Abstract
Background:
Opium is one of the most commonly abused substances in Iran. Understanding the relationship between unhealthy drug use and clinical outcomes is essential due to its public health implications.Objectives:
This study aimed to investigate the effect of opium addiction on serum glucose and lipid profiles in diabetic patients with acute coronary syndromes (ACS).Methods:
In this cross-sectional study, 99 diabetic patients with ACS were examined. Demographic characteristics and laboratory parameters (including hemoglobin A1c (HbA1c), fasting blood sugar (FBS), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TG) were recorded. Patients were divided into two groups: those who used opium and those who did not. All variables were compared between the two groups. Data analysis was performed using SPSS version 18.Results:
The mean age of patients in the opium and non-opium groups was 47.4 ± 11.01 and 47.5 ± 11.12 years, respectively. There was no significant difference between the groups in terms of serum glucose levels (P > 0.05). Additionally, no significant difference was found in TG, total cholesterol, LDL, and HDL between patients who used opium and those who did not (P > 0.05).Conclusions:
This study found that opium use did not have any positive or negative effect on serum glucose levels or lipid profiles in diabetic patients with ACS. Therefore, our results cannot be generalized with certainty.Keywords
1. Background
Addiction is a significant social and health problem in many countries, including Iran (1). Opium is the most commonly abused substance in Iran after tobacco (2). While opioids are widely recognized for their pain-relieving properties, they also affect various other organs, including the central nervous system, intestines, lungs, and heart (3). Opium, primarily derived from the seeds of the Papaver somniferum plant, contains various alkaloids such as morphine, papaverine, codeine, thebaine, and noscapine, which may be responsible for its diverse effects (4).
There is a common belief among the general population that opium has health benefits, such as reducing the risk of diabetes mellitus (DM), hypertension (HTN), and hyperlipidemia (HLP) (2). However, different studies have revealed that opium consumption can be a risk factor for coronary artery disease (CAD) (2). Cardiovascular diseases (CVDs) are the most common cause of death worldwide, and in Iran, about 43% of all mortalities are caused by CVDs (5). Therefore, understanding the relationship between unhealthy drug use and clinical outcomes is essential for public health (6).
The growing incidence of diabetes poses a major global health concern (7). By 2030, it is estimated to become the seventh leading cause of death globally (8). Recent research indicates that opium may have short-term effects that transiently elevate blood lipids; however, its prolonged use can exacerbate diabetes and dyslipidemia. Conversely, reducing substance use in patients with DM may result in better clinical outcomes (9, 10). One study has shown that substance abuse significantly reduced fasting blood sugar in diabetic patients, although the differences were not significant in relation to postprandial blood sugar and glycosylated hemoglobin (11).
2. Objectives
Due to the controversial findings in recent studies, this study set out to investigate the effect of opium addiction on serum glucose and lipid profiles in diabetic patients with acute coronary syndromes (ACS).
3. Methods
3.1. Study Design
In this cross-sectional study, diabetic patients with ACS who were referred to Imam Hossein Hospital in Shahroud, Iran, were investigated. Patients with a history of DM diagnosed for more than six months were included in the study. Patients with type 1 diabetes or with creatinine clearance less than 30 ml/min were excluded. Informed consent was obtained from all participants.
3.2. Data Collection
Demographic characteristics of the patients, including age, sex, and body mass index (BMI), as well as laboratory parameters such as hemoglobin A1c (HbA1c), fasting blood sugar (FBS), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TG), were recorded.
The patients were divided into two groups: the opium group, which included 50 patients with a history of DM who were admitted due to ACS and had used oral opium for at least 6 months and at least 3 days a week. These patients experienced withdrawal symptoms such as nausea, vomiting, diarrhea, anxiety, and insomnia when they did not use opium. The non-opium group included 49 patients who did not use opium at all.
3.3. Statistical Analysis
Data descriptions were presented as median ± standard deviation and frequency (percent). The chi-square test and independent t-test were used to evaluate the differences between the two groups—opium users and non-opium users. A P-value of less than 0.05 was considered statistically significant. All data analyses were performed using SPSS version 18.
4. Results
A total of 99 patients participated in the study. The mean age of the patients in the opium group was 47.4 ± 11.01 years, while in the non-opium group, it was 47.5 ± 11.12 years. Most of the patients were male, with 62% in the opium group and 66% in the non-opium group. Additionally, 76% of the patients in the opium group and 70% in the non-opium group had a BMI in the normal range (Table 1).
Comparison of Demographic Characteristics of Patients in Opium and Non-opium Group
| Variables | Opium | Non-opium | P-Value |
|---|---|---|---|
| Age (y) | 47.4 ± 11.01 | 47.5 ± 11.12 | P > 0.05 |
| Sex | P > 0.05 | ||
| Male | 31 (62) | 33 (66) | |
| Female | 19 (38) | 17 (34) | |
| BMI (kg/m2) | P > 0.05 | ||
| Underweight | 1 (2) | 2 (4) | |
| Normal | 38 (76) | 35 (70) | |
| Overweight | 6 (12) | 7 (14) | |
| Obese | 5 (10) | 6 (12) |
Based on our findings, opium use did not affect FBS or HbA1C levels, as no significant difference was found between the groups in terms of serum glucose (P > 0.05). Moreover, opium use did not affect lipid profiles. There was no significant difference in TG, total cholesterol, LDL, and HDL levels between patients who used opium and those who did not (P > 0.05) (Table 2).
Comparison of Laboratory Parameters in Opium and Non-opium Group
| Variables | Opium | Non-opium | P-Value |
|---|---|---|---|
| FBS | 261.2 ± 60.8 | 265.8 ± 58.6 | > 0.05 |
| HbA1C | 7.1 ± 0.8 | 7.3 ± 0.7) | > 0.05 |
| TG | 296.1 ± 30.9 | 301.4 ± 36.02 | > 0.05 |
| Total Chol | 263.7 ±26.7 | 155.1 ±15.8 | > 0.05 |
| LDL | 153.3 ±15.9 | 155.1 ±15.8 | > 0.05 |
| HDL | 48.7 ± 14.4 | 47.7 ± 13.2 | > 0.05 |
5. Discussion
Opium is the most commonly abused substance in Iran after tobacco (2), and it is commonly believed among the general population that opium has health benefits, such as reducing the risk of DM, HTN, and HLP (2). In this study, we investigated the effect of opium addiction on serum glucose and lipid profiles in diabetic patients with ACS. Based on our findings, opium did not affect fasting blood sugar (FBS), hemoglobin A1C (HbA1C), or lipid profiles, including triglycerides (TG), total cholesterol, LDL, and HDL, in diabetic patients with ACS.
Consistent with our findings, other studies have shown that opium has no positive impact on FBS levels (12, 13). Similarly, Fallahzadeh et al. demonstrated that FBS, lipid profile, and BMI did not differ significantly between patients who used opium and those who did not (14). However, contrasting our findings, Hamrah et al. found that opium use was associated with the male gender, decreased total cholesterol, and lower FBS levels. This may be due to short-term hormonal and neural effects (15). Another study reported a positive impact of opium on reducing total cholesterol levels (16). In our study, opium use was not related to gender. Opium users may experience reduced FBS levels primarily because opium’s anorexic effect diminishes insulin sensitivity and lowers BMI (10).
Another study by Kazemi et al. in Iran, conducted on patients with cardiovascular disease (CVD), found a correlation between opium use and decreased levels of total cholesterol and LDL. However, opium users exhibited lower levels of HDL within the normal range. It is recommended that healthcare professionals and patients be aware of the detrimental impact of opium use on various vascular events (17). A systematic review of diabetic patients demonstrated that total cholesterol was lower in patients who used opium, but no significant differences were found between users and non-users in other lipid profiles (6). Lipid raft microdomains, which are present in the outer layer of the plasma membrane, harbor high levels of cholesterol and are also the location for opioid receptors, including the μ-opioid receptor (MOR), κ-opioid receptor (KOR), and δ-opioid receptor (DOR), along with various signaling factors such as G protein-coupled receptors (GPCRs) (18). A previous study indicated that lowering cholesterol levels could decrease the internalization of DOR in HEK293 cells (19).
It has been shown that opioid agonists with effects on KOR can reduce the consumption of carbohydrate-to-fat ratio in rats (20). Another study, which considered factors such as fat intake, BMI, and other confounding variables, demonstrated that opium users had reduced total cholesterol levels (17). People have used opium for many years because of their beliefs about its beneficial effects on DM, HLP, and CVDs. According to available evidence, opium not only lacks a protective effect on heart disease but is also associated with increased risks of CVDs and cardiovascular mortality (21).
5.1. Conclusions
The results of our study showed that opium use did not have any positive or negative effects on serum levels of glucose or lipid profiles. However, given the different studies with controversial findings on this topic, and considering that opium consumption is influenced by cultural, behavioral, and personality factors, and can vary in different regions, we cannot generalize our results with certainty.
References
-
1.
Habibi MR, Alipour A, Soleimani A, Kiabi FH, Habibi A, Emami Zeydi A. The effect of opium addiction on short-term postoperative outcomes after coronary artery bypass graft surgery: A prospective observational cohort study. Biomedicine (Taipei). 2020;10(4):23-8. [PubMed ID: 33854931]. [PubMed Central ID: PMC7735979]. https://doi.org/10.37796/2211-8039.1042.
-
2.
Mousavi M, Kalhor S, Alizadeh M, Movahed MR. Opium Addiction and Correlation with Early and Six-month Outcomes of Presenting with ST Elevation Myocardial Infarction Treated Initially with Thrombolytic Therapy. Am J Cardiovasc Dis. 2021;11(1):115-23. [PubMed ID: 33815927]. [PubMed Central ID: PMC8012279].
-
3.
Abdiardekani A, Salimi M, Sarejloo S, Bazrafshan M, Askarinejad A, Salimi A, et al. Impacts of opium addiction on patterns of angiographic findings in patients with acute coronary syndrome. Sci Rep. 2022;12(1):15209. [PubMed ID: 36076021]. [PubMed Central ID: PMC9458649]. https://doi.org/10.1038/s41598-022-19683-7.
-
4.
Carlin MG, Dean JR, Ames JM. Opium Alkaloids in Harvested and Thermally Processed Poppy Seeds. Front Chem. 2020;8:737. [PubMed ID: 33195013]. [PubMed Central ID: PMC7482649]. https://doi.org/10.3389/fchem.2020.00737.
-
5.
Borghei Y, Moghadamnia MT, Sigaroudi AE, Ghanbari A. Association between climate variables (cold and hot weathers, humidity, atmospheric pressures) with out-of-hospital cardiac arrests in Rasht, Iran. J Therm Biol. 2020;93:102702. [PubMed ID: 33077123]. https://doi.org/10.1016/j.jtherbio.2020.102702.
-
6.
Ojo O, Wang XH, Ojo OO, Ibe J. The Impact of Opium Abuse on Lipid Profile in Patients with Diabetes: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2019;16(23). [PubMed ID: 31795366]. [PubMed Central ID: PMC6926510]. https://doi.org/10.3390/ijerph16234795.
-
7.
Gautam S, Franzini L, Mikhail OI, Chan W, Turner BJ. Novel Measure of Opioid Dose and Costs of Care for Diabetes Mellitus: Opioid Dose and Health Care Costs. J Pain. 2016;17(3):319-27. [PubMed ID: 26616012]. https://doi.org/10.1016/j.jpain.2015.11.001.
-
8.
Walter KN, Petry NM. Patients with diabetes respond well to contingency management treatment targeting alcohol and substance use. Psychol Health Med. 2015;20(8):916-26. [PubMed ID: 25531935]. [PubMed Central ID: PMC4668112]. https://doi.org/10.1080/13548506.2014.991334.
-
9.
Walter KN, Wagner JA, Cengiz E, Tamborlane WV, Petry NM. Substance Use Disorders among Patients with Type 2 Diabetes: a Dangerous but Understudied Combination. Curr Diab Rep. 2017;17(1):2. [PubMed ID: 28101793]. https://doi.org/10.1007/s11892-017-0832-0.
-
10.
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. [PubMed ID: 27790151]. [PubMed Central ID: PMC5061814]. https://doi.org/10.3389/fphys.2016.00436.
-
11.
Ojo O, Wang XH, Ojo OO, Ibe J. The Effects of Substance Abuse on Blood Glucose Parameters in Patients with Diabetes: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2018;15(12). [PubMed ID: 30501025]. [PubMed Central ID: PMC6313386]. https://doi.org/10.3390/ijerph15122691.
-
12.
Masoomi M, Azdaki N, Shahouzehi B. Elevated Plasma Homocysteine Concentration in Opium-Addicted Individuals. Addict Health. 2015;7(3-4):149-56. [PubMed ID: 26885351]. [PubMed Central ID: PMC4741235].
-
13.
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. [PubMed ID: 26405680]. [PubMed Central ID: PMC4579556]. https://doi.org/10.5812/ijhrba.22702.
-
14.
Fallahzadeh MA, Salehi A, Naghshvarian M, Fallahzadeh MH, Poustchi H, Sepanlou SG, et al. Epidemiologic Study of Opium Use in Pars Cohort Study: A Study of 9000 Adults in a Rural Southern Area of Iran. Arch Iran Med. 2017;20(4):205-10. [PubMed ID: 28412823].
-
15.
Hamrah MS, Hamrah MH, Hamrah MH, Dahi T, Hamrah AT, Zarghami F, et al. Impact of opium use on the conventional coronary artery risk factors among outpatients in Afghanistan: A case-control study In Andkhoy City. Pak J Med Health Sci. 2021;15(1):461-7.
-
16.
Gozashti MH, Yazdi F, Salajegheh P, Dehesh MM, Divsalar K. Fasting Blood Glucose and Insulin Level in Opium Addict versus Non-Addict Individuals. Addict Health. 2015;7(1-2):54-9. [PubMed ID: 26322211]. [PubMed Central ID: PMC4530194].
-
17.
Kazemi M, Bazyar M, Naghizadeh MM, Dehghan A, Rahimabadi MS, Chijan MR, et al. Lipid profile dysregulation in opium users based on Fasa PERSIAN cohort study results. Sci Rep. 2021;11(1):12058. [PubMed ID: 34103610]. [PubMed Central ID: PMC8187592]. https://doi.org/10.1038/s41598-021-91533-4.
-
18.
Paila YD, Chattopadhyay A. Membrane cholesterol in the function and organization of G-protein coupled receptors. Subcell Biochem. 2010;51:439-66. [PubMed ID: 20213554]. https://doi.org/10.1007/978-90-481-8622-8_16.
-
19.
Brejchova J, Vosahlikova M, Roubalova L, Parenti M, Mauri M, Chernyavskiy O, et al. Plasma membrane cholesterol level and agonist-induced internalization of delta-opioid receptors; colocalization study with intracellular membrane markers of Rab family. J Bioenerg Biomembr. 2016;48(4):375-96. [PubMed ID: 27412703]. https://doi.org/10.1007/s10863-016-9667-7.
-
20.
Romsos DR, Gosnell BA, Morley JE, Levine AS. Effects of kappa opiate agonists, cholecystokinin and bombesin on intake of diets varying in carbohydrate-to-fat ratio in rats. J Nutr. 1987;117(5):976-85. [PubMed ID: 3585553]. https://doi.org/10.1093/jn/117.5.976.
-
21.
Nakhaee S, Ghasemi S, Karimzadeh K, Zamani N, Alinejad-Mofrad S, Mehrpour O. The effects of opium on the cardiovascular system: a review of side effects, uses, and potential mechanisms. Subst Abuse Treat Prev Policy. 2020;15(1):30. [PubMed ID: 32303254]. [PubMed Central ID: PMC7164148]. https://doi.org/10.1186/s13011-020-00272-8.