Cardiovascular Complications of Chronic Opium Consumption: A Narrative Review Article

  • Mojtaba ZIAEE Medicinal Plants Research Center, Maragheh University of Medical Sciences, Maragheh, Iran
  • Reza HAJIZADEH Department of Cardiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
  • Arash KHORRAMI Medicinal Plants Research Center, Maragheh University of Medical Sciences, Maragheh, Iran
  • Nariman SEPEHRVAND Department of Medicine, University of Alberta, Edmonton, AB., Canada
  • Saeideh MOMTAZ Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Tehran, Iran
  • Samad GHAFFARI Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Keywords: Opium; Cardiovascular disease; Drug interactions; Metabolic effects; Mortality

Abstract

Abstract

Opiates are the second most prevalent abused illicit sub­stance after cannabis in the world. The latest United Nations Office on Drugs and Crime (UNODC) report estimated 30% increment in opium cultivation worldwide. High prevalence of opium consumption in eastern countries may be due to the high availability and traditional misconceptions. Opium consumption has been linked to hypertension, diabetes mellitus, dyslipidemia, and coronary artery diseases (CAD). In this review, we will review the association between opium use, cardiovascular diseases, and clinical outcomes. The present evidence suggests that chronic opiate consumption may increase the risk of cardiovascular diseases and related mortality.

 

 

References

1. Pathan H, Williams J (2012). Basic opioid pharmacology: an update. Br J Pain, 6:11-16.
2. Warner M, Trinidad JP, Bastian BA, Minino AM, Hedegaard H (2016). Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2010-2014. Natl Vital Stat Rep, 65:1-15.
3. Yousefzadeh G, Shokoohi M, Najafipour H, Eslami M, Salehi F (2015). Association between opium use and metabolic syndrome among an urban population in Southern Iran: Results of the Kerman Coronary Artery Disease Risk Factor Study (KERCADRS). ARYA Atheroscler, 11:14-20.
4. Masoomi M, Ramezani MA, Karimzadeh H (2010). The relationship of opium addiction with coronary artery disease. Int J Prev Med, 1:182-186.
5. Masoudkabir F, Sarrafzadegan N, Eisenberg MJ (2013). Effects of opium consumption on cardiometabolic diseases. Nat Rev Cardiol, 10:733-40.
6. Ahmadi J, Benrazavi L (2002). Substance use among Iranian cardiovascular patients. Eur J Med Res, 7:89-92.
7. Nadimi AE, Amiri FP, Fathollahi MS et al (2016). Opium addiction as an independent risk factor for coronary microvascular dysfunction: A case–control study of 250 consecutive patients with slow–flow angina. Int J Cardiol, 219:301-27.
8. Sadeghian S, Darvish S, Davoodi G et al (2007). The association of opium with coronary artery disease. Eur J Cardiovasc Prev Rehabil, 14:715-717.
9. Najafipour H, Masoomi M, Shahesmaeili A et al (2015). Effects of opium consumption on coronary artery disease risk factors and oral health: Results of Kerman Coronary Artery Disease Risk factors Study a population-based survey on 5900 subjects aged 15-75 years. Int J Prev Med, 6:42.
10. Farahani MA, Ghaffari F, Fatemi NS (2015). Opium addiction in patients with coronary artery disease: a grounded theory study. Med J Islam Repub Iran, 29:267.
11. Masoomi M, Azdaki N, Shahouzehi B (2015). Elevated Plasma Homocysteine Concentration in Opium-Addicted Individuals. Addict Health, 7:149-56.
12. Najafipour H, Beik A (2016). The Impact of Opium Consumption on Blood Glucose, Serum Lipids and Blood Pressure, and Related Mechanisms. Front physiol, 7:436.
13. Aghadavoudi O, Eizadi-Mood N, Najarzadegan MR (2015). Comparing cardiovascular factors in opium abusers and non-users candidate for coronary artery bypass graft surgery. Adv Biomed Res, 4:12.
14. Asgary S, Sarrafzadegan N, Naderi G-A, Rozbehani R (2008). Effect of opium addiction on new and traditional cardiovascular risk factors: do duration of addiction and route of administration matter? Lipids Health Dis, 7:42.
15. Atanasov AG, Waltenberger B, Pferschy-Wenzig EM et al (2015). Discovery and resupply of pharmacologically active plant-derived natural products: A review. Biotechnol Adv, 33:1582-1614.
16. Tekelioglu O (2016) .The relationship of methadone maintenance treatment patients' age, depression, anxiety, and stress. Alliant International University.
17. Botz B, Bölcskei K, Helyes Z (2017). Challenges to develop novel anti‐inflammatory and analgesic drugs. Wiley Interdiscip Rev Nanomed Nanobiotechnol, 9(3).
18. Mamiya T, Noda Y, Ren X et al (2001). Involvement of cyclic AMP systems in morphine physical dependence in mice: prevention of development of morphine dependence by rolipram, a phosphodiesterase 4 inhibitor. Br J Pharmacol, 132:1111-1117.
19. Pottegard A, dePont Christensen R et al (2014). Pharmacoepidemiological assessment of drug interactions with vitamin K antagonists. Pharmacoepidemiol Drug Saf, 23:1160-7.
20. McCance-Katz EF, Sullivan L, Nallani S (2010). Drug Interactions of Clinical Importance among the Opioids, Methadone and Buprenorphine, and other Frequently Prescribed Medications: A Review. Am J addict, 19:4-16.
21. McEwen BJ (2015). The influence of herbal medicine on platelet function and coagulation: a narrative review. Semin Thromb Hemost , 41(3)300-14.
22. Ondieki G, Nyagblordzro M, Kikete S et al (2017). Cytochrome P450 and P-Glycoprotein-Mediated Interactions Involving African Herbs Indicated for Common Noncommunicable Diseases. Evid Based Complement Alternat Med, 2017:258263.
23. Najafi M, Sheikhvatan M (2012). Does analgesic effect of opium hamper the adverse effects of severe coronary artery disease on quality of life in addicted patients? Anesth Pain Med., 2:22-7.
24. Bayani M, Nazemi S, Niaki MK, Ramezani M, Khani A (2014). Opium consumption and lipid and glucose parameters in diabetic patients with acute coronary syndrome: a survey in northern Iran. Tunis Med, 92:497-500.
25. Javadi HR, Allami A, Mohammadi N, Alauddin R (2014). Opium dependency and in-hospital outcome of acute myocardial infarction. Med J Islam Repub Iran, 28:122.
26. Rahimi N, Gozashti MH, Najafipour H et al (2014). Potential effect of opium consumption on controlling diabetes and some cardiovascular risk factors in diabetic patients. Addict Health, 6(1-6).
27. Fallahzadeh MA, Salehi A, Naghshvarian M et al (2017). Epidemiologic Study of Opium Use in Pars Cohort Study: A Study of 9000 Adults in a Rural Southern Area of Iran. Arch Iran Med, 20:205-210.
28. Ebrahimi H, Haghjoo Javanmard S, Asgary S et al (2018). Opium Addiction and Ischemic Stroke in Isfahan, Iran: A Case-Control Study. Euro Neurol, 79:82-85.
29. Badzynska B, Lipkowski AW, Olszynski KH, Sadowski J (2016). Different blood pressure responses to opioids in 3 rat hypertension models: role of the baseline status of sympathetic and renin-angiotensin systems. Can J Physiol Pharmacol, 94(11):1159-1169.
30. Gomes C, Svensson TH, Trolin G (1976). Effects of morphine on central catecholamine turnover, blood pressure and heart rate in the rat. Naunyn Schmiedebergs Arch Pharmacol, 294:141-7.
31. May CN, Ham IW, Heslop KE, Stone FA, Mathias CJ (1988). Intravenous morphine causes hypertension, hyperglycaemia and increases sympatho-adrenal outflow in conscious rabbits. Clin Sci (Lond), 75:71-7.
32. Shanazari AA, Aslani Z, Ramshini E, Alaei H (2011). Acute and chronic effects of morphine on cardiovascular system and the baroreflexes sensitivity during severe increase in blood pressure in rats. ARYA Atheroscler, 7:111-7.
33. Masoumi M, Shahesmaeili A, Mirzazadeh A, Tavakoli M, Ali AZ (2010). Opium addiction and severity of coronary artery disease: a case-control study. J Res Med Sci, 15:27-32.
34. Wallner C, Stöllberger C, Hlavin A, Finsterer J et al (2008). Electrocardiographic abnormalities in opiate addicts. Addiction, 103:1987-1993.
35. Khosoosi Niaki MR, Hamid M, Farshidi F et al (2013). Evaluation of the role of opium addiction in acute myocardial infarction as a risk factor. Caspian J Intern Med , 4:585-589.
36. Sadr Bafghi SM, Rafiei M, Bahadorzadeh L et al (2005). Is opium addiction a risk factor for acute myocardial infarction? Acta Med Iran, 43:218-222.
37. Sadeghian S, Graili P, Salarifar M et al (2010). Opium consumption in men and diabetes mellitus in women are the most important risk factors of premature coronary artery disease in Iran. Int J Cardiol, 141:116-8.
38. Hosseini SK, Masoudkabir F, Vasheghani-Farahani A et al (2011). Opium consumption and coronary atherosclerosis in diabetic patients: a propensity score-matched study. Planta Med, 77:1870-5.
39. Dehghani F, Masoomi M, Haghdoost AA (2013). Relation of opium addiction with the severity and extension of myocardial infarction and its related mortality. Addiction & Health, 5(1-2):35-42.
40. Rezvani MR, Ghandehari K (2012). Is opium addiction a risk factor for ischemic heart disease and ischemic stroke? J Res Med Sci, 17:958-61.
41. Najafipour H, Joukar S, Malekpour-Afshar R et al (2010). Passive opium smoking does not have beneficial effect on plasma lipids and cardiovascular indices in hypercholesterolemic rabbits with ischemic and non-ischemic hearts. J Ethnopharmacol, 127:257-263.
42. Davoodi G, Sadeghian S, Akhondzadeh S et al (2006). Comparison of Specifications, Short Term Outcome and Prognosis of Acute Myocardial Infarction in Opium Dependent Patients and Nondependents. J Tehran Univ Heart Cent, 1:48-53.
43. Roohafza H, Talaei M, Sadeghi M et al (2013). Opium decreases the age at myocardial infarction and sudden cardiac death: a long- and short-term outcome evaluation. Arch Iran Med, 16:154-60.
44. Safaei N (2008). Outcomes of coronary artery bypass grafting in patients with a history of opiate use. Pak J Biol Sci, 11:2594-8.
45. Darrouj J, Karma L, Arora R (2009). Cardiovascular manifestations of sedatives and analgesics in the critical care unit. Am J Ther, 16:339-353.
46. Wang T, Hung C (2003). Enhanced endothelin-1 degradation by intravenous morphine in patients with congestive heart failure: role of neutral endopeptidase 24.11. Heart, 89:211-212.
47. Wuerz RC, Meador SA (1992). Effects of prehospital medications on mortality and length of stay in congestive heart failure. Ann Emerg Med, 21:669-674.
48. LoCasale R, Kern DM, Chevalier P et al (2014). Description of cardiovascular event rates in patients initiating chronic opioid therapy for noncancer pain in observational cohort studies in the US, UK, and Germany. Adv Ther, 31:708-723.
49. Dispennette R, Elliott D, Nguyen L, Richmond R (2014). Drug Burden Index score and anticholinergic risk scale as predictors of readmission to the hospital. Consult Pharm, 29:158-168.
50. Moqaddam A, Musavi S, Khademizadeh K (2009). Relationship of opium dependency and stroke. Addict Health, 1(1), 6-10.
51. Hamzei-Moghaddam A, Shafa MA, Khanjani N, Farahat R (2013). Frequency of Opium Addiction in Patients with Ischemic Stroke and Comparing their Cerebrovascular Doppler Ultrasound Changes to Non-Addicts. Addict Health, 5(3-4):95-101.
52. Khademi H, Malekzadeh R, Pourshams A et al (2012). Opium use and mortality in Golestan Cohort Study: prospective cohort study of 50 000 adults in Iran. BMJ, 344:e2502.
53. Karam GA, Rashidinejad HR, Aghaee MM et al (2008). Opium can differently alter blood glucose, sodium and potassium in male and female rats. Pak J Pharm Sci, 21:180-4.
54. Karam GA, Reisi M, Kaseb AA et al (2004). Effects of opium addiction on some serum factors in addicts with non-insulin-dependent diabetes mellitus. Addict Biol, 9(1):53-8.
55. Mami S, Eghbali M, Cheraghi J et al (2011). Effect of opium addiction on some serum parameters in rabbit. Glob Vet, 7:310-4.
56. Bossone CA, Hannon JP (1991). Metabolic actions of morphine in conscious chronically instrumented pigs. Am J Physiol, 260:R1051-7.
57. Sumathi T, Niranjali Devaraj S (2009). Effect of Bacopa monniera on liver and kidney toxicity in chronic use of opioids. Phytomedicine, 16:897-903.
58. Kouros D, Tahereh H, Mohammadreza A, Minoo MZ (2010). Opium and heroin alter biochemical parameters of human's serum. Am J Drug Alcohol Abuse, 36:135-9.
59. Radmard AR, Khorasanizadeh F, Poustchi H et al (2018). Dilemma of Common Bile Duct Dilatation in Opium-addicts: A Population-based Study on Prevalence and Clinical Outcome. Am J Med Sci,365(1).
60. Lurie E, Soloviova A, Alyabieva T et al (1995). Effect of novel aromatic derivative of GABA on lipid peroxidation in chronically morphinized rats. Biochem Mol Biol Int, 36:13-9.
61. Panchenko LF, Pirozhkov SV, Nadezhdin AV et al (1999). [Lipid peroxidation, peroxyl radical-scavenging system of plasma and liver and heart pathology in adolescence heroin users]. Vopr Med Khim, 45:501-6.
62. Pereska ZJ, Bozinovska C, Dimitrovski C et al (2011). Plasma apo/lipoproteins disturbances as a precondition for metabolic syndrome in HCV seronegative heroin addicts. Am J Drug Alcohol Abuse, 37:196-202.
63. Ghazavi A, Mosayebi G, Solhi H, Rafiei M, Moazzeni SM (2013). Serum markers of inflammation and oxidative stress in chronic opium (Taryak) smokers. Immunol Lett, 153:22-26.
64. Soltaninejad K, Shadnia S (2018). Lead poisoning in opium abuser in Iran: A systematic review. Int J Prev Med, 9:3.
65. Nemati A, Jafari S, Afshari M, Dahmardeh S, Tabrizian K (2016). Comparing Blood Lead Level among Oral/inhaled Opium Addicts with a Non-addict Control Group in the Southeast of Iran. Addict Health, 8:235-241.
66. Salehi H, Sayadi A, Tashakori M et al (2009). Comparison of serum lead level in oral opium addicts with healthy control group. Arch Iran Med, 12(6), 555-8.
67. Masoodi M, Zali MR, Ehsani-Ardakani M et al (2006). Abdominal pain due to lead-contaminated opium: a new source of inorganic lead poisoning in Iran. Arch Iran Med, 9(1):72-5.
68. BeigmohammadiMT,AghdashiM,NajafiA et al (2008). Quadriplegia due to lead-contaminated opium. Middle East J Anaesthesiol, 19:1411-6.
69. Jalili M, Azizkhani R (2009). Lead toxicity resulting from chronic ingestion of opium. West J Emerg Med, 10:244-6.
70. Amiri M, Amini R (2012). A comparison of blood-lead level (BLL) in opium-dependant addicts with healthy control group using the graphite furnace/atomic absorption spectroscopy (GF-AAS) followed by chemometric analysis. Iran Red Crescent Med J, 14:488-91.
71. Aoki Y, Brody DJ, Flegal KM et al (2016). Blood lead and other metal biomarkers as risk factors for cardiovascular disease mortality. Medicine (Baltimore), 95(1):e2223.
72. Peacock W, Hollander J, Diercks D et al (2008). Morphine and outcomes in acute decompensated heart failure: an ADHERE analysis. Emerg Med J, 25:205-209.
73. Safaii N, Kazemi B (2010). Effect of opium use on short-term outcome in patients undergoing coronary artery bypass surgery. Gen Thorac Cardiovasc Surg, 58:62-67.
74. Azarasa M, Azarfarin R, Changizi A, Alizadehasl A (2009). Substance use among Iranian cardiac surgery patients and its effects on short-term outcome. Anesth Analg, 109:1553-9.
75. Rodrigues AD (2019). Drug-drug interactions. CRC Press.
76. Weizman R, Getslev V, Pankova IA, Schrieber S, Pick CG (1999). Pharmacological interaction of the calcium channel blockers verapamil and flunarizine with the opioid system. Brain Res, 818:187-195.
77. Fetrow CW, Avila JR (2001). Professional's handbook of complementary & alternative medicines. ed. Springhouse Publishing Company.
78. Kubica J, Kubica A, Jilma B et al (2016). Impact of morphine on antiplatelet effects of oral P2Y12 receptor inhibitors. Int J Cardiol, 215:201-208.
79. Hobl E-L, Stimpfl T, Ebner J et al (2014). Morphine decreases clopidogrel concentrations and effects: a randomized, double-blind, placebo-controlled trial. J Am Coll Cardiol, 63:630-635.
80. Hobl E-L, Reiter B, Schoergenhofer C et al (2016). Morphine interaction with prasugrel: a double-blind, cross-over trial in healthy volunteers. Clin Res Cardiol, 105:349-355.
81. Hansen PW, Clemmensen L, Sehested T, Fosbøl E et al (2016). Identifying Drug–Drug Interactions by Data Mining: A Pilot Study of Warfarin-Associated Drug Interactions. Circ Cardiovasc Qual Outcomes, 9:621-8.
Published
2019-12-02
How to Cite
1.
ZIAEE M, HAJIZADEH R, KHORRAMI A, SEPEHRVAND N, MOMTAZ S, GHAFFARI S. Cardiovascular Complications of Chronic Opium Consumption: A Narrative Review Article. Iran J Public Health. 48(12):2154-2164.
Section
Review Article(s)