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 »  Abstract
 » Introduction
 » Material and Methods
 » Results
 » Discussion
 »  References

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  Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 53  |  Issue : 4  |  Page : 587-589
 

Opium consumption: A potential risk factor for lung cancer and pulmonary tuberculosis


1 Research Center of Respiratory Diseases, Rasoul Akram General Hospital, Tehran, Iran
2 Firoozgar General Hospital, University Medical Sciences, Tehran, Iran
3 Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Department of Respiratory Diseases, Research Center of Respiratory Diseases, Rasoul Akram General Hospital, University, Tehran, Medical Sciences, Iran

Date of Web Publication21-Apr-2017

Correspondence Address:
SAJ Mousavi
Department of Respiratory Diseases, Research Center of Respiratory Diseases, Rasoul Akram General Hospital, Iran University, Tehran, Iran Medical Sciences
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.204755

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 » Abstract 

OBJECTIVE: Lung cancer is the most common malignancy, as well as the leading cause of cancer-related mortality worldwide. Several studies have shown the causative effect of cigarettes smoking in lung cancer, however, the effect of opium consumption has not yet been well studied. This study has been designed to evaluate the risk of developing lung cancer and pulmonary tuberculosis in pure opium addicts. MATERIALS AND METHODS: We designed an analytic case–control study with 490 participants. People were divided into three groups: Group A were pure opium addicts, Group B consisted of nonsmoker patients who visited the chest medicine clinic due to complaints such as asthma, respiratory tract infections, and other signs and symptoms unrelated to smoking. Group C were chosen from nonsmoker individuals who visited the Emergency Department due to nonrespiratory problems. RESULTS: Statistical analysis showed that the three groups were similar with respect to mean age and gender. In Group A, one patient was diagnosed as having bronchoalveolar carcinoma. No other case of lung cancer was found in all three groups. Furthermore, four patients in Group A (5.3%; 95% confidence interval, 1.3–10.3) were found to have pulmonary tuberculosis, as this was significantly higher as compared with groups B and C (P = 0.009 and P< 0.001, respectively). CONCLUSION: Although, owing to limited number of cases, a robust conclusion cannot be made, this study can be considered as a base for a well-designed, larger study to further clarify the potential effect of opium abuse in developing lung cancer.


Keywords: Addiction, lung cancer, opium, respiratory tract diseases, risk factor, tuberculosis


How to cite this article:
Safari A, Reazai M, Tangestaninejad A, Mafi A, Mousavi S. Opium consumption: A potential risk factor for lung cancer and pulmonary tuberculosis. Indian J Cancer 2016;53:587-9

How to cite this URL:
Safari A, Reazai M, Tangestaninejad A, Mafi A, Mousavi S. Opium consumption: A potential risk factor for lung cancer and pulmonary tuberculosis. Indian J Cancer [serial online] 2016 [cited 2019 Aug 19];53:587-9. Available from: http://www.indianjcancer.com/text.asp?2016/53/4/587/204755



 » Introduction Top


Lung cancer is the most common malignancy, as well as the leading cause of cancer-related mortality worldwide.[1],[2] Despite recent advances in early detection and treatment, including surgery, radiation therapy, chemotherapy, and targeted therapy, the overall survival of the affected patient still remains poor.[3],[4]

Geographic patterns of lung cancer incidence and mortality are very much influenced by past exposure to tobacco smoking. It is estimated that 85% of lung cancer in men and 47% of lung cancer in women is the consequence of tobacco smoking. The percentage of such cases among men is 90%–95% in Europe and North America.[1] Smoking, particularly of cigarettes, accounts for 80%–90% of lung cancer cases. It is estimated that across the developed world, 70%–90% of lung cancer deaths during the year 2000 were attributed to smoking.[1],[4] Several studies have shown the causative effect of cigarettes smoking in lung cancer, however, the effect of other types of “smoke” such as opium smoke has not yet been well evaluated in studies.

Although the rate of opium abuse is decreasing compared with increasing use of synthetic substances, it is still the most popularly abused “drug” in many parts of the world.[5],[6] In many regions of the world, especially the Middle East, long-term recreational use of opium is quite popular. In Iran, opium is widely available, and the country has the highest per capita number of opiate addicts in the world at a rate of 2.8% of Iranians older than 15 years.[5],[7]

Several reasons contribute to this high consumption of opium in Iran. Because of religious laws, drinking alcoholic beverages is forbidden, and it is difficult to obtain (LSD) lysergic acid diethylamide, cocaine, or psychedelics. In contrast, opium has been used for several hundred years for medical purposes, as well as for its mind-expanding qualities.

Many people in Iran believe that opium consumption is beneficial for many organs of the body, including cardiovascular system, and it helps reduce serum lipids and glucose.[8] This belief contrasts with the results of many studies that have shown the correlation of opium abuse with numerous diseases, including laryngeal, esophageal, and bladder malignancies.[6],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18] For example, consuming opium dross (shireh and sukhteh) has been shown to be associated with development of esophageal squamous cell carcinoma.[9],[10],[11],[12],[13] Some studies have considered opium abuse as an independent risk factor for laryngeal carcinoma.[14] Furthermore, several studies have shown that opium dependency is associated with higher rates of developing bladder carcinoma.[6], 12, [15],[16],[17],[18]

The relationship between opium abuse and lung cancer has not been widely studied. The high number of opium addicts in Iran gives scientists the advantage of finding several individuals as “pure opium addicts”; that is, opium addicts who have never smoked cigarettes and are considered to be “neversmokers.”

This study has been designed to evaluate the risk of developing lung cancer in pure opium addicts.


 » Material and Methods Top


Study design

We designed an analytic case–control study with 490 participants. Approval for the conduct of this study was obtained from the research committee and the institutional review board of Tehran University of Medical Sciences, and written consent was taken from all the participants.

Setting and selection of participants

From April 2010 to April 2013, case and control individuals were chosen from the people who visited because of different problems at general clinic of Rasoul Akram Hospital in Tehran, Iran. People were divided into three groups: Group A were pure opium addicts, Group B consisted of nonsmoker patients who visited the chest medicine clinic due to complaints such as asthma, respiratory tract infections, and other signs and symptoms unrelated to smoking. Group C were chosen from nonsmoker individuals who visited the Emergency department due to atypical chest pain. Individuals younger than 18 years, exsmokers, and patients with a significant history of exposure to second-hand smoke, and occupational dusts and toxins such as asbestos, arsenic, mustard gas, nickel, uranium, charcoal, aromatic hydrocarbons, and radon rays were excluded from the study. The study lasted 3 years because of difficulty in finding “pure opium addicts.”

Data collecting and processing

After taking written consent, a thorough physical examination was performed and a chest radiography was taken from all the participants. In total, 78 cases were found to be allocated as Group A. Then, for each case from Group A, two age- and gender-matched controls were chosen from each of the groups B and C. Therefore, in total, 490 patients (78 in Group A, 156 in Group B, and 156 in Group C) entered the study. Patients with respiratory disorders such as pulmonary infections, chronic obstructive pulmonary disease, emphysema, chronic bronchitis, and asthma were not excluded from the study, unless they had risk factors for lung cancer. All “pure opium addicts” were included in the study.

All the chest radiographs were reviewed by the same consultant pulmonologist. Based on the radiograph findings, further tests such as high-resolution spiral computed tomography scan, sputum smear, or bronchoscopy and tissue biopsy were performed for the patients.

Data analysis

Statistical analyses were done using SPSS 16 software (SPSS Inc., Chicago, IL, USA). Parametric and qualitative data were reported as mean [mean, 95% confidence interval (CI)] and frequency (percentage). One-way ANOVA test was used to compare mean age in different groups. Gender distribution in the three groups was compared using Chi-square test. P value <5% was considered as statistically significant.


 » Results Top


In total, 490 participants entered the study. In Group A, 60 patients (76.9%) were male and 18 were female. In Group B, 111 patients (77.15%) were male and 45 were female. In Group C, 124 patients (79.48%) were male and 32 were female. The mean age of groups A, B, and C was 56.89, 58.9, and 55.8 years, respectively (P = 0.11). Statistical analysis showed that the three groups were similar with respect to mean age and gender.

The mean duration of opium consumption in Group A was 18.67 years (95% CI, 15.62–21). The mean amount of daily opium use was 1.8 g (95% CI, 0.6–2.9). In Group A, 59 cases (82.1%) used inhaled opium smoke, 13 patients (15.4%) used oral opium (ingesting opium orally), and 14 patients used both ways of opium consumption.

In Group A, one patient was diagnosed as having bronchoalveolar carcinoma. He was a 65-year-old man with the history of 30-year opium smoke inhalation who also gave the history of occasional bloody sputum (hemoptysis). No other case of lung cancer was found in all the three groups.

Four patients in Group A (5.3%; 95% CI, 1.3–10.3) were found to have pulmonary tuberculosis. When we compared this to only one pulmonary tuberculosis in Group B, and no infected patient in Group C, we found that the frequency of pulmonary tuberculosis was significantly higher in pure opium addicts as compared with groups B and C (P = 0.009 and P< 0.001, respectively).


 » Discussion Top


In the present study, one case of bronchoalveolar carcinoma and four cases of pulmonary tuberculosis were observed in pure opium addicts, whereas there were no cases of lung cancer and only one case of pulmonary tuberculosis was found in the control groups.

Lung cancer age-adjusted incidence rate in the United States in 2010 was 30.5-121.7 per 100,000 in men, and 23.6-79.6 per 100,000 in women, respectively.[19] Based on Mousavi et al.'s study, this figure in Iran has been reported to be 4.73 per 100,000 and 2.08 per 100,000 among Iranian men and women, respectively.[20] The prevalence of tuberculosis in Iran has been reported to be 14.6 per 100,000 populations in 2012.[21]

In our study in Group A, one patient (1.28%) was diagnosed with lung cancer, and four (5.12%) were diagnosed with tuberculosis. Although both figures are much higher than that of general population, because of limited number of cases in this study, a firm conclusion cannot be made. However, this study can be considered as a base for designing further research projects in this area.

In Masjedi et al.'s study, multivariate analysis showed that long-term opium inhalation is a risk factor for developing lung cancer (OR = 1.3). Concomitant cigarette smoke will increase the risk significantly (OR = 35).[22] Mathur and colleagues showed a significant association between opium addiction and pulmonary tuberculosis (OR = 2.61) and opium addiction was found to occur before the development of tuberculosis.[23]

Unlike pure opiates, such as morphine, opium contains several alkaloids and biologically active components with several metabolic effects. Inhaling opium smoke can damage bronchi and pulmonary parenchyma.[24] Opium inhalation exposes respiratory tract to polycyclic and heterocyclic aromatic hydrocarbons and aromatic amines that are considered to be carcinogenic.[25]

Long-term abuse of exogenous opioids, such as morphine and heroin, can suppress both humoral and cellular immune systems.[26],[27],[28] There are also evidences indicating that opiates could act as cancer promoters through impairing immune function, activating angiogenesis and tumor neovascularization,[28] increasing the concentrations of N-nitrosamines through modifying their pharmacokinetics,[29] increasing the release of nitric oxide, or inhibiting production and release of hydrogen peroxide.[30]

Diethylnitromine is one of the substances found in opium that has a substantial carcinogenic potential.[29] Morphine sulfate is the main opium alkaloid, which can induce DNA alkalization. Studies have shown that even one dose of morphine sulfate can increase the rate of DNA alkalization.[16] The alkylation of the DNA constitutes a known alteration precursory to the carcinogenesis provoked by diethylnitromine in some organs, such as esophagus and liver.[16]

Some studies have shown that opioid use is accompanied with increased rate of metastasis and reduced survival in animal models.[31]

Laboratory studies have demonstrated that pyrolysates of opium are highly mutagenic and can induce sister-chromatid exchanges in mammalian cells after metabolic activation.[25]

One of the main obstacles in studying the correlation between opium abuse and lung cancer is the inability to perform randomized controlled clinical trials due to ethical limitations. Also, finding sufficient number of pure opium smokers to participate in an observational studies in not feasible. Majority of opium addicts are also cigarette smokers, which can confound the results of the study, however, there seems to be a causal relationship between opium abuse and development of lung cancer. Although, because of limited number of cases, a robust conclusion cannot be made, this study can be considered as a base for a well-designed, larger study to further clarify the potential effect on opium abuse in developing lung cancer.

 
 » References Top

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