The Outbreak of Lead Poisoning in Opium Users: Presentation and Chelation Therapy
Abstract
Recently, there have been a few reports of an outbreak of lead poisoning due to opium contaminated with lead in Iran. This study aimed to evaluate the clinical features of lead toxicity in opium abusers, and response to oral chelation therapy based on the severity of poisoning. One hundred thirty-three chronic opium users with a diagnosis of lead poisoning were included. Based on blood lead level (BLL), the cases were divided into 2 mild (BLL;40-69 µg/dL) and moderate (BLL;70-100) groups. Both groups received D-penicillamine (D-P) as a Chelator. Changes in BLL compared between two groups. All cases were oral opium users. Abdominal pain (75%), anorexia (55.6%), and constipation (53.2%) were the most common symptoms of lead poisoning. 67.8% of cases experienced only one round of chelation therapy and "Rebound phenomenon" happened in 9% of these. Ninety percent of the patients had wellbeing sensation, and symptoms improved at the end of the first round of treatment. The mean BLL before and after chelation therapy were 66.87 and 45.7 µg/dL, respectively. Oral Chelator reduced BLL in both mild and moderate poisoning groups (35.61% vs. 35.90%, P: 0.057), respectively. The comparison of BLL before and after chelation therapy showed that the treatment was effective equally in both mild and moderate toxicity. However, in a few cases, the rebound phenomenon may occur.
Pourmand A, Al-Tiae TK, Mazer-Amirshahi M. Perspective on lead toxicity, a comparison between the United States and Iran. DARU Journal of Pharmaceutical Sciences. 2012;20(1):70.
Homan C, Brogan G, Orava R. Lead toxicity. In: Viccellio P, editor. Emergency Toxicology. Philadelphia PA: Lippincott‑Raven; 1998. p. 363‑79.
Gidlow DA. Lead toxicity. Occup Med (Lond). 2004;54(2):76-81.
Health UDo, Services H. Second national report on human exposure to environmental chemicals. 2003, US Department of Health and Human Services, Centers for Disease Control and Prevention. National Center for Environmental Health: Atlanta, GA.
Soltaninejad K, Flückiger A, Shadnia S. Opium addiction and lead poisoning. Journal of Substance Use. 2011;16(3):208-12.
Pirkle JL, Brody DJ, Gunter EW, Kramer RA, Paschal DC, Flegal KM, et al. The decline in blood lead levels in the United States: the National Health and Nutrition Examination Surveys (NHANES). Jama. 1994;272(4):284-91.
Roper WL, Houk V, Falk H, Binder S. Preventing lead poisoning in young children: A statement by the Centers for Disease Control, October 1991. Centers for Disease Control, Atlanta, GA (United States), 1991.
Williams RH, Erickson T. Evaluating lead and iron intoxication in an emergency setting. Laboratory Medicine. 2015;29(4):224-31.
Velez L, O'Connell E. Heavy metals. Rosen's Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Elsevier Mosby; 2013.
Abbasi MMH, Ansari M, Shahesmaeili A, Qaraie A. Lead serum levels in opium-dependent individuals. Addiction & health. 2009;1(2):106.
Salehi H, SAYADI AAR, Tashakori M, YAZDAN DR, SOLTANPOUR N, Sadeghi H, et al. Comparison of serum lead level in oral opium addicts with healthy control group. 2009.
Aghaee-Afshar M, Khazaeli P, Behnam B, Rezazadehkermani M, Ashraf-Ganjooei N. Presence of lead in opium. Arch Iran Med. 2008;11(5):553-4.
Malekinejad M, Vazirian M. Transition to injection amongst opioid users in Iran: implications for harm reduction. Int J Drug Policy. 2012;23(4):333-7.
Afzali S, Torabian S, Taheri SK. Do Opium Abusers Develop Lead Toxicity? A Study on Opium Abusers in Hamadan, Iran. Asia Pacific Journal of Medical Toxicology. 2017;6(2):55-8.
Hayatbakhsh MM, Oghabian Z, Conlon E, Nakhaee S, Amirabadizadeh AR, Zahedi MJ, et al. Lead poisoning among opium users in Iran: an emerging health hazard. Subst Abuse Treat Prev Policy. 2017;12(1):43.
Froutan H, Kashefi Zadeh A, Kalani M, Andrabi Y. Lead toxicity: a probable cause of abdominal pain in drug abusers. Medical Journal of The Islamic Republic of Iran (MJIRI). 2011;25(1):16-20.
Amiri M, Amini R. A Comparison of Blood-lead Level (BLL) in Opium-dependant Addicts With Healthy Control Group Using the Graphite Furnace/atomic Absorption Spectroscopy (GF-AAS) Followed by Chemometric Analysis. Iran Red Crescent Med J. 2012;14(8):488-91.
Delangle P, Mintz E. Chelation therapy in Wilson's disease: from D-penicillamine to the design of selective bioinspired intracellular Cu(I) chelators. Dalton Trans. 2012;41(21):6359-70.
Iijima Y, Akuzawa N, Hatori T, Imai K, Kitahara Y, Kurabayashi M. Lead intoxication treated with D-penicillamine. Journal of Medical Cases. 2014;5(4):187-93.
Kim SD. Effects of Oral D-Penicillamine in Treatment of Industrial Lead Poisoning. Korean Journal of Preventive Medicine. 1982;15(1):131-8.
Gonzalez-Ramirez D, Zuniga-Charles M, Narro-Juarez A. [Mobilization of lead in patients with chronic poisoning by that metal. Oral penicillamine]. Arch Invest Med (Mex). 1990;21(3):279-83.
Treatment guidelines for lead exposure in children. American Academy of Pediatrics Committee on Drugs. Pediatrics. 1995;96(1 Pt 1):155-60.
Rogan WJ, Dietrich KN, Ware JH, Dockery DW, Salganik M, Radcliffe J, et al. The effect of chelation therapy with succimer on neuropsychological development in children exposed to lead. N Engl J Med. 2001;344(19):1421-6.
Pirkle JL, Brody DJ, Gunter EW, Kramer RA, Paschal DC, Flegal KM, et al. The decline in blood lead levels in the United States. The National Health and Nutrition Examination Surveys (NHANES). JAMA. 1994;272(4):284-91.
Control CfD, Prevention. Preventing lead poisoning in young children. http://www cdc gov/nceh/lead/Publications/PrevLeadPoisoning pdf. 2005.
Shannon MW, Townsend MK. Adverse effects of reduced-dose d-penicillamine in children with mild-to-moderate lead poisoning. Ann Pharmacother. 2000;34(1):15-8.
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| Issue | Vol 56, No 11 (2018) | |
| Section | Original Article(s) | |
| Keywords | ||
| Opium Lead Poisoning Chelator Therapy | ||
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