Introduction

Nowadays, due to high drug production, increased purity and their low price, drug issues expanded in the world had become a burden on society. Many infectious diseases such as AIDS, hepatitis, and tuberculosis caused by addiction and in future addiction can lead to social and economic issues in society.  Iran because of cultural reasons and geographic location with having two largest drug manufacturers, has very critical and acute conditions with drug use. Addiction causes many economic and cultural damages to society people every day and according to registered statistics, it is the second leading cause of death after accidents in suspicious deaths (1,2).

In a study in Mashhad, most poisonings referred to hospital were female at 52%, and the most common causes of the intoxication in patients were drug use (at 64.6%) and then opium (at 2.9%.) (3). Mehdizadeh  et al showed that the most common causes of toxicity in patients referred to hospital were drug use at 73.3%; Benzodiazepines was the most common drug used ( 4).

In some circumstances, the opioid is used as a tool for suicide, which was often seen in youth. Because of higher mortality rate due to poisoning (48%) in Iran and also, the higher rate of young people in Iran, investigate this opium toxicity has been important in the future for Iran (5). Some studies showed that the rate of drug intoxication can be affected by patients' age and sex, and the effects of opioid take place on specific receptors and mainly in central nervous, respiratory, cardiovascular and digestive system in the body. These interactions are primarily showing its effects on the central nervous system and respiratory system, cardiovascular system and digestive system (6,7).

Low doses use of opioids can affect the hearth and also its more use can lead to inhibition of respiration, pulmonary and non-pulmonary edema, hypoxia and pneumonia in the respiratory system (8). Currently, the pattern of opioid uses change from Traditional Drugs to chemical drugs, which has far more damaging effects. The aim of this study was to investigate the clinical manifestations and factors associated with opioid intoxication in patients referred to Ardabil city hospital during 2014 and-2015.

Methods

This is a cross sectional study that has been done on 180 patients referred to Ardabil Sabalan hospital who werehospitalized with opium toxicity (Opiates, methadone, crystal, crack, Tramadol, and heroin). The data collection tool used was a checklist that includes individual characteristics (age, sex, place of residence, occupation, and marital status), type of opioid intoxication, the intoxication, history of mental illness and the symptoms. Because of the retrospective nature of the study there is no need to obtain informed consent from patients. Collected data analyzed by statistical methods such as table, graph chi-square test in SPSS 16 Software. A p-value less than 0.05 was considered as significant.

Results

75 (42%) of cases were intoxicated with Tramadol, 61 (33.9%) with opium, 31 (17.2%) with methadone, and 13 (7.2%) with Crystal, Crack and Heroin combined are the opioid toxicity sources in patients.

Most patients were male (n=145, 80.6%) and aged 20-30 years (n=68, 37.8%) (Table 1). 166 (92.2%) of patients were married. Most of the patients (n=86, 47.7%) were unemployed and 86.1% were in Urban areas. 55 (35.5%) have an elementary school level of education. Many of patients (39%) were referred in spring season.

31% of all patients had history of Psychosis, 15% had a history of physical illness, 12% had history of physical and mental illness and 42% of patients were without illness.

Poisoning in 166 patients (92%) was informed, and all other poisonings were not informed. Of all patients, 150 patients (83.3%) had clinical symptoms.  Symptoms were seen in 100% of consumers of crystal, crack and heroin, and the lowest percent of symptoms seen was in the methadone groups at 77.4%. According to Table 2, the rate of all used opioids in patients with clinical symptoms were significantly more than other patients (p=0.001).

From 151 patients, 31 (20.5%) have Asthma. The majority of asthma was in opium users at 40.5%. 27 (18.1%) had restlessness. From all patients with ocular symptoms, 38 (16%) have muse. Most of ocular symptoms were seen in Heroin users (60%). From all patients with clinical symptoms, 27(18%) had Nausea and vomiting, with the majority being seen in Heroin users at 66.6%.From all patients with Digestive symptoms, 7 (7.6%) have Hypertension, and most of the cases were seen in Crack users. From all patients with Kidney symptoms, 20 (77%) had Urinary Retention and most of the cases were seen in Crack users.

Of all patients with clinical symptoms, most patients had neurologic symptoms (87.4%) (Table 3).

Discussion

Drug intoxications is one the most common causes of poisoning in patients referred to emergency of hospitals and can lead to serious damages and even death in admitted patients by poisoning. However, many of them are controlled and do not die but it has only economical and healthy outcomes for patients in future.

Most poisonings were seen in the age groups 20-30 which was similar with other study results (7-10). In this study the mean age of patients was 31.5 years and in Farzaneh study, the mean age of patients was 34.5 years(11). Results showed that poisoning in females and single patients were 19.4% and 7.8% lower than male and marriage patients, respectively. These findings were different than other studies that can be related to lower rate of opium use and overdoses among females (12-13).

In this study, most patients were deliberately poisoned, which revealed that the toxicity in this study was opium use not only for suicide but for other uses. In Guloglu et al study in Turkey most of patients used opioids for suicide and only from them about one percent deal to death (14).

In this study, 75 patients (42%) were poisoned with Tramadol which was the most commonly used drugs, similar to what has been found in other studies (11, 15-16). Also, our study results were different from American studies because of the rate of Tramadol use (17-18).

Of patients taking tramadol, 20% had tension which was lower than other studies (17). 87.4% of patients had neurological symptoms such as restlessness, headache, dizziness or loss of consciousness which was similar to Eizadi study results. From these results it was revealed that because of tramadol inhibitory effects on monoamine reuptake, severe CNS toxicity can be occurred in patients (19). In this study, the most common side effect of opioid use as well as poisoning with Tramadol was Neurological symptoms in patients.

According to the studies done in other places, respiratory symptoms as well as decreased level of consciousness, respiratory depression and meiosis, suppressed respiratory symptoms were the most common symptoms and it can said that many factors such as history of drug abuse, food intake and many other causes were associated with occurrence of symptoms in patients (20-22).

Conclusion

Results of this study showed that use of Tramadol has a main role in poisoning of patients who admitted to emergency of hospitals which was related to indiscriminate selling of drugs and selling drugs without a prescription at pharmacies of Ardabil cities. Doing studies in future for reduction tramadol arbitrary use among people, programing to treat opioid-dependent patients, and doing training courses to raise patients and hospital emergency personnel awareness for appropriate initial treatment of poisoned patients is necessary.

Acknowledgement

Authors would like to thanks all Ardabil Sabalan hospital staff for their help in doing study.

Conflict of interest: None to be declared.

Funding and support: The result of this study was financially supported by Ardabil University of Medical Science.