A new illicit opioid dependence outbreak, evidence for a combination of opioids and steroids

Abstract

Opioid abuse is common in Iran. In 2005, a new version of locally produced illicit opioid vials, so called Norgesic, appeared in the illicit market, which gained popularity rapidly and led to an improvement of stigmatizing the general appearance of dependent cases. Later, some cases suffered Cushing's-like problems. A prospective case series was designed to evaluate 18 Norgesic-dependent subjects who volunteered for abstinence therapy in a rehabilitation clinic from November 1, 2005, to December 30, 2005. In this study, we aimed to describe the clinical and paraclinical findings in detail and define the potential determinants of this Cushing's syndrome outbreak. History, physical examination, plasma cortisol level, and urine screen tests were used to describe the patients. All subjects were male with a mean (SEM) age of 29.8 +/- 1.6 years. The opioid-dependence period was 8.4 +/-0.9 years. In an average of 4.7 +/- 0.3 months, subjects increased their usage to 5.5 +/- 0.5 vials a day. Patients claimed to gain weight. Striae were seen in 38.9%, previously documented psychological problems in 33.3%, weakness in 27.8%, high systolic blood pressure in 22.2%, moon face in 16.7%, hirsutism in 11.1%, extensive dermal infection in 11.1%, gynecomastia in 5.6%, back pain in 5.6%, insomnia in 5.6%, and lack of potency in 5.6%. Their cortisol level, on average, was 4.8 +/- 1.1 microg/dL. Hepatitis C virus was positive in 22.2%. Urine-screening tests were positive for morphine and negative for buprenorphine. In conclusion, these new vials contain steroids as well as opioids. This combination could be more dangerous than opioids themselves.

Factors Related to Seizure in Tramadol Poisoning and Its Blood Concentration

“…Opioid dependency, overdose, and related complications are common in Iran in various age groups and gender [6,7]. In recent years, tramadol overdose has become one of the most common causes of poisoning admissions to emergency departments in this country [5,[8][9][10]].…”

Factors Associated With the Course of Femoral Head Osteonecrosis; A Retrospective Study

“…The systemic and musculoskeletal complications of Temgesic abuse imposed a heavy burden on the healthcare system in the recent years (4,5). This drug has been widely abused as a result of its low cost and its ability to mask the typical malnourished appearance of opium-dependent patients.…”

“…Temgesic vials contain corticosteroids and almost all abusers have signs of hypercortisolism, such as striae on their abdominal skin (4). Biochemical studies revealed that the available product in Iran consists of diacetylmorphine, acetylcodeine, pheniramine and heroin (4,5,15). As each vial contains 0.4mg Dexamethasone (4), patients of the present study had received an average of 767 mg (ranged 299 to 1792) Dexamethasone by the time of pain onset, which is equivalent to 5061 mg (ranged 1973 to 11827) of prednisone (16).…”

“…Of note, there has been an increased incidence of osteonecrosis in drug abusers in Iran following the introduction of "Temgesic" to the illicit market several years ago (4). Temgesic is a combination of opioid and steroid medications and is used intravenously (5).…”

The toxic effect of opioid analgesics on human sperm motilityin vitro

“…It was well known that continual use of opioids could result in the tolerance and dependence of opioids (Koushesh et al, 2009). Prenatal exposure to opiates can have devastating effects on the development of human fetuses (Slamberová et al, 2005).…”