Kerman University of Medical Sciences

Document Type: Original Article


Yong-Mi Kim, PhD Associate Professor School of Library and Information Studies University of Oklahoma Schusterman Center 4502 East 41st Street Tulsa, OK 74135


Background: Prescription drug monitoring programs (PDMPs) are instrumental in controlling opioid misuse,
but opioid users have increasingly shifted to cocaine, creating a different set of medical problems. While
opioid use results in multiple medical comorbidities, findings of the existing studies reported single
comorbidities rather than a set, and furthermore, those findings are often conflicting because of the lack of
controlling for other substances in the analysis when combined use of substance creates synergistic effects.
On the other hand, the findings from cocaine use are mainly related to kidney and heart problems, which lack
specificity. Because medical comorbidities from opioid and cocaine use are very different, it is imperative to
investigate medical comorbidities from opioids and cocaine in order to minimize negative effects from
PDMPs. Therefore, this study attempts to discover sets of medical comorbidities from opioid and cocaine use
by controlling for other substances in the analysis.
Methods: A data mining technique, association rule mining algorithm, was employed to discover sets of
medical comorbidities using electronic medical records. This method is ideal to discover co-occurring
medical comorbidities.
Findings: Opioid use was associated with a set of [high diastolic blood pressure (DBP), abnormal specific
gravity], [high body mass index (BMI), low blood gas] among others. Cocaine use correlated with [high
creatine kinase (CK), high blood urea nitrogen (BUN)], [high CK, cardiopulmonary] among others.
Conclusion: The findings of this study addresses some of the conflicting findings by eliminating multidrug
and reports sets of medical comorbidities from opioid and cocaine use


Substance Abuse and Mental Health Services
Administration. SAMHSA/HHS: An Update on the
Opioid Crisis [Online]. [cited 2018 Mar 14];
Available from: URL:
2. Haffajee RL, Jena AB, Weiner SG. Mandatory use
of prescription drug monitoring programs. JAMA
2015; 313(9): 891-2.
3. U.S. Department of Justice, Drug Enforcement
Administration. State Prescription Drug Monitoring
Programs [Online]. [cited 2016 Jun]; Available from:
4. Raymond J, Bryant M. In Search of New Ways to
Tame Opioid Crisis. Alva Review-Courier [Online].
[cited 2017 Sep 17]; Available from: URL:
5. Oklahoma Attorney General. The Oklahoma
Commission on Opioid Abuse Final Report [Online].
[cited 2018 Jan 23]; Available from: URL:
6. Cicero TJ, Kurtz SP, Surratt HL, Ibanez GE, Ellis
MS, Levi-Minzi MA, et al. Multiple determinants of
specific modes of prescription opioid diversion. J
Drug Issues 2011; 41(2): 283-304.
7. Inciardi JA, Surratt HL, Lugo Y, Cicero TJ. The
diversion of prescription opioid analgesics. Law
Enforc Exec Forum 2007; 7(7): 127-41.
8. Oklahoma Bureau of Narcotics and Dangerous
Drugs. 2018 Oklahoma Drug Threat Assessment
[Online]. [cited 2018 Sep 12]; Available from: URL:
9. McCall JC, Baldwin GT, Compton WM. Recent
increases in cocaine-related overdose deaths and the
role of opioids. Am J Public Health 2017; 107(3):
10. Muhuri PK, Gfroerer JC, Davies MC. Associations
of Nonmedical Pain Reliever Use and Initiation of
Heroin Use in the United States [Online]. [cited 2013
Aug]; Available from: URL:
11. Addiction Center. Polydrug Use [Online]. [cited
2018 Sep 4]; Available from: URL:
12. Havens JR, Lofwall MR, Frost SD, Oser CB,
Leukefeld CG, Crosby RA. Individual and network
factors associated with prevalent hepatitis C
infection among rural Appalachian injection drug
users. Am J Public Health 2013; 103(1): e44-e52.
13. Vickerman P, Hickman M, May M, Kretzschmar M,
Wiessing L. Can hepatitis C virus prevalence be used
Medical Comorbidities between Opioid and Cocaine Users Kim
Addict Health, Autumn 2019; Vol 11, No 4 231, 07 October
as a measure of injection-related human
immunodeficiency virus risk in populations of
injecting drug users? An ecological analysis.
Addiction 2010; 105(2): 311-8.
14. Havakuk O, Rezkalla SH, Kloner RA. The
cardiovascular effects of cocaine. J Am Coll Cardiol
2017; 70(1): 101-13.
15. Schwartz BG, Rezkalla S, Kloner RA.
Cardiovascular effects of cocaine. Circulation 2010;
122(24): 2558-69.
16. Mallappallil M, Sabu J, Friedman EA, Salifu M.
What do we know about opioids and the kidney? Int
J Mol Sci 2017; 18(1).
17. Bayani M, Nazemi S, Khosoosiniaki M, Ramezani
M, Khani A. Opium consumption and lipid and
glucose parameters in diabetic patients with acute
coronary syndrome: A survey in northern Iran. Tunis
Med 2014; 92(7): 497-500.
18. Sanli DB, Bilici R, Suner O, Citak S, Kartkaya K,
Mutlu FS. Effect of different psychoactive
substances on serum biochemical parameters. Int J
High Risk Behav Addict 2015; 4(2): e22702.
19. Rahimi N, Gozashti MH, Najafipour H, Shokoohi
M, Marefati H. Potential effect of opium
consumption on controlling diabetes and some
cardiovascular risk factors in diabetic patients.
Addict Health 2014; 6(1-2): 1-6.
20. Roohafza H, Talaei M, Sadeghi M, Haghani P,
Shokouh P, Sarrafzadegan N. Opium decreases the
age at myocardial infarction and sudden cardiac
death: A long- and short-term outcome evaluation.
Arch Iran Med 2013; 16(3): 154-60.
21. Gautam S, Franzini L, Mikhail OI, Chan W, Turner
BJ. Longitudinal analysis of opioid analgesic dose
and diabetes quality of care measures. Pain Med
2015; 16(11): 2134-41.
22. Rose AJ, Hermos JA, Frayne SM, Pogach LM,
Berlowitz DR, Miller DR. Does opioid therapy affect
quality of care for diabetes mellitus? Am J Manag
Care 2009; 15(4): 217-24.
23. Mysels DJ, Sullivan MA. The relationship between
opioid and sugar intake: review of evidence and
clinical applications. J Opioid Manag 2010; 6(6):
24. Haghpanah T, Afarinesh M, Divsalar K. A review on
hematological factors in opioid-dependent people
(opium and heroin) after the withdrawal period.
Addict Health 2010; 2(1-2): 9-16.
25. Shahabinejad G, Sirati-Sabet M, Kazemi-Arababadi
M, Nabati S, Asadikaram G. Effects of opium
addiction and cigarette smoking on hematological
parameters. Addict Health 2016; 8(3): 179-85.
26. Leeman RF, Sun Q, Bogart D, Beseler CL, Sofuoglu
M. Comparisons of cocaine-only, opioid-only, and
users of both substances in the National
Epidemiologic Survey on Alcohol and Related
Conditions (NESARC). Subst Use Misuse 2016;
51(5): 553-64.
27. Novick T, Liu Y, Alvanzo A, Zonderman AB, Evans
MK, Crews DC. Lifetime cocaine and opiate use and
chronic kidney disease. Am J Nephrol 2016; 44(6):
28. Asgary S, Sarrafzadegan N, Naderi GA, Rozbehani
R. Effect of opium addiction on new and traditional
cardiovascular risk factors: do duration of addiction
and route of administration matter? Lipids Health
Dis 2008; 7: 42.
29. Gudin JA, Mogali S, Jones JD, Comer SD. Risks,
management, and monitoring of combination opioid,
benzodiazepines, and/or alcohol use. Postgrad Med
2013; 125(4): 115-30.
30. Bellum S. Real Teens Ask About Speedballs
[Online]. [cited 2013 Jun 26]; Available from: URL:
31. Antai-Otong D. Medical Complications of cocaine
addiction: clinical implications for nursing practice. J
Addict Nurs 2006; 17(4): 215-25.
32. Churchwell MD, Mueller BA. Selected
pharmacokinetic issues in patients with chronic
kidney disease. Blood Purif 2007; 25(1): 133-8.
33. Steele MR, Belostotsky V, Lau KK. The dangers of
substance abuse in adolescents with chronic kidney
disease: a review of the literature. CANNT J 2012;
22(1): 15-22.
34. Edmondson DA, Towne JB, Foley DW, Abu-Hajir
M, Kochar MS. Cocaine-induced renal artery
dissection and thrombosis leading to renal infarction.
WMJ 2004; 103(7): 66-9.
35. Weber JE, Chudnofsky CR, Boczar M, Boyer EW,
Wilkerson MD, Hollander JE. Cocaine-associated
chest pain: how common is myocardial infarction?
Acad Emerg Med 2000; 7(8): 873-7.
36. National Kidney Foundation. Anemia and Chronic
Kidney Disease [Online]. [cited 2015]; Available
from: URL:
37. Norris KC, Thornhill-Joynes M, Robinson C,
Strickland T, Alperson BL, Witana SC, et al.
Cocaine use, hypertension, and end-stage renal
disease. Am J Kidney Dis 2001; 38(3): 523-8.
38. Kim YM, Kathuria P, Delen D. Uncovering different
CKD-related medical issues among African American
gender groups using Apriori. In: Hawamdeh S, Allen
J, Alemneh D, editors. Knowledge discovery and data
design innovation: Proceedings of the International
Conference on Knowledge Management (ICKM
2017) (Innovation and Knowledge Management).
River Edge, NJ: World Scientific Publishing
Company; 2017. p. 27-45.
Medical Comorbidities between Opioid and Cocaine Users Kim
232 Addict Health, Autumn 2019; Vol 11, No 4, 07 October
39. Bemanian S, Motallebi M, Nosrati SM. Cocaineinduced renal infarction: Report of a case and review
of the literature. BMC Nephrology 2005; 6: 10.
40. Draper JC, McCance-Katz EF. Medical illness and
comorbidities in drug users: implications for
addiction pharmacotherapy treatment. Subst Use
Misuse 2005; 40(13-14): 1899-8.
41. Garg S, Hoenig M, Edwards EM, Bliss C, Heeren T,
Tumilty S, et al. Incidence and predictors of acute
kidney injury in an urban cohort of subjects with
HIV and hepatitis C virus coinfection. AIDS Patient
Care STDS 2011; 25(3): 135-41.
42. McCord J, Jneid H, Hollander JE, de Lemos JA,
Cercek B, Hsue P, et al. Management of cocaineassociated chest pain and myocardial infarction: A
scientific statement from the American Heart
Association Acute Cardiac Care Committee of the
Council on Clinical Cardiology. Circulation 2008;
117(14): 1897-907.
43. Najafipour H, Beik A. The impact of opium
consumption on blood glucose, serum lipids and
blood pressure, and related mechanisms. Front
Physiol 2016; 7: 436.
44. Tan P, Steinbach M, Kumar V. 1st ed. Introduction
to data mining. Boston, MA: Pearson; 2005.
45. Han J, Kamber M, Pei J. Data mining: Concepts and
techniques. 3rd ed. San Francisco, CA: Morgan
Kaufmann; 2012.
46. Shen CC, Hu LY, Hu YH. Comorbidity study of
borderline personality disorder: applying association
rule mining to the Taiwan national health insurance
research database. BMC Med Inform Decis Mak
2017; 17(1): 8.
47. Huang YC. Mining association rules between
abnormal health examination results and outpatient
medical records. Health Inf Manag J 2013; 42(2):
48. Pattanaprateep O, McEvoy M, Attia J, Thakkinstian
A. Evaluation of rational nonsteroidal antiinflammatory drugs and gastro-protective agents use;
association rule data mining using outpatient
prescription patterns. BMC Med Inform Decis Mak
2017; 17(1): 96.
49. McNicholas PD, Murphy TB, O'Reganc M.
Standardising the lift of an association rule. Comput
Stat Data Anal 2008; 52(10): 4712-21.
50. National Council of State Boards of Nursing.
Toxicology 101: A Quick Reference Guide [Online].
[cited 2018]; Available from: URL:
51. Marks S, Rosielle DA. Opioids for cough #199. J
Palliat Med 2010; 13(6): 769-70.
52. Morice AH, Menon MS, Mulrennan SA, Everett CF,
Wright C, Jackson J, et al. Opiate therapy in chronic
cough. Am J Respir Crit Care Med 2007; 175(4):
53. Perper JA, Van Thiel DH. Respiratory complications
of cocaine abuse. Recent Dev Alcohol 1992; 10:
54. Skluzacek PA, Szewc RG, Nolan CR, III, Riley DJ,
Lee S, Pergola PE. Prediction of GFR in liver
transplant candidates. Am J Kidney Dis 2003; 42(6):
55. Verdoia M, Barbieri L, Schaffer A, Bellomo G,
Marino P, De LG. Impact of renal function on mean
platelet volume and its relationship with coronary
artery disease: A single-centre cohort study. Thromb
Res 2016; 141: 139-44.
56. Nabipour S, Ayu SM, Hussain HM. Burden and
nutritional deficiencies in opiate addictionsystematic review article. Iran J Public Health 2014;
43(8): 1022-32.
57. Akkina SK, Ricardo AC, Patel A, Das A, Bazzano
LA, Brecklin C, et al. Illicit drug use, hypertension,
and chronic kidney disease in the US adult
population. Transl Res 2012; 160(6): 391-8.
58. Kozor R, Grieve SM, Buchholz S, Kaye S, Darke S,
Bhindi R, et al. Regular cocaine use is associated
with increased systolic blood pressure, aortic
stiffness and left ventricular mass in young otherwise
healthy individuals. PLoS One 2014; 9(4): e89710.
59. Ali SR, Krugar M, Houghton J. Upper airway
obstruction and acute lung injury associated with
cocaine abuse. Int J Clin Pract 2002; 56(6): 484-5.
60. Buttner A. Neuropathological alterations in cocaine
abuse. Curr Med Chem 2012; 19(33): 5597-600.
61. Hosten AO. BUN and creatinine. In: Walker HK,
Hall WD, Hurst JW, editors. Clinical methods: The
history, physical, and laboratory examinations. 3rd ed.
Boston, MA: Butterworths; 1990. p. 874-78.
62. Medicine Plus. Blood in Urine: How do You Test for
Blood in Urine? [Online]. [cited 2019 Apr 15];
Available from: URL:
63. Brubaker RH, Meseeha M. High anion gap
metabolic acidosis. StatPearls [online]. [cited 2019
Jun 4]; Available from: URL: