The term opioid refers to a broad class of medications that are used most frequently for their analgesic effects. Along with this effect, they also produce euphoria, and it is for this reason that they have been used illicitly, as well as medicinally, for thousands of years. While the most well-known complications of opioid use and misuse include respiratory and central nervous system depression, there are many other toxicities that have been associated with these drugs. Many complications can occur with multiple different opioids, such as non-cardiogenic pulmonary edema, while many of the complications are unique to the opioid used as well as the route of administration. This review focuses on the pulmonary complications associated with opioid use and abuse, but opioids can affect nearly every organ system. Their effects on the pulmonary system can be direct, such as causing granulomatous change, but they can also work indirectly. For example, opioids cause respiratory depression by decreasing sensitivity of peripheral chemoreceptors to carbon dioxide and decreasing activity in the central respiratory centers. Opioids have also been reported to affect the immune system, and place users at increased risk for many different infectious complications. Patients can have a wide array of signs and symptoms, sometimes making it difficult to recognize opioids as a cause for a patient's clinical picture. Due to the sedative effects of opioids, patients are also often not able to provide a reliable history. Knowledge of the possible toxicities of opioids can help prepare a physician to recognize the many complications associated with opioid use.

/pdf/the-effects-of-opioids-on-the-lung-600xg2idhu.pdf

The effects of opioids on the lung

Norjizak is a new drug abused in the past few years in Iran with symptoms and complications distinct from other common forms of drug and characterized by higher rate of mortality. The present study aims to analyze the chemical components of this substance. Five samples were obtained from abusers referring from different areas of Tehran to a treatment clinic. All samples were 2 ml vials with yellowish fluid. Thin Layer Chromatography (TLC) was performed first to analyze the samples semi-quantitatively and the quantitative levels of components were then explored using high-performance liquid chromatography (HPLC). TLC revealed steroid (in form of betamethasone), heroin, codeine, morphine and thebaine in all five samples. Four samples contained acetaminophen and two samples contained caffeine. None of them contained amphetamine, benzodiazepine, tricyclic antidepressant, aspirin, barbiturates, tramadol and buprenorphine. HPLC revealed that heroin, codeine, morphine and thebaine constituted the narcotic foundation in all samples. In addition, the heroin to acetylcodeine ratio was significantly lower in three samples, which indicates their higher toxicity. The results of the present study on the chemical components of Norjizak showed that this substance is an opiate one similar to heroin and the heroin-based crack prevalent in Iran which contains betamethasone.

A tentative component analysis of Norjizak: A new abused drug in Iran.

Dear Editor,

Infectious diseases including HIV and viral hepatitis constitute a major health concern with high prevalences among injecting drug users (IDUs) in Iran (1, 2) IDUs that share needles and syringes and practice sexual behaviors are at risk groups for being infected with blood-borne infectious diseases such as HCV (3) The recent increasing use of opioids in Iran has been strongly associated with health-related harms (4) including transmitting HIV, HCV, and HBV infections (5-9) In 2005, a new illicit opioid, named as Norjizak, was introduced in Iran’s illicit drug market and it gained popularity in a short period of time and contributed to transmitting blood-borne infectious diseases Norjizak which is also written as Norjizac, Norgesic, and Norchizack in Iran is a narcotic drug which is a combination of several opioids with Dexamethason or Benzodiazepines (10) Its main route of administration is injection Norjizak is also used intramuscularly and/or subcutaneously Its injection is associated with several medical complications including abscess formation, development of septic emboli and soft tissue infections in IDUs, but a few studies have focused on Norjizak injection and its health-related problems in Iran (11) A recent study on the patterns of pre-treatment drug abuse, drug treatment history, and characteristics of 810 drug dependent-patients at drug use treatment clinics in Tehran, Iran showed that Norjizak injecting was prevalent as a main drug of abuse among 05% of the sample before entry to Methadone maintenance treatment (12) In another study on hospitalized drug users in Loghman Hakim and Imam Hussein hospitals in southern Tehran, a total of 221 patients were studied The study results showed that 54% included injecting Norzijak users (INUs) (13) A research study on 18 male Norjizak-dependent patients with a mean age of 298 years who volunteered for treatment at a drug use treatment clinic showed various psychological and physical impacts associated with Norjizak injecting such as striae, weakness, high systolic blood pressure, moon face, hirsutism, extensive dermal infection, gynecomastia, backache, insomnia, lack of potency, and 222% of the sample was infected with HCV (14) In a study on infectious complications and mortality due to Norjizak injecting in comparison with other injecting opioids, 690 patients whom were admitted to a hospital in Isfahan city were studied The study findings showed that 145% were INUs Compared with other groups, Norjizak group was younger and the death rate was 375% which was higher than other groups (15) In a study, 14 vials of Norjizak were tested for detecting HCV Two-hundred micro-liters of the solution in each vial were obtained and using a high pure viral nucleic acid kit, RNA extraction was done Thereafter, C-DNA was produced by the use of Moloney Murine Leukemia Virus reverse transcriptase (Fermentas, Life Science) Using specific primers and a probe for the detection of HCV (Tagman probe), PCR was done (Corrbette Research 6000) The study results showed that 14% of the vials were positive for HCV (16) Norjizak injecting is a crucial health concern and risky behaviors related to norjizak injecting account for a considerable proportion of incident blood-borne infectious diseases such as HCV Therefore, treatment interventions and harm reduction programs are necessary to prevent or reduce Norjizak injecting among IDUs With reducting Norjizak injecting and consequently, decreasing the spread of blood-borne infectious diseases, these programs help both INUs and the community There is evidence that access to Methadone maintenance treatment (MMT) could be helpful for reducing illicit drug injection and can be considered as a major intervention for preventing from transmitting blood-borne infectious diseases in Iran (17) In recent years, a harm reduction approach has been rapidly developed for IDUs in Iran Methadone and Buprenorphine maintenance treatment programs have become widespread (18) A study on MMT outcomes in Iran showed that the prevalence of drug injection in the MMT group was lower compared with the control group (16% vs 100%) There was also a considerable difference in needle and syringe sharing (40% in the control group vs 4% in the MMT group) (19) In recent years, needle and syringe programs (NSPs) have been also developed to decrease sharing practices among IDUs in Iran (20, 21), but implementing specific harm reduction strategies that specifically target INUs should be considered by policymakers and health providers The medical and health impacts of Norjizak injecting in Iran are complex and devastating, therefore, extensive research is still required to investigate the effects of Norjizak injecting on general health and transmitting blood-borne infectious diseases Drug education on Norjizak injecting and its risks for being infected with viral infections such as HCV is essential Norjizak injecting is a critical health concern among some Iranian IDUs that requires a collaborative and consistent response among all health providers Treatment interventions and harm reduction programs should be specifically implemented for the current treatment needs of INUs in Iran

Norjizak injection: a critical risk for transmitting blood-borne infectious diseases.

Comparison of Total Hip Arthroplasty and Core Decompression In avascular Necrosis of the Femoral Head After Taking temgesic and Norgesic

Background: Opiates are the main drugs of abuse, and Methadone Maintenance Treatment (MMT) is the most widely administered drug addiction treatment program in Iran. Our study aimed to investigate patterns of pre-treatment drug abuse, addiction treatment history and characteristics of patients in MMT in Tehran. Methods: We applied a stratified cluster random sampling technique and conducted a cross-sectional survey utilizing a standard patient characteristic and addiction history form with patients (n=810) in MMT. The Chi-square test and t-test served for statistical analyses. Results: A clear majority of the participants were men (96%), more than 60% of whom were between 25 and 44 years of age, educated (89% had more than elementary education), and employed (>70%). The most commonly reported main drugs of abuse prior to MMT entry were opium (69%) and crystalline heroin (24%). The patients’ lifetime drug experience included opium (92%), crystalline heroin (28%), cannabis (16%), amphetamines (15%), and other drugs (33%). Crystalline heroin abusers were younger than opium users, had begun abusing drugs earlier, and reported a shorter history of opiate addiction. Conclusion: Opium and crystalline heroin were the main drugs of abuse. A high rate of addiction using more dangerous opiate drugs such as crystalline heroin calls for more preventive efforts, especially among young men.

/pdf/patterns-of-pre-treatment-drug-abuse-drug-treatment-history-25dsvdzyti.pdf

Patterns of pre-treatment drug abuse, drug treatment history and characteristics of addicts in methadone maintenance treatment in Iran

Cushing's syndrome results from lengthy and inappropriate exposure to excessive concentrations of either endogenous or exogenous glucocorticoids. This study described 30 patients with a novel type of severe exogenous Cushing's syndrome in a group of intravenous drug users due to illicit use and dependence on a new opioid combination, Norjizak. Thirty consecutive patients (2 women and 28 men) who presented with a novel type of severe exogenous Cushing's syndrome and other complications were admitted to the emergency departments of Qom and Isfahan University of Medical Sciences, Isfahan, Iran, between September 2005 and September 2007 were enrolled. All participating patients were intravenous drug users who used a narcotic drug called Norjizak, a combination of different opioids with dexamethason or benzodiazepines. Patients were first evaluated and managed based on the current illness, and then entered into a detoxification program by a medical team. Clinical data were collected by an open interview and the patient's files using a standard form. High-performance liquid chromatography was used to determined glucocorticoid existence in the brand. The major complaints and clinical findings were withdrawal symptoms, severe edema, osteoporotic fracture, impairment in glucose tolerance, decreased libido, and sepsis (including necrotizing pneumonia, cutaneous infection, multivalvular endocarditis, osteomyelitis, and urogenital infection). Most patients had started with 2 or 3 vials per day and then increased the dose compulsively to maximum of approximately 15 to 20 vials per day. The concentration of Dexamethhasone disodium phosphate in each 2 mL vial was 0.4 to 1 mg/mL. Heroin was also found in them. We are witnessing a special exogenous Cushing syndrome due to the mixing of opiates and dexamethasone. Norjizak syndrome is the clinical condition of poisoning with a second material when it is combined with opiates due to compulsive dose increment and long duration.

A case series of abuse of a new opioid combination, Norjizak.

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Mansour Siavash

Author Tools

Chat about Author

Papers

A case series of abuse of a new opioid combination, Norjizak.