Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. May 19, 2020; 10(5): 95-100
Published online May 19, 2020. doi: 10.5498/wjp.v10.i5.95
Abdominal pain related to adulterated opium: An emerging issue in drug addicts
Maryam Vahabzadeh, Bruno Mégarbane
Maryam Vahabzadeh, Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Bruno Mégarbane, Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris-Diderot University, INSERM UMRS-1144, Paris 75010, France
Author contributions: Vahabzadeh M and Mégarbane B have developed the framework of the paper; Vahabzadeh M wrote the first draft; Vahabzadeh M and Mégarbane B worked in subsequent drafts; all authors confirmed the last version before submission. The authors read and approved the final manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Bruno Mégarbane, MD, PhD, Professor, Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris-Diderot University, INSERM UMRS-1144, 2 Rue Ambroise Paré, Paris 75010, France.
Received: December 23, 2019
Peer-review started: December 23, 2019
First decision: February 20, 2020
Revised: April 7, 2020
Accepted: April 23, 2020
Article in press: April 23, 2020
Published online: May 19, 2020

Lead may contaminate opium, heroin and illicit opiates and is particularly observed in Iran. Lead, a natural heavy metal is able to interfere with several organ functions after ingestion or inhalation. Lead poisoning manifestations are non-specific and thus lead poisoning remains difficult to diagnose. Among the manifestations, abdominal pain is almost the most frequent symptom causing patients to seek medical care. In patients with a history of opium addiction presenting with moderate-to-severe abdominal pain, lack of diagnosis of lead toxicity may thus result in time-consuming and unnecessary medical work-ups that can end up in invasive surgery. This paper aims to briefly review abdominal pain as an emergency issue and the leading symptom of lead poisoning that brings most of the patients to healthcare facilities. All published adult cases and case series of opium addicts admitted with abdominal pain due to lead-adulterated opium consumption have been reviewed. A trend of increasing numbers of lead poisoning cases has recently emerged among opium addicts in Iran. Due to the non-specific manifestations and hazardous effects, psychiatrists and emergency physicians should consider lead poisoning in patients with a past or present history of opium addiction referred for acute abdominal pain, particularly in case of colicky abdominal pain.

Keywords: Addiction, Opium, Lead, Poisoning, Abdominal pain, Toxicity

Core tip: Lead may contaminate opium, heroin and illicit opiates, as is particularly observed in Iran. Abdominal pain is almost the most frequent symptom bringing the patients to medical care. Psychiatrists and emergency physicians should be aware of this complication and consider lead poisoning in opiate users referred for acute abdominal pain. Specific early management is crucial to improve prognosis.