Sociodemographic and Toxico-clinical Characteristics of Patients with Opioid/Stimulant Poisoning

Document Type : Original Article

Authors

1 Department of Clinical Toxicology, School of Medicine, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Epidemiology & Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran

10.34172/ahj.1565

Abstract

Background: This study aimed to examine the toxico-clinical and sociodemographic characteristics of patients who have experienced poisoning from common illicit drugs, such as opioids and stimulants.
Methods: This retrospective chart review study was conducted on cases of opioid and stimulant poisoning who were admitted to the referral poisoning emergency center in the central part of Iran, Isfahan, from January 2019 to January 2020. The toxico-clinical and sociodemographic characteristics of patients were evaluated.
Findings: Data obtained from 496 patients were analyzed. Poisoning with opioids and stimulants accounted for 67.13% and 7.86% of cases, respectively. Most of the patients in both the opioid and stimulant groups were male. The most common route of poisoning was ingestion (82%) for opioids and inhalation (43.6%) for stimulants. Suicide (40.2%) was common in patients with opioid poisoning, whereas abuse (28.2%) was more commonly observed in stimulant poisoning. There were no significant differences regarding marital status, occupation, education, criminal convictions, history of somatic diseases, and psychiatric diseases between patients with opioid and stimulant poisoning. The mortality rate in opioid poisoning was 0.9%, whereas no deaths were reported in patients with stimulant poisoning. Binary regression analysis showed that age, coma/stupor, abnormal respiratory manifestations, previous cardiovascular disease, incomplete response to naloxone, and endotracheal intubation were predictive factors for worse outcomes (complications/death) in opioid poisoning.
Conclusion: Opioid poisoning was more common than stimulant poisoning. Except for the type and route of exposure, there were no significant differences between patients poisoned with opioid or stimulant drugs. This highlights the necessity for targeted interventions based on specific clinical characteristics to improve patient outcomes.

Keywords

References

  1. Shukla L, Ghadigaonkar DS, Murthy P. Poisoning with drugs of abuse: identification and management. Indian J Crit Care Med. 2019;23(Suppl 4):S296-304. doi: 10.5005/jp-journals-10071-23309.
  2. National Institute on Drug Abuse (NIDA) [Internet]. Available from: https://nida.nih.gov/research-topics/trends-statistics/ overdose-death-rates.
  3. Mattson CL, Tanz LJ, Quinn K, Kariisa M, Patel P, Davis NL. Trends and geographic patterns in drug and synthetic opioid overdose deaths - United States, 2013-2019. MMWR Morb Mortal Wkly Rep. 2021;70(6):202-7. doi: 10.15585/mmwr. mm7006a4.
  4. Jones CM, Bekheet F, Park JN, Alexander GC. The evolving overdose epidemic: synthetic opioids and rising stimulant-related harms. Epidemiol Rev. 2020;42(1):154-66. doi: 10.1093/epirev/mxaa011.
  5. Papamihali K, Collins D, Karamouzian M, Purssell R, Graham B, Buxton J. Crystal methamphetamine use in British Columbia, Canada: A cross-sectional study of people who access harm reduction services. PLoS One. 2021;16(5):e0252090. doi:10.1371/journal.pone.0252090.
  6. Papamihali K, Collins D, Karamouzian M, Purssell R, Graham B, Buxton J. Crystal methamphetamine use in British Columbia, Canada: a cross-sectional study of people who access harm reduction services. PLoS One. 2021;16(5):e0252090. doi: 10.1371/journal.pone.0252090.
  7. Farrell M, Martin NK, Stockings E, Bórquez A, Cepeda JA, Degenhardt L, et al. Responding to global stimulant use: challenges and opportunities. Lancet. 2019;394(10209):1652- 67. doi: 10.1016/s0140-6736(19)32230-5.
  8. Rostam-Abadi Y, Gholami J, Amin-Esmaeili M, Safarcherati A, Mojtabai R, Ghadirzadeh MR, et al. Tramadol use and public health consequences in Iran: a systematic review and meta-analysis. Addiction. 2020;115(12):2213-42. doi: 10.1111/ add.15059.
  9. Babakhanian M, Zarghami M, Alipour A, Khosravi A, Hashemi- Nazari SS, Saberi M, et al. An estimation of drug-related deaths in Iran, using the capture-recapture method (2014- 2016). Addict Health. 2020;12(2):87-97. doi: 10.22122/ahj. v12i2.266.
  10. Mehrpour O, Akbari A, Jahani F, Amirabadizadeh A, Allahyari E, Mansouri B, et al. Epidemiological and clinical profiles of acute poisoning in patients admitted to the intensive care unit in eastern Iran (2010 to 2017). BMC Emerg Med. 2018;18(1):30. doi: 10.1186/s12873-018-0181-6.
  11. Rastegari A, Baneshi MR, Hajebi A, Noroozi A, Karamouzian M, Shokoohi M, et al. Population size estimation of people who use illicit drugs and alcohol in Iran (2015-2016). Int J Health Policy Manag. 2023;12:6578. doi: 10.34172/ ijhpm.2022.6578.
  12. Heyman GM, McVicar N, Brownell H. Evidence that social-economic factors play an important role in drug overdose deaths. Int J Drug Policy. 2019;74:274-84. doi: 10.1016/j. drugpo.2019.07.026.
  13. Rossen LM, Khan D, Warner M. Trends and geographic patterns in drug-poisoning death rates in the US, 1999- 2009. Am J Prev Med. 2013;45(6):e19-25. doi: 10.1016/j. amepre.2013.07.012.
  14. Nechuta SJ, Tyndall BD, Mukhopadhyay S, McPheeters ML. Sociodemographic factors, prescription history and opioid overdose deaths: a statewide analysis using linked PDMP and mortality data. Drug Alcohol Depend. 2018;190:62-71. doi: 10.1016/j.drugalcdep.2018.05.004.
  15. Monnat SM. Factors associated with county-level differences in US drug-related mortality rates. Am J Prev Med. 2018;54(5):611-9. doi: 10.1016/j.amepre.2018.01.040.
  16. Frankenfeld CL, Leslie TF. County-level socioeconomic factors and residential racial, Hispanic, poverty, and unemployment segregation associated with drug overdose deaths in the United States, 2013-2017. Ann Epidemiol. 2019;35:12-9. doi: 10.1016/j.annepidem.2019.04.009.
  17. Baptiste-Roberts K, Hossain M. Socioeconomic disparities and self-reported substance abuse-related problems. Addict Health. 2018;10(2):112-22. doi: 10.22122/ahj.v10i2.561.
  18. Ciucă Anghel DM, Nițescu GV, Tiron AT, Guțu CM, Baconi DL. Understanding the mechanisms of action and effects of drugs of abuse. Molecules. 2023;28(13):4969. doi: 10.3390/ molecules28134969.
  19. Docherty JR, Alsufyani HA. Pharmacology of drugs used as stimulants. J Clin Pharmacol. 2021;61 Suppl 2:S53-69. doi: 10.1002/jcph.1918.
  20. Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Series B Stat Methodol. 199557(1):289-300. doi: 10.1111/j.2517-6161.1995.tb02031.x.
  21. Amirabadizadeh A, Nezami H, Vaughn MG, Nakhaee S, Mehrpour O. Identifying risk factors for drug use in an Iranian treatment sample: a prediction approach using decision trees. Subst Use Misuse. 2018;53(6):1030-40. doi: 10.1080/10826084.2017.1392981.
  22. Eskandarieh S, Jafari F, Yazdani S, Hazrati N, Saberi- Zafarghandi MB. Compulsory maintenance treatment program amongst Iranian injection drug users and its side effects. Int J High Risk Behav Addict. 2014;3(4):e21765. doi: 10.5812/ijhrba.21765.
  23. Soroosh D, Neamatshahi M, Zarmehri B, Nakhaee S, Mehrpour O. Drug-induced prolonged corrected QT interval in patients with methadone and opium overdose. Subst Abuse Treat Prev Policy. 2019;14(1):8. doi: 10.1186/s13011-019-0196-3.
  24. Rahimi M, Lookzadeh S, Sadeghi R, Soltaninejad K, Shadnia S, Pajoumand A, et al. Predictive factors of mortality in acute amphetamine type stimulants poisoning; a review of 226 cases. Emerg (Tehran). 2018;6(1):e1. doi: 10.22037/ emergency.v6i1.18137.
  25. Paydar P, Sabzghabaee AM, Paydar H, Eizadi-Mood N, Joumaa A. Outcome of treatment in patients with methamphetamine poisoning in an Iranian tertiary care referral center. J Res Pharm Pract. 2015;4(3):167-72. doi: 10.4103/2279-042x.162365.
  26. Overdose Death Rates [Internet]. 2019. Available from: https://www.drugabuse.gov/related-topics/trends-statistics/ overdose-death-rates.
  27. Pinheiro I, Dejager L, Libert C. X-chromosome-located microRNAs in immunity: might they explain male/female differences? The X chromosome-genomic context may affect X-located miRNAs and downstream signaling, thereby contributing to the enhanced immune response of females. Bioessays. 2011;33(11):791-802. doi: 10.1002/ bies.201100047.
  28. Darnall BD, Stacey BR. Sex differences in long-term opioid use: cautionary notes for prescribing in women. Arch Intern Med. 2012;172(5):431-2. doi: 10.1001/archinternmed.2011.1741.
  29. Vallersnes OM, Jacobsen D, Ekeberg Ø, Brekke M. Mortality, morbidity and follow-up after acute poisoning by substances of abuse: a prospective observational cohort study. Scand J Public Health. 2019;47(4):452-61. doi: 10.1177/1403494818779955.
  30. Altekruse SF, Cosgrove CM, Altekruse WC, Jenkins RA, Blanco C. Socioeconomic risk factors for fatal opioid overdoses in the United States: findings from the Mortality Disparities in American Communities Study (MDAC). PLoS One. 2020;15(1):e0227966. doi: 10.1371/journal.pone.0227966.
  31. Shokrzadeh M, Hajimohammadi A, Hoseinpoor R, Delaram A, Shayeste Y. An epidemiological survey of drug poisoning and a comparison with other poisonings cases admitted to a university hospital in Gorgan, Iran, 2008-2015. Int J Epidemiol Res. 2017;4(2):94-103.
  32. Georgieva E, Benkova K, Vlaeva N, Karamalakova Y, Miteva R, Abrashev H, et al. Is illicit substance use gender-specific? The basic points of mental and health disorders. Toxics. 2022;10(7):344. doi: 10.3390/toxics10070344.
  33. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617-27. doi: 10.1001/ archpsyc.62.6.617.
  34. Mohebbi E, Haghdoost AA, Noroozi A, Molavi Vardanjani H, Hajebi A, Nikbakht R, et al. Awareness and attitude towards opioid and stimulant use and lifetime prevalence of the drugs: a study in 5 large cities of Iran. Int J Health Policy Manag. 2019;8(4):222-32. doi: 10.15171/ijhpm.2018.128.
  35. Moradinazar M, Najafi F, Jalilian F, Pasdar Y, Hamzeh B, Shakiba E, et al. Prevalence of drug use, alcohol consumption, cigarette smoking and measure of socioeconomic-related inequalities of drug use among Iranian people: findings from a national survey. Subst Abuse Treat Prev Policy. 2020;15(1):39. doi: 10.1186/s13011-020-00279-1.
  36. Lee JO, Herrenkohl TI, Kosterman R, Small CM, Hawkins JD. Educational inequalities in the co-occurrence of mental health and substance use problems, and its adult socio-economic consequences: a longitudinal study of young adults in a community sample. Public Health. 2013;127(8):745-53. doi: 10.1016/j.puhe.2013.04.005.
  37. Oquendo MA, Volkow ND. Suicide: a silent contributor to opioid-overdose deaths. N Engl J Med. 2018;378(17):1567-9. doi: 10.1056/NEJMp1801417.
  38. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse. In: Phillips JK, Ford MA, Bonnie RJ, editors. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: National Academies Press (US); 2017. doi: 10.17226/24781.
  39. Webster LR. Risk factors for opioid-use disorder and overdose. Anesth Analg. 2017;125(5):1741-8. doi: 10.1213/ ane.0000000000002496.
  40. Yeh HT, Chen HY, Liu SW, Weng TI, Fang CC, Yu JH, et al. Clinical presentations and predictors of in-hospital mortality in illicit drug users in the new psychoactive substances (NPS) endemic era in Taiwan. Toxics. 2022;10(7):386. doi: 10.3390/ toxics10070386.
  41. Kiyatkin EA, Choi S. Brain oxygen responses induced by opioids: focus on heroin, fentanyl, and their adulterants. Front Psychiatry. 2024;15:1354722. doi: 10.3389/ fpsyt.2024.1354722.
  42. Wermeling DP. Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access. Ther Adv Drug Saf. 2015;6(1):20-31. doi: 10.1177/2042098614564776.
  43. McDonald R, Strang J. Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria. Addiction. 2016;111(7):1177-87. doi: 10.1111/add.13326.
Addiction & Health
Volume 17
Pages 1-8

Files

Share

How to cite

Statistics