses between treatment retention and primary opioid of choice (P < 0.05) and logistic regression were conducted. RESULTS Among the 191 participants included in this analysis, heroin was the primary substance of choice for 135 participants (70.7%) and opium for 56 (29.3%). Bivariate analysis showed that the opium group was more likely to be satisfied with family situation, employed and retained in treatment than the heroin group while less likely to experience incarceration and use multiple substances. When adjusting for covariates, primary opioid of choice was not significantly associated with retention in either methadone or opium tincture treatment arm. DISCUSSION AND CONCLUSIONS Positive factors, such as employment, housing and family support, seem to collectively explain the higher retention in treatment among those who primarily use opium compared to those who use heroin. To optimise retention in opioid agonist treatment, biopsychosocial care models should be further evaluated to improve psychosocial functioning.
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Affiliation(s)
- Michael Jae Song
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Kiana Kianpoor
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Mohammadali Nikoo
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Alireza Kazemi
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Christian Schuetz
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Kerry Jang
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Ali Gholami
- Kian Methadone Maintenance Treatment Clinic, Private Practice and Mazandaran University of Medical Sciences, Sari, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Michael Krausz
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
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24
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Kunnukattil Shaji N. Grappling with Morphine: A Local History of Painkiller Use in Kerala, India. Can Bull Med Hist 2021; 38:S118-S142. [PMID: 34739760 DOI: 10.3138/cbmh.482-102020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In this article I argue that the scarcity of painkillers in the Global South is driven by a central asymmetry in which the health of developed countries is valued over that of the much poorer countries that comprise the rest of the world. To elucidate this point, I argue that by examining the history of various legal institutions and specific events, like the opioid crisis, that have shaped the global production of opium and production in India, one will be able to see the genealogy of the imbalance and inequality that has always affected care. I turn to the state of Kerala to explore instances in which these legal inflections live within the contemporary guidelines for palliative care, and thus constantly affect the supply and delivery of care. This also ties in with the much longer history of opium control for the growth of the global pharmaceutical industry, within which India has been uniquely placed.
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Affiliation(s)
- Nishanth Kunnukattil Shaji
- Nishanth Kunnukattil Shaji - Department of Science and Technology Studies, Rensselaer Polytechnic Institute, Troy, New York, United States
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25
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Wu Z, Han Y, Caporaso JG, Bokulich N, Mohamadkhani A, Moayyedkazemi A, Hua X, Kamangar F, Wan Y, Suman S, Zhu B, Hutchinson A, Dagnall C, Jones K, Hicks B, Shi J, Malekzadeh R, Abnet CC, Pourshams A, Vogtmann E. Cigarette Smoking and Opium Use in Relation to the Oral Microbiota in Iran. Microbiol Spectr 2021; 9:e0013821. [PMID: 34523990 PMCID: PMC8557864 DOI: 10.1128/spectrum.00138-21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/26/2021] [Indexed: 12/27/2022] Open
Abstract
Cigarettes and opium contain chemicals and particulate matter that may modify the oral microbiota. This study aimed to investigate the association between cigarette and opium use with the oral microbiota. A total of 558 participants were recruited from Iran between 2011 and 2015. Individuals were categorized as never cigarette nor opium users, ever cigarette-only smokers, ever opium-only users, and ever both cigarette and opium users. Participants provided saliva samples for 16S rRNA gene sequencing. Logistic regression, microbiome regression-based kernel association test (MiRKAT), and zero-inflated beta regression models were calculated. For every increase in 10 observed amplicon sequence variants (ASVs), the odds for being a cigarette-only smoker, opium-only user, and both user compared to never users decreased by 9% (odds ratio [OR] = 0.91; 95% confidence interval [95% CI] = 0.86 to 0.97), 13% (OR = 0.87; 95% CI = 0.75 to 1.01), and 12% (OR = 0.88; 95% CI = 0.80 to 0.96), respectively. The microbial communities differed by cigarette and opium use as indicated by MiRKAT models testing the three beta-diversity matrices (P < 0.05 for all). Three genera were less likely and one genus was more likely to be detected in cigarette-only smokers or opium-only users than in never users. The relative abundance of the phylum Actinobacteria (never, 14.78%; both, 21.20%) was higher and the phyla Bacteroidetes (never, 17.63%; both, 11.62%) and Proteobacteria (never, 9.06%; both, 3.70%) were lower in users of both cigarettes and opium, while the phylum Firmicutes (never, 54.29%; opium, 65.49%) was higher in opium-only users. Cigarette and opium use was associated with lower alpha-diversity, overall oral microbiota community composition, and both the presence and relative abundance of multiple taxa. IMPORTANCE Cigarette smoking and opium use are associated with periodontal disease caused by specific bacteria such as Porphyromonas gingivalis, which suggests a link between cigarette smoking and opium use and the oral microbiota. Alterations of the oral microbiota in cigarette smokers compared to nonsmokers have been reported, but this has not been studied across diverse populations. Additionally, the association of opium use with the oral microbiota has not been investigated to date. We conducted this study to investigate differences in the oral microbiota between ever users of cigarettes only, opium only, and both cigarettes and opium and never users of cigarettes and opium in Iran. Lower alpha-diversity, distinct overall oral microbial communities, and the presence and relative abundance of multiple taxa have been found for users of cigarettes and/or opium.
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Affiliation(s)
- Zeni Wu
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Yongli Han
- Biostatistics Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - J. Gregory Caporaso
- Center for Applied Microbiome Science, Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, USA
| | - Nicholas Bokulich
- Center for Applied Microbiome Science, Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, USA
| | - Ashraf Mohamadkhani
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Moayyedkazemi
- Department of Internal Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Xing Hua
- Biostatistics Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, Maryland, USA
| | - Yunhu Wan
- Biostatistics Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Shalabh Suman
- Cancer Genomics Research Laboratory, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Leidos Biomedical Research Laboratory, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Bin Zhu
- Cancer Genomics Research Laboratory, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Leidos Biomedical Research Laboratory, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Amy Hutchinson
- Cancer Genomics Research Laboratory, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Leidos Biomedical Research Laboratory, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Casey Dagnall
- Cancer Genomics Research Laboratory, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Leidos Biomedical Research Laboratory, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Kristine Jones
- Cancer Genomics Research Laboratory, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Leidos Biomedical Research Laboratory, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Belynda Hicks
- Cancer Genomics Research Laboratory, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Leidos Biomedical Research Laboratory, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Jianxin Shi
- Biostatistics Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Digestive Disease Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Christian C. Abnet
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Akram Pourshams
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Emily Vogtmann
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, USA
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Pierini E. Different Peoples, Different Inebriations: The Recognition of Different Cultures of Intoxication in Early Modern English Medicine. Can Bull Med Hist 2021; 38:S72-S92. [PMID: 34403613 DOI: 10.3138/cbmh.488-112020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In early modern Europe, the global dimensions of the drug trade and the introduction of new substances contributed to the development of new cultures of intoxication. This process was particularly evident in England, where a new intoxication culture emerged from the recognition of how different substances produced similar reactions. Medical travel literature provides a critical source for examining alternative methods of drug consumption in the non-Western world in this period: culturally embedded practices like Turkish opium eating or Native American tobacco smoking became significant benchmarks for comparing with Western habits of alcohol consumption. This article argues that the early modern Western medical community relied on comparisons of intoxication in other contexts in an effort to describe its own culturally embedded practices of alcohol intoxication.
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Affiliation(s)
- Edoardo Pierini
- Edoardo Pierini - Histoire de la Médecine, Université de Genève, Geneva, Canton of Geneva, Switzerland
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27
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Rezaei A, Rezaei M. Effects of opioids and psychoactive drugs on blood lipid and glucose indices; a systematic review of population-based evidences. Endocr Metab Immune Disord Drug Targets 2021; 21:2181-2190. [PMID: 34370658 DOI: 10.2174/1871530321666210809155928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/03/2021] [Accepted: 06/10/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Based on a common belief among people, narcotic substances and psychoactive drugs may help to reduce blood glucose and lipid profile leading to reduced risk of cardiovascular diseases. This hypothesis has been verified in several studies; however, there is no conclusive agreement on the reducing effects of opium and other opioid derivatives on blood glucose and lipids. In the present review, we collected all related literature to evaluate the effects of opioids and psychoactive drugs abuse in altering blood glucose and lipid profile, and discuss their long-term effects. METHODS A systematic literature search was performed in January 2021 using "lipid profile", "glucose", and "opium" including all their equivalents, main derivatives and similar terms. The data were then extracted and reported qualitatively. RESULTS Overall, 46 articles with 37407 participants were included after several step-by-step procedures of article selection. Findings of this study suggested that opioids may reduce blood glucose and low-density lipoproteins, while increasing triglyceride. However, these effects are temporary, and long-term substance abuse exacerbates glucose and lipid-associated diseases such as diabetes and atherosclerosis. CONCLUSION Although there are many confounding factors that may affect the results of the included literature; however, based on the findings of these studies, the long-term beneficial effects of opioids on lipid profile and blood glucose cannot be accepted.
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Affiliation(s)
- Azam Rezaei
- Department of Internal Medicine, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Maryam Rezaei
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
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28
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Kamali M, Kamali H, Doustmohammadi M, Sheikhbardsiri H, Moghadari M. Treatment of opium addiction in persian medicine: A review study. J Educ Health Promot 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] [What about the content of this article? (0)] [Affiliation(s)] [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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29
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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30
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Nalini M, Khoshnia M, Kamangar F, Sharafkhah M, Poustchi H, Pourshams A, Roshandel G, Gharavi S, Zahedi M, Norouzi A, Sotoudeh M, Nikmanesh A, Brennan P, Boffetta P, Dawsey SM, Abnet CC, Malekzadeh R, Etemadi A. Joint effect of diabetes and opiate use on all-cause and cause-specific mortality: the Golestan cohort study. Int J Epidemiol 2021; 50:314-324. [PMID: 32810213 PMCID: PMC7938504 DOI: 10.1093/ije/dyaa126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Many diabetic individuals use prescription and non-prescription opioids and opiates. We aimed to investigate the joint effect of diabetes and opiate use on all-cause and cause-specific mortality. METHODS Golestan Cohort study is a prospective population-based study in Iran. A total of 50 045 people-aged 40-75, 28 811 women, 8487 opiate users, 3548 diabetic patients-were followed during a median of 11.1 years, with over 99% success follow-up. Hazard ratio and 95% confidence intervals (HRs, 95% CIs), and preventable death attributable to each risk factor, were calculated. RESULTS After 533 309 person-years, 7060 deaths occurred: 4178 (10.8%) of non-diabetic non-opiate users, 757 (25.3%) diabetic non-users, 1906 (24.0%) non-diabetic opiate users and 219 (39.8%) diabetic opiate users. Compared with non-diabetic non-users, HRs (95% CIs) for all-cause mortality were 2.17 (2.00-2.35) in diabetic non-opiate users, 1.63 (1.53-1.74) in non-diabetic opiate users and 2.76 (2.40-3.17) in diabetic opiate users. Among those who both had diabetes and used opiates, 63.8% (95% CI: 58.3%-68.5%) of all deaths were attributable to these risk factors, compared with 53.9% (95% CI: 50%-57.4%) in people who only had diabetes and 38.7% (95% CI: 34.6%-42.5%) in non-diabetic opiate users. Diabetes was more strongly associated with cardiovascular than cancer mortality. The risk of early mortality in known cases of diabetes did not depend on whether they started opiate use before or after their diagnosis. CONCLUSIONS Using opiates is detrimental to the health of diabetic patients. Public awareness about the health effects of opiates, and improvement of diabetes care especially among individuals with or at risk of opiate use, are necessary.
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Affiliation(s)
- Mahdi Nalini
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Khoshnia
- Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, USA
| | - Maryam Sharafkhah
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Liver and Pancreaticobilliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Pourshams
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran
| | - Samad Gharavi
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Zahedi
- Ischemic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Alireza Norouzi
- Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran
| | - Masoud Sotoudeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Nikmanesh
- Digestive Disease Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Sasan Alborz Research Center, Masoud Clinic, Tehran, Iran
| | - Paul Brennan
- Section of Genetics, International Agency for Research on Cancer, Lyon, France
| | - Paolo Boffetta
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Sanford M Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Christian C Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Etemadi
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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31
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Mohebbi E, Hadji M, Rashidian H, Rezaianzadeh A, Marzban M, Haghdoost AA, Naghibzadeh Tahami A, Moradi A, Gholipour M, Najafi F, Safari-Faramani R, Alizadeh-Navaei R, Ansari-Moghaddam A, Bakhshi M, Nejatizadeh A, Mahmoudi M, Shahidsales S, Ahmadi-Simab S, Arabi Mianroodi AA, Seyyedsalehi MS, Hosseini B, Peyghambari V, Shirkhoda M, Shirkoohi R, Ebrahimi E, Manifar S, Mohagheghi MA, Rozek L, Brennan P, Poustchi H, Etemadi A, Pukkala E, Schüz J, Malekzadeh R, Weiderpass E, Rahimi-Movaghar A, Boffetta P, Kamanagar F, Zendehdel K. Opium use and the risk of head and neck squamous cell carcinoma. Int J Cancer 2021; 148:1066-1076. [PMID: 32895947 DOI: 10.1002/ijc.33289] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/13/2020] [Accepted: 07/24/2020] [Indexed: 02/05/2023]
Abstract
Scant evidence exists to support the association of opium use with head and neck cancer, limited to the larynx and oral cavity. In a multicenter case-control study-Iran Opium and Cancer study, we recruited 633 cases of head and neck squamous cell carcinoma (HNSCC) (254 lip and oral cavity, 54 pharynx, 327 larynx and 28 other subsites within the head and neck) and 3065 frequency-matched controls from April 2016 to April 2019. Odds ratios (ORs) for opium use and 95% confidence intervals (95% CIs) were obtained using mixed-effects logistic regression because of heterogeneity among centers. The adjusted OR (95% CI) for regular opium use was 3.76 (2.96-4.79) for all HNSCC combined. Strong dose-response effects were observed by frequency or amount of use, and duration of use. Regular opium uses significantly increased the risk of HNSCC of the pharynx, larynx and other subsites within the head and neck with OR (95% CI) of 2.90 (1.40-6.02), 6.55 (4.69-9.13) and 5.95 (2.41-14.71), respectively. The observed associations were significant even among never tobacco smokers (including cigarette and water-pipe smoking). Moreover, by the multiplicative interaction scale, the effect of opium use could be varied by cigarette smoking on HNSCC, 8.16 (6.20-10.74). For the first time, the current study showed opium users have an increased risk of several anatomic subsites of HNSCC.
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Affiliation(s)
- Elham Mohebbi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
- Pathology and Stem Cell Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Hadji
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
- Health Science Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Hamideh Rashidian
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Abass Rezaianzadeh
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Marzban
- School of Public Health, Department of Epidemiology and Biostatistics, Bushehr University of Medical Sciences, Bushehr, Iran
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, The Persian Gulf Department of Aging Health Research, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ali Akbar Haghdoost
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ahmad Naghibzadeh Tahami
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Abdolvahab Moradi
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahin Gholipour
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health, Institute of Health, Kermanshah Medical Sciences University, Kermanshah, Iran
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roya Safari-Faramani
- Research Center for Environmental Determinants of Health, Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-communicable diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Mahdieh Bakhshi
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Azim Nejatizadeh
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
- Molecular Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | | | | | - Ali Asghar Arabi Mianroodi
- Department of Otorhinolaryngology Head and Neck Surgery, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Bayan Hosseini
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Vahideh Peyghambari
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Shirkhoda
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shirkoohi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Elmira Ebrahimi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheila Manifar
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mohagheghi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Laura Rozek
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul Brennan
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Hossein Poustchi
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Etemadi
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Eero Pukkala
- Health Science Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Finnish Cancer Registry, Helsinki, Finland
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - 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
| | - Farin Kamanagar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, Maryland, USA
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute of Iran, Tehran 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ballas SK. Opioids and Sickle Cell Disease: From Opium to the Opioid Epidemic. J Clin Med 2021; 10:438. [PMID: 33498726 DOI: 10.3390/jcm10030438] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/30/2022] Open
Abstract
Sickle cell disease (SCD) is an inherited disorder of hemoglobin structure. The clinical effects of the sickle gene are pleiotropic in nature causing multiple phenotypic expressions associated with the various complications of the disease. The hallmark of the disease is pain that could be acute, chronic, nociceptive, or neuropathic that could occur singly or in various combinations. The acute vaso-occlusive painful crisis (VOC) is the most common cause of admissions to the Emergency Department and/or the hospital. Although progress has been made in understanding the pathophysiology of SCD as well as in developing preventive and curative therapies, effective pain management continues to lag behind and depend mostly on the use of opioids. This review describes the history of opioids from the ancient times of opium to the current use of the many controversial opioids. In addition, the major cause of death of patients with SCD is the complications of the disease itself and not the use of opioids. The use of opioids by patients with SCD has been stable over the years. Judicious use of opioids to treat sickle cell pain according to available guidelines could minimize the unnecessary suffering experienced by patients with SCD.
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Li YY, Ghanbari R, Pathmasiri W, McRitchie S, Poustchi H, Shayanrad A, Roshandel G, Etemadi A, Pollock JD, Malekzadeh R, Sumner SCJ. Untargeted Metabolomics: Biochemical Perturbations in Golestan Cohort Study Opium Users Inform Intervention Strategies. Front Nutr 2020; 7:584585. [PMID: 33415121 PMCID: PMC7783045 DOI: 10.3389/fnut.2020.584585] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022] Open
Abstract
Objective: Over 50 million people worldwide are estimated to use opioids, of which ~30 million use opiates (opium and its derivatives). Use of opiates has been associated with a variety of adverse complications such as neurological and behavioral outcomes, addiction, cancers, diabetes, and cardiovascular disease. While it is well known that opiates exert their neurobiological effects through binding with mu, kappa, and delta receptors to exert analgesic and sedative effects, mechanistic links to other health effects are not well understood. Our study focuses on the identification of biochemical perturbations in Golestan Cohort Study (GCS) opium users. Methods: We used untargeted metabolomics to evaluate the metabolic profiles of 218 opium users and 80 non-users participating in the GCS. Urine samples were obtained from adult (age 40–75) opium users living in the Golestan Province of Iran. Untargeted analysis of urine was conducted using a UPLC-Q-Exactive HFx Mass Spectrometry and a 700 MHz NMR Spectrometry. Results: These GCS opium users had a significantly higher intake of tobacco and alcohol and a significantly decreased BMI compared with non-users. Metabolites derived from opium (codeine, morphine, and related glucuronides), nicotine, and curing or combustion of plant material were increased in opium users compared with non-users. Endogenous compounds which differentiated the opium users and non-users largely included vitamins and co-factors, metabolites involved in neurotransmission, Kreb's cycle, purine metabolism, central carbon metabolism, histone modification, and acetylation. Conclusions: Our study reveals biochemical perturbations in GCS opium users that are important to the development of intervention strategies to mitigate against the development of adverse effects of substance abuse.
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Affiliation(s)
- Yuan-Yuan Li
- Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Reza Ghanbari
- Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Science, Tehran, Iran
| | - Wimal Pathmasiri
- Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Susan McRitchie
- Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Hossein Poustchi
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Science, Tehran, Iran
| | - Amaneh Shayanrad
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Science, Tehran, Iran
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Arash Etemadi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States
| | - Jonathan D Pollock
- Genetics, Epigenetics, and Developmental Neuroscience Branch, National Institute on Drug Abuse, Bethesda, MD, United States
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Science, Tehran, Iran
| | - Susan C J Sumner
- Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Abstract
The American Civil War resulted in massive numbers of injured and ill soldiers. Throughout the conflict, medical doctors relied on opium to treat these conditions, giving rise to claims that the injudicious use of the narcotic caused America's post-bellum opium crisis. Similar claims of medical misuse of opioids are now made as America confronts the modern narcotic crisis. A more nuanced thesis based on a broader base of Civil War era research suggests a more complex set of interacting factors that collectively contributed to America's post-war opium crisis.
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Abstract
According to the Afghanistan Ministry of Health, 3.5 million people use drugs, 2.4 million of which are regular users. In this cross-sectional study, it was aimed to determine epidemiological characteristics of addicts in a treatment center in Kabul. Eight hundred people were included. Statistical analysis was done with SPSS 22.0. The average age was 30.74 years, 88.9% were male, and 50.6% were married. Further, 35.9% have never been trained, 60.5% of participants were living in urban areas, 62.8% were refugees, 17.5% were unemployed, and 30.3% of them had monthly income below 147.1 USD. The average age of starting substance use was 19.9 years. "Friendship environment" was the leading reason to start (36.6%), followed by "reduce troubles" with 22.3%. The most preferred substance was cannabis (46.0%), followed by opium (25.3%) and heroin (17.0%). Heroin was the most commonly used substance lifelong (87.1%), followed by cannabis (66.3%) and opium (65.5%). When compared to individuals younger than 18, heroin use rates were 3.52 times higher in the 18-to-30 age range, 5.49 times higher in the 31-to-45 age range, and 1.86 times higher in urban residents than rural. Cannabis use was 12.24 times more among men than women, 2.79 times higher among divorced or widowed individuals than singles, 1.68 times higher among refugees than non-refugees, and 2.26 times higher among drug traffickers than non-traffickers. Opium use was 1.63 times higher for refugees than non-refugees and 3.24 times higher in those who worked in drug fields than those who did not. Periodic assessment of prevalence of drug use and the establishment of drug use monitoring systems are recommended.
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Affiliation(s)
- Mohammad İsmail Farook
- Public Health Doctorate Program, Gazi University Graduate School of Health Science, Ankara, Turkey
| | - Mustafa Necmi İlhan
- Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Cemal Koçak
- General Directorate of Public Health, Republic of Turkey, Ministry of Health, Ankara, Turkey
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Ebrahimi E, Akhavan MH, Akrami R, Mahmoodi M, Hesami S, Hashemi M, Razavi SM, Hadji M, Zendehdel K. Association between mitochondrial DNA content and opium exposure. J Biochem Mol Toxicol 2020; 34:e22559. [PMID: 33034947 DOI: 10.1002/jbt.22559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/10/2020] [Accepted: 05/29/2020] [Indexed: 01/09/2023]
Abstract
To date, not much study has been done to investigate the mitochondrial DNA (mtDNA) copy number as the potential biomarker for opium exposure. Here, we conducted a cross-sectional study to determine the relative mtDNA content as the potential biomarker for opium exposure. Quantitative real-time PCR was performed to investigate the mtDNA copy number variation across 205 individuals, including blood samples of 45 opium users, 41 cigarette users, 47 dual users, and 72 never users of any product. We found a significantly higher mtDNA content among the opium-only users (adjusted OR: 3.21; 95% CI: [1.34, 7.66]; P = .009) and dual users (adjusted OR: 2.64; 95% CI: [1.15, 6.1]; P = .02) compared to that in never users even after adjustment for confounding factors, age, and sex. Discordantly, analysis of mitochondrial DNA in cigarette smokers revealed an indirect association between cigarette smoking and mtDNA content although it was not statistically significant. The reason behind the increased mitochondrial DNA is unclear. The possible hypothesis is that there might be a way to compensate for the oxidative damage induced by opium consumption. Taken together, our findings indicated that the mtDNA copy number may alter during opium exposure. Since changes in the mitochondrial DNA copy number was associated with the etiology of many diseases including cancer, further investigations on the mtDNA copy number may shed light on the carcinogenicity of opium consumption and means for early detection among the populations who have been exposed to opium and its products.
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Affiliation(s)
- Elmira Ebrahimi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.,Cancer Biology Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran, Iran
| | - Mohammad H Akhavan
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.,Department of Genetics, Faculty of Advanced Sciences and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Rahim Akrami
- Department of Epidemiology & Biostatistics, School of Public Health, Sabzevar University of Medical Sciences, Sabzevar, Iran.,Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Mahmoodi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Hesami
- Medical Genetics Department, Cancer Institute, Imam Khomeini Hospital, Tehran, Iran
| | - Mehrdad Hashemi
- Department of Genetics, Faculty of Advanced Sciences and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Seyed M Razavi
- Department of Occupational Health Engineering, School of Public Health, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Maryam Hadji
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.,Health Science Unit, Faculty of Social Science, Tampere University, Tampere, Finland
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.,Cancer Biology Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran, Iran
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Fanaei H, Riki F, Khayat S, Bornavard M. Brain-derived neurotrophic factor and nerve growth factor concentrations in maternal and umbilical cord blood of opium-addicted mothers. Int J Dev Neurosci 2020; 80:594-600. [PMID: 32738830 DOI: 10.1002/jdn.10055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/24/2020] [Accepted: 07/25/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND It is reported that opium consumption during pregnancy is associated with adverse pregnancy outcomes and neurodevelopmental defects in infants. BDNF and NGF alterations during pregnancy cause neurobehavioral deficits in the offspring. The aim of this study was to investigate the effect of opium addiction of pregnant women on BDNF and NGF levels in maternal and umbilical cord blood as well as pregnancy outcome. MATERIALS AND METHODS The present research was a cross-sectional study. Thirty-five addicted pregnant women and 35 healthy pregnant women were included in the study. Blood samples were taken immediately after delivery from the maternal vein and umbilical cord. Then, BDNF and NGF concentrations in serum were measured by ELISA kits. The outcomes of pregnancy were determined by a checklist. Descriptive, t test, Mann-Whitney, and Chi-squared test were used to analyze the data. SPSS version 21 software was used for the analyses. A p-value <.05 was considered significant. RESULTS BDNF levels were significantly lower in maternal and umbilical cord blood in the opium-addicted group (917.2 31 ± 316.5 and 784.6 ± 242.9 pg/ml, respectively) compared to the control group (1351 ± 375 and 1063 ± 341 pg/ml, respectively) (p < .0001 and p < .0002, respectively). Similarly, NGF level was significantly lower in maternal and umbilical cord blood in the opium-addicted group (302.7 ± 35.50 and 226.6 ± 45.43 pg/ml, respectively) compared to the control group (345.7 ± 43.16 and 251.2 ± 37.72 pg/ml, respectively) (p < .0001 and p = .0165, respectively). Adverse pregnancy outcomes such as NICU admissions, congenital anomalies, neonatal deaths, meconium contaminated amniotic fluid, respiratory problems, neonatal resuscitation, and low Apgar score were significantly higher in the opium-addicted group than in the control group. CONCLUSION The results of this study revealed that opium consumption during pregnancy reduces BDNF and NGF levels in maternal and umbilical cord blood, which may cause neurodevelopmental disorders in later periods of infants' life.
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Affiliation(s)
- Hamed Fanaei
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.,Department of Physiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Farideh Riki
- Department of Physiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Samira Khayat
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Morad Bornavard
- Department of Physiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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Vazirinejad R, Najafipour R, Rezaeian M, Ghazizadeh A, Doost Mohammadi F. Opium and risk of gastrointestinal cancer: a case-control study. Turk J Med Sci 2020; 50:697-705. [PMID: 32041383 PMCID: PMC7379408 DOI: 10.3906/sag-1907-100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 02/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background/aim Gastrointestinal (GI) cancers are among the most common cancers in the world. Many risk factors may increase the chance of developing GI cancers. In recent years, a number of epidemiological studies have reported evidence of carcinogenic effects of opium in humans. This study aimed to investigate the relationship between opium use and GI cancer. Materials and methods This case-control study was performed on 95 patients with GI cancer and 190 healthy individuals (matched for age, sex, place of residence, and smoking) in Rafsanjan, Iran, in 2018. Diet information, as well as history of smoking, the use of hookah, opium, and its derivatives was collected using a checklist in interview sessions. Conditional logistic regression was performed to investigate the proposed relationship and to estimate odds ratios (OR). Results After adjusting the confounding variables, the use of opium was significantly associated with an increased risk of GI cancer development (OR = 5.95, 95% CI: 2.4–14.9). Also, a dose-response association was found between the cumulative use of opium and the risk of GI cancers. Consumption of fruit and vegetables reduced the risk of developing GI cancers in opium users (OR = 4.9 and 4.7, respectively). Conclusion Opium, in the form used among drug users in this area, can lead to an increased risk of GI cancers. Fruit and vegetables have a protective and modifying effect on the risk of GI cancer development caused by opium consumption.
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Affiliation(s)
- Reza Vazirinejad
- Department of Epidemiology and Biostatics, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Roya Najafipour
- Department of Public Health, School of Health, Bam University of Medical Sciences, Bam, Iran
| | - Mohsen Rezaeian
- Department of Epidemiology and Biostatics, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Alireza Ghazizadeh
- Department of Internal Medicine, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Fateme Doost Mohammadi
- Department of Epidemiology and Biostatics, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Firouzabadi N, Haghnegahdar M, Khalvati B, Dehshahri A, Bahramali E. Overexpression of Adiponectin Receptors in Opium Users with and without Cancer. Clin Pharmacol 2020; 12:59-65. [PMID: 32607004 PMCID: PMC7304683 DOI: 10.2147/cpaa.s256289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/05/2020] [Indexed: 11/23/2022] Open
Abstract
Aim Opium addiction is a serious public health concern in the Middle East countries causing various illnesses. Opium use is associated with an increased risk of several cancers; however, the underlying mechanisms are not yet fully elucidated. Altered levels of adiponectin and its related main receptors, Adiponectin receptor 1 and 2 (AdipoR1 and AdipoR2) have been associated with several malignancies. Opium users are at risk of various cancers. All together let us to the hypothesis that probable overexpression of AdipoRs in opium users might be linked to the occurrence of cancer in this population. Methods One hundred opium users along with 100 healthy non-opium users were enrolled in the study. Opium users were followed up for 5 years (2014–2019) to evaluate the occurrence of malignancies. AdipoR1 and AdipoR2 expressions were measured using a flow cytometry method. Results Expression of AdipoR1 and AdipoR2 was significantly higher in opium users compared with the healthy control group (P=0.0001 and 0.0001, respectively). Eight opium users developed cancer during the follow-up period. Subjects abusing opium developed cancer by 8.6 folds comparing to non-opium users (P=0.034; OR=8.6; 95% CI (1.06–70.1)). Expression of these two receptors was significantly higher in opium users developing cancer compared with cancer-free opium (P=0.001). Conclusion Considering the significant overexpression of AdipoR1 and AdipoR2 in opium users and in opium users who developed malignancies and the association between upregulation of these receptors in most cancers affecting opium users and assessment of AdipoRs may serve as an early detection tool of cancer in this population.
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Affiliation(s)
- Negar Firouzabadi
- Department of Pharmacology & Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.,Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Non-Communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Maral Haghnegahdar
- Department of Pharmacology & Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahman Khalvati
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Ali Dehshahri
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ehsan Bahramali
- Digestive Disease Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Doodkanloy Milan F, Torabi M, Mirzaee M. The relationship between blood lead level and the severity of abdominal pain in opioid-addicted patients during a hospital outbreak. J Addict Dis 2019; 37:211-216. [PMID: 31580206 DOI: 10.1080/10550887.2019.1663088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
An increase in the incidence of abdominal pain in opioid abusers over a period of time increased the suspicion of lead poisoning. The severity of abdominal pain and its relationship with blood lead level (BLL) were investigated during a hospital outbreak. This was a descriptive, cross-sectional study on opioid-addicted patients presenting with abdominal pain. Pain severity was measured based on the numerical rating scale (NRS). Blood lead and serum uric acid levels were determined. The presence of basophilic stippling was sought in the peripheral blood smear. Also, the X-ray was performed to assess abdominal cavity. Of 239 patients, 160 opioid addicts presenting with abdominal pain participated in the study. There were significant associations between the severity of abdominal pain and the type of opioid, the route and, duration of opioid consumption, the presence of basophilic stippling in peripheral blood smear and radio-opaque opioids in abdominal X-ray, as well as BLL and serum uric acid level (P < 0.0001). Opium abuse is a common cause of lead poisoning in Iran. The patients with lead poisoning may present with abdominal pain. The severity of abdominal pain significantly correlated with BLL. Continuous screening of BLL is recommended in opioid abusers.
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Affiliation(s)
- Fatemeh Doodkanloy Milan
- Specialist in Emergency Medicine, Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Torabi
- Associate Professor of Emergency Medicine, Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Moghaddameh Mirzaee
- Associate professor Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Paeezi M, Zamani N, Hassanian-Moghaddam H, Shadnia S, Zamani N, Chaleshi V, Mafi AA. Treatment of adult lead poisoning with D-penicillamine. Drug Metab Pers Ther 2019; 34:/j/dmdi.ahead-of-print/dmpt-2019-0003/dmpt-2019-0003.xml. [PMID: 31188756 DOI: 10.1515/dmpt-2019-0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/12/2019] [Indexed: 06/09/2023]
Abstract
Background The aim of the current study was to evaluate the efficacy of D-penicillamine in the treatment of lead poisoning mainly in the outpatient setting. Methods In a case series study performed during the recent epidemic of lead poisoning in Iran, lead-poisoned patients referring to our outpatient clinic were treated with 250-mg D-penicillamine capsules administered every 6 h for 5 or 10 days based on availability of the medication. They were recommended to re-check blood lead level (BLL) 4 weeks after cessation of the treatment and refer to our clinic again. Results In 63 patients with lead poisoning but without signs and symptoms of lead encephalopathy, median BLL was 106 [84, 131] μg/dL on presentation, which declined to a mean of 52.6 ± 28.8 μg/dL after a median treatment period of 7 [5, 10] days (p < 0.001). There was no statistically significant difference between the 5- and 10-day treatment protocols regarding complications and recovery. Treatment had resulted in a median decrease of 54 μg/dL [33, 90] (range: -20 to 231 μg/dL) in the patients' BLLs (33.9% declined in BLL measurements; range: -29.69% to 99.06%). Conclusions D-penicillamine may be an acceptable substitute treatment in adult lead poisoning. Although our sample size was limited, we could not detect any serious adverse effects in our cases showing that D-penicillamine resulted in acceptable recovery rates. This may be helpful especially in epidemics with limitations in antidote access.
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Affiliation(s)
- Maryam Paeezi
- Department of Clinical Toxicology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Excellence Center of Clinical Toxicology, Iranian Ministry of Health, Tehran, Iran
| | - Nasim Zamani
- Department of Clinical Toxicology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Excellence Center of Clinical Toxicology, Iranian Ministry of Health, Tehran, Iran
- Department of Clinical Toxicology, Loghman Hakim Hospital, South Karegar Street, Tehran, Iran, Phone/Fax: 00982155424041
| | | | - Shahin Shadnia
- Department of Clinical Toxicology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Excellence Center of Clinical Toxicology, Iranian Ministry of Health, Tehran, Iran
| | - Naghmeh Zamani
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahid Chaleshi
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Ali Mafi
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ray T, Pandey SS, Pandey A, Srivastava M, Shanker K, Kalra A. Endophytic Consortium With Diverse Gene-Regulating Capabilities of Benzylisoquinoline Alkaloids Biosynthetic Pathway Can Enhance Endogenous Morphine Biosynthesis in Papaver somniferum. Front Microbiol 2019; 10:925. [PMID: 31114562 PMCID: PMC6503101 DOI: 10.3389/fmicb.2019.00925] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/11/2019] [Indexed: 11/21/2022] Open
Abstract
Secondary metabolite biosynthesis in medicinal plants is multi-step cascade known to be modulated by associated endophytes. While a single endophyte is not able to upregulate all biosynthetic steps, limiting maximum yield achievement. Therefore to compliment the deficient characteristics in an endophyte we tried consortium of endophytes to achieve maximum yield. Here, efforts were made to maximize the in planta morphine yield, using consortium of two endophytes; SM1B (Acinetobacter sp.) upregulating most of the genes of morphine biosynthesis except T6ODM and CODM, and SM3B (Marmoricola sp.) upregulating T6ODM and CODM in alkaloid-less Papaver somniferum cv. Sujata. Consortium-inoculation significantly increased morphine and thebaine content, and also increased the photosynthetic efficiency of poppy plants resulted in increased biomass, capsule weight, and seed yields compared to single-inoculation. The increment in morphine content was due to the modulation of metabolic-flow of key intermediates including reticuline and thebaine, via upregulating pertinent biosynthetic genes and enhanced expression of COR, key gene for morphine biosynthesis. This is the first report demonstrating the endophytic-consortium complimenting the functional deficiency of one endophyte by another for upregulating multiple genes of a metabolic pathway similar to transgenics (overexpressing multiple genes) for obtaining enhanced yield of pharmaceutically important metabolites.
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Affiliation(s)
- Tania Ray
- Microbial Technology Department, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow, India
| | - Shiv S Pandey
- Microbial Technology Department, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow, India
| | - Alok Pandey
- Biotechnology Division, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow, India
| | - Madhumita Srivastava
- Analytical Chemistry Department, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow, India
| | - Karuna Shanker
- Analytical Chemistry Department, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow, India
| | - Alok Kalra
- Microbial Technology Department, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow, India
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Mousavi-Mirzaei SM, Talebi A, Amirabadizadeh A, Nakhaee S, Azarkar G, Mehrpour O. Increasing the Risk of Stroke by Opium Addiction. J Stroke Cerebrovasc Dis 2019; 28:1930-5. [PMID: 31000450 DOI: 10.1016/j.jstrokecerebrovasdis.2019.03.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/07/2019] [Accepted: 03/16/2019] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Stroke is among the leading causes of mortality and morbidity in the world. Besides the identified risk factor, Ischemic stroke evidence show drug use develops or exacerbates the atherosclerotic process. The current study aimed at comparing cerebrovascular ultrasounds' changes in addicted and nonaddicted people who developed ischemic stroke. METHODS In the current cross-sectional study, a total of 133 patients with ischemic stroke who were admitted to Vali-Asr hospital from June 2016 to April 2017 were enrolled. For obtaining the quantitative data, t test or Mann-Whitney test was employed to compare the addict or no-addict groups, as well as, categorical data testing was performed using chi-square test. Also, the multiple logistic regression was used for identifying the factors and the significance level was set at 5%. RESULTS The current study was performed on 133 patients, among them 41 patients (30.8%) were opium addicted, and 92 patients (69.2%) were nonaddict. The mean [IQR] number of atherosclerotic plaques were significantly higher in opium addicted group in comparison with the nonaddicted group (3.0 [1.0-4.0] versus 1.5 [0.0-3.0], P = .008). The possibility of increasing the number of plaques in addicted patients was 1.42 times higher than the nonaddicted patients (odds ratio (95% confidence interval): 1.42 (1.11-1.81), P = .005). CONCLUSION The findings demonstrated a significant difference in the vessel stenosis pattern between the addict and nonaddict ischemic stroke groups. To investigate the possible effects of opium use and its associated parameters, ie, dosage, duration of use, and the way of opium use on ischemic stroke, further studies are required.
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Fakoor M, Akhgari M, Shafaroodi H. Lead Poisoning in Opium-Addicted Subjects, Its Correlation with Pyrimidine 5'-Nucleotidase Activity and Liver Function Tests. Int J Prev Med 2019; 10:36. [PMID: 30967922 PMCID: PMC6425880 DOI: 10.4103/ijpvm.ijpvm_490_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/31/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Lead may be added to the opium by drug smugglers. It can cause elevated blood lead level (BLL) in opium-addicted patients. Erythrocyte pyrimidine 5′-nucleotidase (P5N) activity is susceptible to high BLL. The aim of this study was to find out whether opium-addicted patients show erythropathy and elevated liver enzymes explainable by high BLL and decreased P5N activity. Methods: Forty orally opium-addicted subjects and 40 normal healthy volunteers were enrolled in this study. BLL was measured in whole blood specimens using atomic absorption spectrometry instrumentation. Enzymatic activity, protein amount of P5N, and erythrocyte purine/pyrimidine ratio were determined. Blood films were analyzed for the presence of basophilic stippling of red cells and hemolytic anemia. The level of liver function enzymes was measured. Results: The mean BLL for opium-addicted patients was significantly higher than control group (P < 0.001). On the contrary, P5N activity showed a valid decrease in opium-addicted patients when compared with control group (P < 0.001). In line with repressed P5N activity, erythrocyte purine/pyrimidine ratio in patients was lower than control group (P < 0.001). A statistically significant reverse correlation was found between BLL and P5N activity (P < 0.05, r = −0.85). The prevalence of both basophilic stippling (P < 0.001, z = 6.62) and hemolytic anemia (P < 0.001, z = 6.52) in study population was significantly associated with elevated BLL. We could not find any significant correlation between serum level of liver enzymes and BLL. Conclusions: Opium-addicted patients in Tehran, Iran, are at high risk of lead poisoning which may result in hematologic problems and possibly hepatic damage.
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Affiliation(s)
- Mandana Fakoor
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University (IAUPS), Tehran, Iran
| | - Maryam Akhgari
- Department of Forensic Toxicology, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
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Nikoo M, Moazen-Zadeh E, Nikoo N, Javidanbardan S, Kazemi A, Choi F, Vogel M, Gholami A, Tavakoli S, Givaki R, Jazani M, Mohammadian F, Markazi Moghaddam N, Goudarzi N, Schutz C, Jang K, Akhondzadeh S, Krausz M. Comparing opium tincture and methadone for medication-assisted treatment of patients with opioid use disorder: Protocol for a multicenter parallel group noninferiority double-blind randomized controlled trial. Int J Methods Psychiatr Res 2019; 28:e1768. [PMID: 30714249 PMCID: PMC6877259 DOI: 10.1002/mpr.1768] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES This is the first study to compare the safety and efficacy of opium tincture (OT) with methadone for treatment of opioid use disorder. METHODS In this multicenter, double-blind, noninferiority controlled trial, a stratified sample of 204 participants with opioid use disorder were recruited from community outreach, drop-in centers, and triangular clinics. Participants were excluded in case of active participation in another treatment program for opioid use disorder, hypersensitivity to trial medications, pregnancy, and certain serious medical conditions. They were randomized to receive either OT or methadone with an allocation ratio of 1:1 using a patient-centered flexible dosing strategy. Eligible participants were followed for a period of 12 weeks. Primary outcome is the difference in percentage of patients retained in the treatment. Secondary outcomes are craving, withdrawal symptoms, physical health, mental health, quality of life, and severity of substance use problems, cognitive function, safety profile, cost-effectiveness, and participants' satisfaction. Both intention-to-treat and per-protocol analyses will be conducted. The Ethics Board of the University of British Columbia and Tehran University of Medical Sciences approved the study. (clinicaltrials.gov; NCT02502175). RESULTS To be reported after final analysis. CONCLUSIONS If shown to be effective, OT will diversify the options for medication-assisted treatment of opioid use disorder.
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Affiliation(s)
- Mohammadali Nikoo
- Addiction and Concurrent Disorders Group, Institute of Mental Health, Centre for Health Evaluation and Outcome Sciences, Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Ehsan Moazen-Zadeh
- Addiction and Concurrent Disorders Group, Institute of Mental Health, Centre for Health Evaluation and Outcome Sciences, Department of Psychiatry, University of British Columbia, Vancouver, Canada.,Psychiatric Research Center, Roozbeh Hospital, Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Nooshin Nikoo
- Addiction and Concurrent Disorders Group, Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Sanam Javidanbardan
- Addiction and Concurrent Disorders Group, Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Alireza Kazemi
- Addiction and Concurrent Disorders Group, Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, Canada.,Health Information Management and Technology Group, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fiona Choi
- Addiction and Concurrent Disorders Group, Institute of Mental Health, Centre for Health Evaluation and Outcome Sciences, Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Marc Vogel
- Department of Psychiatry (UPK), Division of Addictive Disorders, University of Basel, Basel, Switzerland
| | - Ali Gholami
- Kian Methadone Maintenance Treatment Clinic, Private Practice and Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
| | - Saeed Tavakoli
- Rooz-e-No Methadone Maintenance Treatment Clinic, Private Practice and Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Reza Givaki
- Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Jazani
- Sales, Marketing, Export, and Medical Department, Darou Pakhsh Pharmaceutical Mfg.Co., Tehran, Iran
| | - Fatemeh Mohammadian
- Pharmacovigilance & Clinical Trial Manager, Darou Pakhsh Pharmaceutical Mfg Co., Tehran, Iran
| | - Nader Markazi Moghaddam
- Department of Health Management and Economics, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Nasser Goudarzi
- Department of Psychology, AJA University of Medical Sciences, Tehran, Iran
| | - Christian Schutz
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kerry Jang
- Institute of Mental Health, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Michael Krausz
- Addiction and Concurrent Disorders Group, Institute of Mental Health, Centre for Health Evaluation and Outcome Sciences, Department of Psychiatry, University of British Columbia, Vancouver, Canada
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Sarkar S, Lal R, Varshney M, Kumar S, Singh Balhara YP. Can Tramadol be Used for Maintenance Treatment of Opioid Dependence? Subst Use Misuse 2019; 54:506-513. [PMID: 30395757 DOI: 10.1080/10826084.2018.1521427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Certain limitations of the existing opioid substitution therapies necessitate exploration of other options for maintenance of patients with opioid dependence. This study aimed to present the experience of use of tramadol for long-term treatment of patients with opioid dependence. METHODS This was a cross-sectional interview-based observational study conducted in Uttar Pradesh state in India. Patients with opioid dependence who received oral tramadol treatment for a period of more than 6 months were recruited. Outcome was assessed in terms of self-reported abstinence on tramadol. RESULTS A total of 102 participants were recruited in the study, with a mean age of 41.3 years. All the participants were males. Abstinence to extraneous opioids was reported by 58.8% of the sample, and the median dose of tramadol at which abstinence was achieved was 350 mg/d. Those who reported to be taking natural opioids (raw opium or poppy husk) at the time of seeking treatment had higher rates of achieving abstinence. CONCLUSIONS Tramadol may be a possible option for the maintenance treatment among some opioid-dependent individuals. Further studies are required to establish its efficacy vis-à-vis other medications used in opioid substitution treatment.
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Affiliation(s)
- Siddharth Sarkar
- a National Drug Dependence Treatment Centre , All India Institute of Medical Sciences , New Delhi , India
| | - Rakesh Lal
- a National Drug Dependence Treatment Centre , All India Institute of Medical Sciences , New Delhi , India
| | - Mohit Varshney
- a National Drug Dependence Treatment Centre , All India Institute of Medical Sciences , New Delhi , India
| | - Saurabh Kumar
- a National Drug Dependence Treatment Centre , All India Institute of Medical Sciences , New Delhi , India
| | - Yatan Pal Singh Balhara
- a National Drug Dependence Treatment Centre , All India Institute of Medical Sciences , New Delhi , India
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Ebdali RT, Tabaee SS, Tabaei S. Cardiovascular complications and related risk factors underlying opium consumption. J Cell Physiol 2018; 234:8487-8495. [PMID: 30478829 DOI: 10.1002/jcp.27780] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/30/2018] [Indexed: 12/23/2022]
Abstract
Opium is considered as the second most abused addictive compound in worldwide. It seems that one of the causes for common consumption of opium in many countries is a traditional belief, even among medical personnel, through which opium might have advantageous influences on cardiovascular events and be beneficial in controlling hypertension, dyslipidemia, and diabetes. According to several investigations, it is thought that opium not only has no beneficial effects on cardiovascular events, but it might have deleterious influences on these settings. As a result, people need to be trained with regard to the adverse effects of opium on cardiovascular events. In this review, we try to go through the understanding of the effects of opium cardiovascular disorders and related complications such as blood pressure, blood sugar, lipid circumstances, and finally atherosclerosis.
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Affiliation(s)
- Reyhaneh T Ebdali
- Department of Cardiology, Neyshabur University of Medical Science, Neyshabur, Iran
| | | | - Samira Tabaei
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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LeClaire EL, Duong J, Wykes RM, Miller KE, Winterton TL, Bimali M. Randomized controlled trial of belladonna and opiate suppository during intravesical onabotulinum toxin A injection. Am J Obstet Gynecol 2018; 219:488.e1-488.e7. [PMID: 29902447 DOI: 10.1016/j.ajog.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 05/29/2018] [Accepted: 06/05/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Intravesical injection with onabotulinum toxin A injection can be performed in-office under local anesthesia. Rectally administered pain medication presents a potentially feasible and previously uninvestigated adjunct to office-based anesthesia protocols. OBJECTIVE The primary aim of this study was to determine whether adding a belladonna and opiate suppository to standard lidocaine instillation resulted in reduction of bladder injection pain during onabotulinum toxin A injection procedure. STUDY DESIGN This was a prospective, randomized, double-blind, placebo-controlled study of patients undergoing onabotulinum toxin A bladder injection at a single clinic. Patients age ≥18 years, who met clinical criteria for invasive treatment of refractory urinary symptoms, had previously documented postvoid residual volumes <150 mL, and elected for in-office intravesical onabotulinum toxin A injection were eligible to participate. Participants were randomized by computer-generated block randomization to receive a belladonna and opiate (belladonna alkaloid with morphine 16.2/7.5 mg) or placebo suppository. Suppositories were placed immediately prior to lidocaine-based anesthesia, which all participants received. All participants underwent a standardized injection procedure using the same rigid cystoscope, needle type, and injection pattern (20 injections total). A 0-10 numeric rating scale was used to assess pain intensity before anesthesia and suppository, 40 minutes after administration of anesthesia and suppository, after first 10 bladder injections, and immediately after completion of 20 injections. Pain increase during procedure was calculated using the difference between score 40 minutes after administration of anesthesia and suppository and score after first 10 bladder injections. Postvoid residual were measured immediately postprocedure and 2 weeks later. Patient satisfaction with pain control was measured using a Likert scale. Our primary outcome was change in pain level from anesthetic baseline to midprocedure (score after first 10 bladder injections to score 40 minutes after administration of anesthesia and suppository). A final sample size of 26 patients was needed to have 80% power (alpha = 0.05) to detect a 50% reduction in bladder injection pain during the procedure as defined by our primary outcome. An intent-to-treat approach was used for all analyses. RESULTS In all, 26 participants were enrolled and randomized with 13 in each study arm. Participants in the treatment group were slightly older than in the placebo group (P = .05); there were no statistically significant differences in medical comorbidities. Median score after first 10 bladder injections to score 40 minutes after administration of anesthesia and suppository for the placebo group and treatment group was 4 (range 1-10) and 5 (range 0,9), respectively (P = .94). Median scores immediately after completion of 20 injections for the placebo group and treatment group were 3 (range 0-10) and 2 (range 0,8), respectively (P = .29). There were no significant differences in preinjection pain scores reported before anesthesia and suppository and at 40 minutes after administration of anesthesia and suppository. Postprocedure postvoid residual >200 mL was noted in 5 (38%) of the placebo group and 3 (23%) of the treatment group (P = .67). Two-week postprocedure postvoid residual >200 mL was noted in 3 (25%) of the placebo group and 2 (15%) of the treatment group (P = .64) for an overall rate of 20%. Eleven (84%) participants in each group reported being "mostly satisfied" or "very much satisfied" with pain control. CONCLUSION Belladonna and opiate suppository use did not significantly reduce bladder injection pain, or increase risk of urinary retention immediately postprocedure or 2 weeks later. Satisfaction with pain control among onabotulinum toxin A injection patients is high.
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