Abstract: Lead (Pb) poisoning among people using opium has been an increasing problem in Iran. The present study highlights the clinical effects of lead toxicity associated with opium use in Iran, Kerman province. Between January 2016 and June 2016, patients with signs and symptoms of Pb poisoning were questioned to assess whether they had a history of opium dependency. In total, 249 patients were enrolled onto this cross-sectional study, all were opium dependent. Para-clinical data including blood lead level (BLL), demographic information, user preferences, and symptoms were obtained. The patients used either opium (83.9%), refined opium (6.4%) or a combination of both (9.7%) via ingestion (71.9%), smoking (8.4%) or a combination of both (19.7%). The overall median BLL was 80.0 μg/dL [IQR: 51.7–119.0]. The median BLL did not differ significantly between opium and refined opium users. Further, BLL was not significantly affected by the type of substance, route of use, duration of use, or daily quantity consumed. Common symptoms included abdominal pain (86.9%), constipation (75.8%), anorexia (71.5%) and nausea (54.7%). Linear regression analysis showed log of BLL was significantly associated with abdominal pain, myalgia and anorexia. The study unravelled an increase in opium-related Pb poisoning in the Kerman province. Raised awareness of this emerging Pb source and investigation of its aetiology is recommended. Pb poisoning should be considered among the primary differential diagnosis of opium users with gastrointestinal symptoms.

Abstract: Substance abuse and its consequences are major health hazards in the world. Opium addiction is a common form of substance abuse in Iran. Adulteration of illegal substances in the process of production and distribution of the drug in black market with many types of materials have been reported. One of the main goals of the adulteration of illegal substances is cutting of the substance for deal and increase of the weight for more benefit. However, adding of adulterating agents to illegal drugs could be considered as a cause of nonspecific and rare toxicity during substance abuse. Although the presence of lead in street-level heroin, marijuana, and amphetamines has been reported from some countries previously, recently, several reports suggested lead poisoning in Iranian opium addicts. Adulteration of opium with lead is a new source of lead poisoning in Iran in which the opium abuse is frequent and it could be a new health problem in the future. In this regard, evaluation of blood lead level would be important for early diagnosis of lead poisoning in opium addicts.

Abstract: BACKGROUND: Opium is one of the most common substances used worldwide with variable epidemiologic features in different regions. This study was performed in southern Iran, to find the epidemiology of opium use and its association with different factors and diseases. METHODS: This cross-sectional study was performed on baseline data extracted from Pars Cohort Study performed in Valashahr, a rural area in southern Iran. For any subject, information was collected about demographic factors, some common diseases including heart disease, stroke and hypertension and the state of using opium, other substances and cigarettes. RESULTS: There were 4276 males and 4988 females, with a mean age of 52.6 ± 9.7 years of whom 8.4% reported opium use (17.3% of males and 0.7% of females). In men, the history of stroke and heart disease were significantly more common in opium users (12.6% vs. 8.8%, P = 0.001 and 2.8% vs. 1.5%, P = 0.01, respectively) while the history of hypertension was significantly more common in non-opium users (7.8% vs. 10.3%, P = 0.04). Younger age, male gender, being non-married and positive history of joint pain, cigarette smoking and alcohol consumption were the factors associated with opium use. CONCLUSION: Opium use is common in non-married men who have a positive history of cigarette smoking and alcohol consumption in the rural population of southern Iran. It is associated with increased risk of heart disease and stroke and decreased risk of hypertension in males. Global interventional and preventive measures are required to control this complicated social problem.

Abstract: Introduction: One of the newest non-occupational sources of lead contamination is drug addiction, which has recently been addressed as a major source of lead poisoning in some countries. The present study aimed to investigate the blood lead level (BLL) of asymptomatic opium addicts. Methods: This case-control study was conducted during a one-year period to compare BLL of three groups consisting of opium addicts, patients under methadone maintenance therapy (MMT), and healthy individuals. Results: 99 participants with the mean age of 55.43±12.83 years were studied in three groups of 33 cases (53.5% male). The mean lead level in opium addicts, MMT and control groups were 80.30 ± 6.03 μg/L, 67.94 ± 4.42 μg/L, and 57.30±4.77 μg/L, respectively (p=0.008). There was no significant difference in BLL between MMT and healthy individuals (p=0.433) and also between opium addicts and MMT individuals (p=0.271).Oral opium abusers had significantly higher lead levels (p = 0.036). There was a significant correlation between BLL and duration of drug abuse in opium addict cases (r=0.398, p=0.022). The odds ratio of having BLL ≥ 100 in oral opium users was 2.1 (95% CI: 0.92 - 4.61; p = 0.43). Conclusion: Based on the result of present study, when compared to healthy individuals, opium addicts, especially those who took substance orally had significantly higher levels of blood lead, and their odds of having BLL ≥ 100 was two times. Therefore, screening for BLL in opium addicts, particularly those with non-specific complaints, could be useful.

Abstract: The Golden Crescent region of South Asia—comprising Afghanistan, Iran, and Pakistan—is a principal global site for opium production and distribution. Over the past few decades, war, terrorism, and a shifting political landscape have facilitated an active heroin trade throughout the region. Protracted conflict has exacerbated already dire socio-economic conditions and political strife within the region and contributed to a consequent rise in opiate trafficking and addiction among the region’s inhabitants. The worsening epidemic of injection drug use has paralleled the rising incidence of HIV and other blood-borne infections in the region and drawn attention to the broader implications of the growing opiate trade in the Golden Crescent. The first step in addressing drug use is to recognize that it is not a character flaw but a form of mental illness, hence warranting humane treatment of drug users. It is also recommended that the governments of the Golden Crescent countries encourage substitution of opium with licit crops and raise awareness among the general public about the perils of opium use.

Abstract: Previous studies have shown significant associations between OPRK1 and susceptibility to opioid dependence and the relationships between libido dysfunction and insomnia among opium addicts who unde...

Abstract: Merchants of War and Peace challenges conventional arguments that the major driving forces of the First Opium War were the infamous opium smuggling trade, the defence of British national honour, and cultural conflicts between ‘progressive’ Britain and ‘backward’ China Instead, it argues that the war was started by a group of British merchants in the Chinese port of Canton in the 1830s, known as the ‘Warlike party’ Living in a period when British knowledge of China was growing rapidly, the Warlike party came to understand China’s weakness and its members returned to London to lobby for intervention until war broke out in 1839

Abstract: Thailand’s near-total elimination of opium poppy cultivation is attributed to “alternative development” programming, which replaces illicit crops with licit ones. However, opium poppy cultivation was not drastically reduced because substitute crops earned the same income as opium: nothing can equal the price of opium to smallholder farmers, especially those without land tenure. Thailand’s reduction in poppy cultivation was achieved by the increased presence and surveillance capability of state security actors, who, year by year, were able to locate and destroy fields, and arrest cultivators, with increasing accuracy. This coercion was also accompanied by benefits to cultivators, including the provision of health and education services and the extension of roads; both stick and carrot constituted the encroachment of the Thai state. The provision of citizenship to hill tribe members also gave them a vested interest in the state, through their ability to hold land, access health care, education and work opportunities, amongst others. These initiatives did not occur without costs to hill tribe cultures for whom a symbiotic relationship with the land was and remains disrupted. These findings indicate that alternative development programming unlinked to broader state-building initiatives in Afghanistan, Myanmar and other opium poppy-producing areas will fail, because short-term, high-yield, high value, imperishable opium will remain the most logical choice for poor farmers, especially given the lack of a farmer’s vested interest in the state which compels them to reduce their income whilst offering them no other protections or services.

Abstract: In early March of 1839, a Chinese opium broker known to his British suppliers as Shik Po was on the lam. The Qing authorities in the region were on high alert, as the entire southeast coast was experiencing the height of the world’s first war on drugs. Shik sought out protection from his British partners, hiding on the Jardine-Matheson opium ship the Lady Hayes while it was anchored in Shenhu Bay, just offshore from his hometown of Yakou village in Jinjiang county, Fujian.1 As Captain John Rees and Shik Po watched from the deck of the Lady Hayes, Qing troops once again descended on the secluded bay, setting fire to boats and houses in the village. Yakou was home to some of the most active and aggressive opium brokers on the coast, and local authorities had repeatedly attacked the village during the late 1830s, burning the infrastructure of the opium trade to the ground, only to see it rebuilt in the morning.

Abstract: The colonial opium monopoly systems remained a major point of international contention in the decades prior to World War II, driving a major wedge between British and US drug diplomats in particular. The issue typified the deeper divide between Anglo-American drug diplomacy in Asia. The British approach stemmed from imperial realities and a self-perception of pragmatism aiming for gradual suppression of opium consumption via regulation. In contrast, the US approach remained grounded in a disdain for British (and broader European) imperialism in Asia and a moralistic, self-interested zeal driving towards absolute and immediate prohibition in the region. After decades of dispute, in 1942/1943, the US Federal Bureau of Narcotics initiated a campaign to force a change in British and Dutch colonial opium policies in Asia. The British were reluctant to pursue prohibitionist policies, which they feared would be politically destabilising, fiscally detrimental and difficult to implement. However, they even...

Abstract: This chapter attempts to widen the area of debate by developing certain themes that show opium smoking as a phenomenon that radically affected all levels of Chinese society. Opium was highly regarded in China, both as a medicinal drug and as an aphrodisiac. Merchants sometimes smoked because they believed opium sharpened their wits and helped them to drive shrewder business deals with their competitors. The habit of opium smoking in China was an offshoot and development of tobacco smoking. an described opium smoking as being a harmful trap, set by the barbarians in Taiwan to ensnare Han Chinese: neophytes were given free meals and free opium at first, but once they were hooked they were made to pay. The vagueness of this data has led to an understandable imprecision about who was smoking what and when, and has even led some students to reject the data altogether.

Abstract: Background: Like any other drug abuse, opium use is known to have detrimental effects on oral health. Oral hygiene neglect in opium users can lead to tooth loss resulting in further functional, esthetic, and dieting problems. Therefore, the aim of this study was to assess the association between tooth loss and opium addiction in a large-scale population. Materials and Methods: This study was part of an extensive study related to the risk factors of cardiovascular disease and conducted by the center for physiological research during 2012–2015 in Kerman. A total of 5900, 15–75-year-old individuals, were recruited by a single-stage random cluster sampling method. Factors including opium and smoking consumption, factors related to oral health, hygiene, and the number of missing teeth were examined. Data were collected through questionnaires, interviews, and physical examination. Results: Of 5900 individuals, 2662 (45.1%) were men and the rest were women, which 1011 individuals (17.1%) consumed opium. The prevalence of opium abuse was significantly higher in men. Regarding the oral dental indicators, the numbers of missing teeth (P Conclusions: Opium addiction is associated with higher tooth loss, especially, in women opium users. Dental practitioners and health politicians should pay special attention to the oral health of addicts before tooth loss occurs.

Abstract: In the United States and elsewhere, many medicines legally require prescriptions, and none is allowed on the market without substantial evidence of its safety and efficacy. This situation reflects two major changes that occurred in the mid-twentieth century: first, the medical profession gained control over distribution of many drugs, inserting the prescriber between manufacturer and user; second, government gained regulatory powers over what drugs were allowed on the market, inserting itself between manufacturer and doctor. These changes were nearly simultaneous in the United States, occurring quickly between 1938 and 1951, and, as we shall see, they were intimately connected. However, even though these changes were to a great extent mirrored in the regulatory regimes of other developed nations, they were hardly automatic and inevitable.1 Rather, as I shall argue here, the politics of pharmaceuticals regulation were briefly linked to narcotics control in 1940s America in a manner that has been forgotten, along with potential regulatory strategies that were never tried.

Abstract: 1. Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran 2. UCLA Integrated Substance Abuse Programs, Los Angeles, USA 3. Dept. of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran 4. Dept. of Neuroscience and Addiction, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran

Abstract: Background: Lead is a toxic metal which is widely distributed in the environment and can be accumulated in the many organs such as gastrointestinal system. Several clinical signs suggest lead poisoning include anemia, abdominal pain, constipation and/or neurologic signs. We report a case series of patients with abdominal pain due to lead contaminated opium who underwent diagnostic work up including plain abdominal radiograph and/or CT scan. Methods: We hereby describe 119 consecutive patients hospitalized in our emergency department who presented with complains of acute, severe abdominal pain due to lead contaminated opium (September 2015 - October 2016). Upon admission they were first suspected to have lead poisoning due to their abnormal imaging findings. Demographic, clinical and laboratory data, imaging and levels of lead were collected for all patients. Results: Of 119 enrolled patients, 116 subjects (97.5%) were male. The mean age of our patients was 50.4 13.4 (18 - 92 years). They all had a history of oral consumption of opium on a daily basis. Half of the patients had a history of several hospitalizations. One also had a history of a negative laparotomy. Several tiny metallic densities were visualized in the colon in the obtained plain abdominal radiographs that were confirmed in CT scan in some patients. Laboratory data revealed anemia in majority of them with mean hemoglobin 10.4 2.4 g/dL. Mean blood lead level was 76.2 fL (range 20 - 316). Serum lead level was classified into four levels: lead level 100 (n = 25; 21.0%). All patients were referred to psychiatrist for quitting opium. Conclusions: Our case series highlights the role of imaging in possibility of lead poisoning among opium users, that presented with acute abdominal pain with an unknown cause.

Abstract: Background:Raw opium is a kind of drug, abused a lot in Iran. In a vast majority of cases, various impurities including lead are added to raw opium. This study aimed to evaluate Blood Lead Level (BLL) and probable clinical symptoms triggered by it among opium abusers. Methods:This study was case control and conducted on 40 patients addicted to raw opium (case group) and 40 patients without any kind of addiction (control group) who were hospitalized in the poisoning ward of Farshchian hospital, Hamadan, Iran. BLL was measured by Atomic Absorption Spectroscopy (AAS) and compared between the two groups. Para clinical tests and peripheral blood smear were also assessed to check basophilic erythrocytes. Results: The patients’ mean age was 51.9±15.8 years in the control group and 53.2±15 years in the case group. Besides, the mean of BLL was 4.02±3.16 µg/dl in the control group and 22.41±21.14 µg/dl in the case group, and the difference was statistically significant (p<0.001). Moreover, routes of exposure included inhalation (72.5%), oral (12.5%), and both (15%). The results indicated no significant associations between the route of exposure and BLL (p<0.281).Furthermore, no special clinical symptoms were observed in most patients in both groups. Nonetheless, anemia and basophilic erythrocytes were detected in 3 patients who had high BLL. Conclusion:With regard to the high BLL in raw opium abuser, it seems that poisoning with lead should be considered if patients with a history of raw opium addiction refer to physicians.

Abstract: Background: Osteoporosis and osteopenia are the most common metabolic bone diseases making the patients vulnerable to bone fragility and fracture. In this study, the association of opium consumption and osteoporosis adjusted for other risk factors was studied.Methods: In this cross-sectional study, 619 cases including 73 men and 546 women referred to densitometry center in Kerman, Iran, were studied. Demographic information, history of opium consumption, medications, and other risk factors were collected using a structured questionnaire.Findings: In a univariate analysis, opium consumption, aging, and having a body mass index (BMI) lower than 24 accompanied an increased chance of osteoporosis, while taking physical exercises on a daily basis reduces the chance of osteoporosis. Through multivariable analysis, the two variables of age group and BMI group turned out to be of significance; that is, the chance of osteoporosis or osteopenia in the age group of higher than 60 years and 45-60 years being placed in one of the levels of osteoporosis or osteopenia was 4.9 and 3.1 times higher than the age groups lower than 45 years, respectively, after being adjusted to the other variables.Conclusion: Considering the results of this study, though the risk of bone density reduction in the individuals consuming opium was higher, due to the disparity between opium consumption in the two sexes, the difference was not significant between the two groups, and it is proposed that studies on larger samples and in the both sexes be conducted to determine the impacts of opium on the bone density.

Abstract: Introduction: Opium addiction is a social and health problem in many parts of the world, including Iran. The exact effects of this substance on the cardiovascular system and postoperative complications are not clear And the results of studies in this regard are also contradictory, Therefore, the present study aims to compare short-term mortality After coronary artery bypass surgery In two groups Opium consumer And non-consumer was done. Methods: This cross-sectional study was performed on 194 patients who were hospitalized during September 2013 to September 2015 In Valiasr Hospital of Birjand, they were under CABG operations conducted. In this study, short-term mortality(Hospital and a month After discharge) Through existing records And phone calls were reviewed. All data were analyzed by SPSS 22 software and analyzed using descriptive and inferential statistics. Results: Of the 194 patients who had undergone surgery twenty-three patients (12.2%) used opioid Among them, In the form of Inhaler, 13 patients (56.5%) orally And 3 patients (13%) was a combination of orally and inhaled. In general, there is a case of mortality during surgery And 7 cases (77.77%) of mortality occurred in the Hospital ward. During the one month follow up, There was a death case. Among the non-addicted patients164 case were alive and 7 died And among addicted patients as well 22 cases were alive And there was a death case. Finally, the results showed, No statistically significant difference between the mortality after surgery, Blood lipids, and diabetes, In two groups Opium consumer And non-consume(p>0/05). But hypertension in the non-addicted group was significantly higher (p <0.05). Conclusions: Based on the results of this study, there was no significant relationship between opioid dependence and short-term mortality in patients after CABG surgery. Due to low sample size and cross-sectional study, The design of cognitive studies with higher sample sizes seems to be necessary in order to discover causal relationships.

Abstract: Swidden cultivators in the Southeast Asian highlands may work far from lowland centres, but certain crops attract powerful interests. During the First Indochina War (1946–54), French and Vietnamese political actors climbed the hills in pursuit of the Black River region's opium production and trade. Even after combat formally ended, opium contests continued into an independent Vietnam, intersecting with larger struggles over ethnic difference, state resource claims, and market organization. Using upland cultivators to examine post-colonial statemaking, this article tells a new story about opium's tangled relationship with socialist rule in Vietnam. Drawing on French and Vietnamese archival records, it traces the operation of successive opium regimes through war and into restive peace. Based on evidence of opium tax and purchase operations conducted by the Democratic Republic of Vietnam (DRV) from 1951 to 1960, it argues that regulating the commodity sensitized cultivators to their long, fraught relations with state power. Far from passive, cultivating subjects animated revolutionary ideals, engaged smuggling networks, negotiated resource rights, and mounted an oppositional social movement. Peaking in 1957, the movement and subsequent crackdown illustrate tensions embedded in post-colonial relations of exchange and rule.

Abstract: Background: Studies have shown that Iran has a high rate of opiate abuse and the most prevalently used is opium. This study was aimed to evaluate risk factors in patients with acute opium intoxication who referred to Loghman Hakim Hospital, Tehran, Iran, in 2011.Methods: A total number of 383 patients with acute opium overdose, who were referred to the Emergency Department of Loghman Hakim Hospital in Tehran during 2011, were enrolled into this descriptive, cross-sectional study. Clinical data including level of consciousness, vital signs, mode of consumption, medical management, and laboratory results were recorded. Independent t-test was used to analyze the results.Findings: Level of consciousness at admission was lower in patients who expired compared to survivors (P = 0.020). Respiratory depression and tachycardia were both more common among patients who expired compared to survivors (P = 0.001). Increase in urea, creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), serum glutamic oxaloacetic transaminase (SGOT), and serum glutamic pyruvic transaminase (SGPT) was more common among patients who died compared to survivors and the relationships between death due to opium poisoning and increase in these factors were all statistically significant (P ≤ 0.001).Conclusion: The findings of this study clarify the importance of clinical and laboratory findings of patients with opium poisoning in predicting their outcome, although further studies in this context are appreciated.

Abstract: Abstract:This article analyses the ways that social reformers and colonial officials envisioned and attempted to manage opium dens in colonial South Asia at the end of the nineteenth century. It argues that the opium den in India became a location for moral anxieties about gender, sexuality, consumption and imperial rule, and examining colonial depictions of the den reveals the conflicts, tensions and imperatives that determined colonial opium policy. Moreover, the changes to the colonial regulation of opium dens in particular recommended by the Royal Commission on Opium of 1893 help illuminate the priorities of colonial opium policy, and by extension imperial rule.

Abstract: Background: This study aimed to identify the most important factors of changing pattern of drug abuse from opium to methamphetamine in Iranian drug-dependent women. Materials and Methods: This study was a phenomenological study. The data were analyzed by the 7-step Colaizzi method. Subjects selected from patients who were referred to addiction rehabilitation residential center of welfare organization in Bojnurd city located in northeast Iran. Results: We found 8 conceptual classes, and 32 codes from the analysis of data. The individual factors were as follow: elevation of mood, obtaining more pleasure, increasing energy and improving performance, relief of physical pain, and sensation seeking. Conclusions: Depth review and analyses of interviews revealed that individual factors are the most important factor in crystal meth abuse.

Abstract: Beginning in the late eighteenth century, opium became one of the world’s great commodities, fueling the growth of Britain’s imperial ambitions—indeed, as economic historian Carl Trocki has provoca...

Abstract: We present an unusual cause of respiratory arrest resulting from sole ingestion of home-brewed opium tea. A 64-year-old woman was found unresponsive and in respiratory arrest by a first responder. There were no obvious signs of regular recreational drug use. On presentation to the local district general hospital, the patient was in extremis, with severe physiological and biochemical derangements. A naloxone infusion was commenced and she later made a good recovery. It was subsequently discovered that she had brewed opium tea from opium buds she had picked from a nearby commercial poppy farm, a practice she had learnt while in Afghanistan.