Changes in Opioid Poisoning Pattern in Children: A Retrospective Study in Rasht, Iran

Background: Poisoning comprises about 7% of accidents in children under 5-year-old and 2% of all pediatric deaths in developing countries. To warn against and prevent future potential poisoning with opioid substances, this comparative study was conducted on pediatric cases referred to the 17th Shahrivar Hospital in Rasht, Iran, in 2006 and 2018. Methods: In this retrospective, cross-sectional study, all hospitalized pediatric cases diagnosed with opioid poisoning in 2006 and 2018 were investigated systematically. The demographic data, such as age, gender, city or village of residence, the poisoning substances involved, and the clinical outcomes were extracted from the medical records and entered on an appropriately-designed form. The data analysis was performed, using SPSS software, version 21. Results: Fifty pediatric cases were examined with a mean age of 44.38±3.8 months old. Among these cases, 14 children had been poisoned, 13 of whom with opium and one with morphine in 2006; while in 2018, 36 children had been poisoned with methadone and only one with opium. Conclusion: Comparing years 2006 with 2018, a considerable increase in pediatric opioid poisoning cases was observed with a tendency toward methadone being the substance involved. The occurrences might be due to unsafe access of unaware children to this drug, especially after the initiation of methadone maintenance treatment for opiate addicts, who were mainly the parents or relatives living in the same household.

Evaluation of Clinical Symptoms and Serum Lead Level in Patients with History of Oral Opium Use being Admitted to Hazrat Rasoul Akram, Firoozgar, Firoozabadi and Haft Tir Hospitals, Tehran

Introduction: Drug abuse and its complications is a socio-health problem in Middle Eastern countries such as Iran. Smugglers may add lead to drug during drug production, which is in order to increase its weight for greater benefit. Considering the frequency of the patients with various complaints among Iranians, this study was designed and conducted to evaluate the clinical symptoms and serum levels of lead in patients being admitted to Hazrat Rasoul Akram, Firoozgar, Firouzabadi and Haft Tir hospitals with any complaints. Materials and Methods: In this case-control study, serum levels of lead were measured in 128 samples in case and control groups. The case group consisted of 64 patients using oral opium who being admitted to Rasoul Akram and Firoozgar, Haft Tir and Firouzabadi hospitals with different complaints in May 2017. The control group consisted of 64 patients with no history of addiction that were homogenized with the case group in terms of age and sex. They were evaluated for serum levels of lead and other variables. Data were analyzed by SPSS software. Results: The mean serum lead level was 76.34±17.82 in the group using opium and was 7.68±3.72 in the control group that the difference was statistically significant (P <0.001). The most common complaints of patients were abdominal pain and symptoms of bowel obstruction. The mean rate of oral opium consumption was 1.73±0.23 in subjects under 50 years old and with a mean of 2.89±0.27 in subjects over 50 years old. Serum lead level was significantly (P = 0.032) increased compared to the amount consumed. Duration of oral opium consumption was 5 months to 30 years with a mean of 15.24 years, which was not significantly correlated to serum lead level (P = 0.213). Also, the hemoglobin range was significantly correlated to different levels of lead in patients consuming oral opium (P = 0.027). Conclusion: The findings of the present study showed a high mean serum lead level in oral opium addicts in the study population. The results also confirm numerous reports suggesting the definitive diagnosis of lead poisoning as a justifying factor in addicted patients with nonspecific symptoms, which may indicate the need for serum lead level screening in opiate addicts to prevent more serious complications.

The relation of stress coping strategies and self-handicapping strategies to the process of opiate addicts behavior changes

Background/Aim. During a progress of addictive behavior treatment, the strategies of coping with stress are engaged, but addicts may continue with self-handicapping behavior which is opposite to changing a problematic behavior. The aim of this study was to examine the stress coping (CS) strategies and self-handicapping (SH) strategies in relation to the process of addictive behavior change. Methods. In the descriptive clinical study, the sample of 200 consecutively recruited inpatient opiate addicts were explored. They underwent methadone therapy. The general information questionnaire, the Indicator of coping strategies (CSI), SHquestionnaire for assessing self-handicapping behavior (SH) and the University Rhode Island Change Assessment (URICA) questionnaire for the assessment of process of change were completed. The Student t-test, Pearson?s correlation coefficient and multiple regression analysis were applied. The SPSS for Windows was used and the p ? 0.05 defined as statistically significant. Results. Among the CS, there were significant correlations between avoiding problems strategy and all SH strategies (p ? 0.02). The social support was directly proportionate to the process of change (p = 0.03, ? = 0.35). However, the process of change inversely correlated to internal handicaps in interpersonal relationships strategy (IHI) (p = 0.02; ? = -0.54) and strategy of focusing to the problem (p = 0.00, ? = -0.44). Conclusion. The significant positive predictor for the process of addictive behavior change was a strategy of social support, but focusing on the problem and the strategy of internal handicaps in achievement situations were significant negative predictors. The evaluation of motivation process and stress coping strategies could be useful for creation of improved tailored treatment of opiate addiction.

Heroin overdose - suicide or accident?

Background/Aim. Suicide is a public health problem. Due to frequent overdose among drug addicts, there is a question about suicidality in this population. The aim of this study is to determine the specificity and distinctive factors in opiate addicts who have overdosed with an intention to commit suicide compared to addicts who have overdosed accidentally. Methods. The survey included 150 heroin addicts who were in the substitution program: 49 subjects who overdosed with a clear suicidal intention and 101 addicts who overdosed without suicidal intention. The subjects filled out the questionnaire about socio-demographic data and data regarding their addiction, the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) as well as the Manchester Short Assessment of Quality of Life (MANSA) questionnaire about the quality of life. For statistical analysis, Pearson's ?2 test, Student t-test and univariate variance analysis were used. Results. The addicts who attempted suicide w?re younger persons (29.7 vs. 36.3 years of age), started to take heroin earlier (17.8 vs. 21.3 years of age; p= 0.013), they use it for a longer period (14.1 vs. 9.2 years; p = 0.00) and take it intravenously for a longer period (11.6 vs. 6.5 years; p = 0.00). The suicide was preceded by a traumatic event (p = 0.015) and there were several attempts of suicide (p = 0.004). The quality of life regarding accommodation, friends and organization of their free time was assessed as not so good (p = 0.03). Conclusion. In accordance with the obtained data, it is necessary to design programs for the prevention of suicide among addicts in general and especially programs that would be aimed at younger addicts.

Quality of life of treated opiate addicts in the methadone maintenance program and those treated with buprenorphine

Background/Aim. Although the characteristics of the treatment are the most researched determinants of quality of life of opiate addicts, it is indisputable that there is a certain influence of the characteristics of addicts and addiction, too. The aim of this study was to determine which addicts characteristics, as well as the characteristics of the addiction and treatment have predicative influence on the quality of life of the opiate addicts treated in the methadone maintenance program and those treated with buprenorphine. Methods. The epidemiological cross-sectional study was carried out in 2013 at the Clinical Center Nis, on a total of 64 opiate addicts, both sexes, aged 18 and older (32 addicts in the methadone program, chosen by random selection, and 32 addicts treated with buprenorphine, matched by sex and age). Necessary data were collected in a ?face to face? interview with the examinees, based on the autonomous kind of a questionnaire, together with the use of the standardized World Health Organization (WHO) instruments: for health status, for the level of severity of addiction and for the quality of life measuring) based on which the health index (EQ-5D), Addiction Severity Index (ASI) and the quality of life index (WHOQOL-BREF) were calculated. The data were described by the methods of descriptive statistics, while the differences between groups were analyzed by applying ?2 and t-test. Multiple regressions were used to determine the predictors. Results. The addicts in the methadone program showed much worse perception of quality of life than those treated in another way, although, according to the values of quality of life, they did not differ significantly. The most numerous predictors of the level of quality of life were health characteristics, characteristics of the socioeconomic position of the examinees, as well as different consequences of addiction. The influence of treatment was less noticeable. Participating in the methadone program had predicative influence on perception and the level of quality of life of the addicts in mental area and that of the environment. The influence of the characteristics of methadone treatment in physical and social area was insignificant. Conclusion. Variations in the perception and level of the quality of life of opiate addicts in different areas cannot be explained using only one predictor. The number of determining variables is large, and its impact complex.