@2024 Afarand., IRAN

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ISSN: 1027-1457    Scientific Journal of Forensic Medicine 2019;25(2):65-69

Background
Lead is one of the heavy metals that can be a factor of acute or chronic toxicity. Smugglers may add lead to drugs during the production process in order to increase its weight and earning more benefits.
Previous Studies
... [1-3]. In recent years, numerous reports have reported lead poisoning in opium dependents [4-8]. Drug abuse and its complications are a health and social problems in many countries, such as Iran. In addition, many nonspecific symptoms in drug dependents mimic the symptoms of lead poisoning. On the other hand, the prevalence of several symptoms, including mental disorders, symptoms that mimic diseases, such as cholecystitis and pancreatitis, and nonspecific abdominal pain are high in drug-dependent patients [10-15]. Adding lead to opium is very dangerous, and in addition to acute poisoning, it can dramatically increase morbidity and even mortality, and also cause irreparable damage to individuals and society. Accordingly, it seems that implementing a purposeful care plan can greatly reduce the psychological burden as well as the subsequent problems and consequences of this phenomenon [16].
Aim(s)
The aim of the present study was to investigate the relationship between blood lead levels in consumers of edible opium with abdominal pain.
Research type
This is a cross-sectional descriptive study.
Research society, place and time
This study was carried out on 122 consumers of edible opium with abdominal pain who referred to the emergency department of the Rasoul Akram, Firoozgar, Haft-e-Tir and Baharlu hospitals in 2016.
Sampling method and number
Subjects were included in the study by census sampling. People who worked in battery manufacturing factories or occupations, like soldering, wiring, pottery, ammunition manufacturing, radiator manufacturing and coloring production were excluded.
Used devices&materials
A questionnaire was used to collect all patient information, including demographic information, health status and lifestyle and blood lead levels and blood factors were measured. Data were analyzed by SPSS software using independent T-test and chi-square test.
Findings by Text
The mean age of patients was 49.25 ±13.00 years and 98% were male and 2% female. Symptoms observed in patients were low appetite, constipation, nausea and vomiting, body aches, anemia, weight loss, gum involvement, swelling of the foot and joint pain, of which the highest frequency was related to the constipation (72.1%) followed by anesthesia (53.3%). The duration of oral opioid use in patients ranged from one year to more than 5 years, with the highest frequency being over 5 years (69.7%). All patients with abdominal pain were included in the study and blood lead levels in 100% of patients were above 25 µg / dl (toxic). Hemoglobin, hematocrit, mean cell volume (MCV), serum glutamic pyruvic transaminase (SGPT) and duration of drug use at different levels of lead in patients with oral opioid consumption were not significantly associated with abdominal pain (p> 0.05). However, there was a significant relationship between the consumption different levels of lead in patients with abdominal pain (p = 0.01) and the blood lead level was significantly increased by the increased consume (Tables 1 and 2).
Main comparison to the similar studies
Lead poisoning affects the central and peripheral nervous system, kidney function, vascular system and gastrointestinal tract and causes anemia, renal destruction, neuropathy and gastrointestinal symptoms [17]. In cases of moderate to chronic exposure, often symptoms of central nervous system involvement and nephropathy are observed [18]. In adults, elevated blood lead levels are mainly due to contacts in workplaces [2]. In recent years, due to increased levels of workplace safety, the incidence of lead poisoning in adults has declined worldwide and a new form of non-occupational-related poisoning has emerged [19]. … [20-22]. In 2009, Salehi et al., in their study, compared serum lead levels in drug dependents and healthy individuals. This case-control study was performed in the addiction recovery center of Moradi Hospital of Rafsanjan University of Medical Sciences in 2007 and 2008. Blood lead levels were measured in 44 cases in both case and control groups. The results of this study showed a significant increase in serum lead level in drug dependents compared to the control group. Therefore, screening for blood lead concentrations in drug dependents with nonspecific complaints is particularly useful [23]. In Wolf et al. study (2001), blood lead level (BLL) in the drug-dependent patients was higher than the control group and the difference was statistically significant. In addition, BLL was associated with drug use in dependent patients. Both groups were homogenized and the only difference was oral drug use. Therefore, an increase in BLL in the case group may be due to the drugs contaminated by lead. About 40% of patients had a toxic level of lead, which was equivalent to a blood lead of more than 25 μg / dl [13].
Suggestions
In future studies, it is recommended that lead levels be measured in a laboratory using the same method.
Limitations
This research was a retrospective this, in which blood lead levels were measured in different laboratories.
Conclusions
The blood lead level in the consumers of edible opium with abdominal pain is above 25μg/dL which showed the toxicity. Therefore, there is a strong potential for lead poisoning in consumers of edible opium.
Acknowledgments
We thank the supports provided by the Iran University of Medical Sciences and the cooperation of the authorities, professors and colleagues in Rasoul Akram, Firoozgar, Haft-e-Tir and Baharlu hospitals.
Conflict of interest
None declared.
Ethical Permissions
This study was approved by the Medical Ethics Committee (Approval code: IR.IUMS.FMD.REC 1396.9411307035).
Funding Sources
This article was extracted from the thesis on the Emergency Medicine by Dr. Zeinab Neghabi.

TABLES and CHARTS

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