Opium Use and Risk of Mortality from Digestive Diseases: A Prospective Cohort Study

Abstract

Background Opium use, particularly in low doses, is a common practice among adults in northeastern Iran. We aimed to investigate the association between opium use and subsequent mortality from disorders of the digestive tract. Methods We used data from the Golestan Cohort Study (GCS), a prospective cohort study in northeastern Iran, with detailed, validated data on opium use and several other exposures. A total of 50,045 adults were enrolled during a four-year period (2004–2008) and followed annually until December 2012, with a follow-up success rate of 99%. We used Cox proportional hazard regression models to evaluate the association between opium use and outcomes of interest. Results 8,487 (17%) participants reported opium use, with a mean duration of 12.7 years. During the follow-up period 474 deaths from digestive diseases were reported (387 due to gastrointestinal cancers and 87 due to nonmalignant etiologies). Opium use was associated with an increased risk of death from any digestive disease (adjusted hazard ratio (HR) = 1.55, 95% CI 1.24 – 1.93). The association was dose-dependent, with a HR of 2.21 (1.57–3.31) for the highest quintile of cumulative opium use vs. no use (Ptrend = 0.037). The hazard ratios (95% CI) for the associations between opium use and malignant and nonmalignant causes of digestive mortality were 1.38 (1.07 – 1.76) and 2.60 (1.57 – 4.31), respectively. Increased risks were seen both for smoking opium and for ingestion of opium. Conclusion Long-term opium use, even in low doses, is associated with increased risk of death from both malignant and nonmalignant digestive diseases.

Global incidence of oesophageal cancer by histological subtype in 2012

“…In the latter study, high-temperature cooking methods, including barbecuing and frying, were also found to increase the risk for oesophageal cancer. In Iran, opium use has been found to increase mortality from oesophageal cancer by 50% 26. Also, low socioeconomic status, poverty and poor oral hygiene have been linked to an increased risk of oesophageal SCC 23 27 28.…”

Gastric Cancer: Descriptive Epidemiology, Risk Factors, Screening, and Prevention

“…Among these risk factors are poor oral hygiene and tooth loss (37, 113, 114), opium use (36, 115-117), infection with Ebstein-Barr virus (118, 119), and eating pickled vegetables (120). …”

Efficacy of pharmacological therapies for the treatment of opioid-induced constipation: systematic review and network meta-analysis

“…In the West, there is an epidemic of opioid prescribing,3 4 which in USA has led the surgeon general to discourage strongly the prescription of these drugs for non-malignant pain in adults 5. As well as the risk of long-term addiction and higher rates of death among opioid users,6 these drugs have undesired actions on the GI tract, due to the location of µ-opioid receptors. Opioids lead to delayed GI transit and hard, infrequent stools,7 with up to 50% of individuals taking these drugs reporting constipation, which they attribute to opioid use 8 9…”