Street Level Heroin, an Overview on Its Components and Adulterants

Akhgari, Maryam; Etemadi-Aleagha, Afshar; Jokar, Farzaneh

doi:10.1016/b978-0-12-800213-1.00081-x

Cited by 23 publications

(29 citation statements)

References 56 publications

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“…Petty dealers sell methamphetamine and prescription opioids to distributor networks as well as drug users . Adulterated drugs can cause health‐related harms and death . As documented by other surveys, methamphetamine has been used in patients seeking opiate cessation in Iran.…”

Section: Discussionmentioning

confidence: 99%

“…An other reason for inducing death after poly drug use of methadone with other sedative/hypnotics is reduced tolerance due to drug‐free period, that is a gradual process which happens within days to weeks . The problem arises when drug users use prescription opioids and adulterated street drugs with unknown purity as an attempt to produce euphoria in the initial abstinence phase of treatment .…”

Section: Discussionmentioning

confidence: 99%

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Forensic Toxicology Perspectives of Methadone‐associated Deaths in Tehran, Iran, a 7‐year Overview

Akhgari

Amini-Shirazi

Iravani

2017

Basic Clin Pharma Tox

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Methadone has a long history of pain relief and successful substitute for maintenance treatment in heroin and narcotic addiction. The aim of the study was to assess the trends of methadone-associated deaths in Tehran, Iran, in 2009-2015, from a forensic toxicology point of view. All methadone-associated deaths during this 7-year study period were evaluated according to demographic parameters and forensic toxicology analysis results. Results showed that 1274 cases of methadone-associated deaths were investigated during the study period. The incidence rate of methadone-associated deaths had risen 7.7 times in 2015 in comparison with 2009 (p < 0.05). The majority of cases were men (90.35%), aged from 20 to 40 years. About 80% of cases had shown positive results for other drugs and poisons in combination with methadone. Methamphetamine and tramadol were the most drugs detected in post-mortem samples. Death rates among methadone users in Tehran, Iran, increased year by year during 2009-2015. These findings raise the attention to the concomitant use of drugs with the need for changes in regulation and regulatory policy to restrict access and use of controlled drugs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Forensic Toxicology Perspectives of Methadone‐associated Deaths in Tehran, Iran, a 7‐year Overview

Akhgari

Amini-Shirazi

Iravani

2017

Basic Clin Pharma Tox

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“…Besides impurities in street drugs can cause health hazards [ 7 ]. In Iran, street MA (Shishe) is an impure cocktail of different chemicals originated from manufacturing processes and other active pharmaceutical ingredients with unknown doses [ 7 , 40 , 41 ]. In previous studies conducted on street MA samples in Iran many impurities of origin such as N-acetylmethamphetamine, N,N-dimethylamphetamine, phenmethrazine and benzaldehyde were detected [ 7 , 42 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Histopathological study of cardiac lesions in methamphetamine poisoning-related deaths

2017

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BackgroundMethamphetamine abuse is a worldwide health concern. Methamphetamine causes health hazards in many vital organs. It can cause damage to cardiac tissue via catecholamines release. Methamphetamine related deaths are becoming one of the most important problems in Iran. The purpose of the present study was to determine cardiac pathology in methamphetamine poisoning-related deaths.MethodsThe study included 100 cases of methamphetamine poisoning-related deaths and 100 cases as control group. Toxicology analysis of liver, gastric content, bile, urine, blood and vitreous humor were conducted to detect drugs, poisons and alcohols using thin layer chromatography, gas chromatography/mass spectrometry, and high performance liquid chromatography. Positive toxicology analysis results except for amphetamine and methamphetamine were excluded from the study in order to omit interfering factors. The most striking features of cardiac damage were observed by light microscopy.ResultsMethamphetamine and amphetamine were detected in either urine or gastric content samples. In all of the cases methamphetamine toxicity was determined to be a direct cause of death by forensic medicine practitioner. Cardiovascular pathology was noted in 68% of studied cases. The most common histopathologic features were myocardial fiber hypertrophy, mild, moderate to severe atherosclerosis and focal degeneration/necrosis.ConclusionThe results of the present study indicate that cardiotoxicity is one of the major contributing factors in methamphetamine poisoning related deaths. Overall, the current study highlights the fact that cardiotoxic effects of methamphetamine can explain increasing reports of heart failure and consequently death in young abusers.Trial registrationNot applicable.Graphical AbstractHistopathological study of cardiac lesions in methamphetamine poisoning-related deaths

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“…The results indicated that the majority of deaths were ascribed to opioid poisoning. This is possibly due to several factors such as poly substance abuse, use of impure street level opium, mass production and smuggling of opium by Afghanistan (Iran's neighbour to the east) and many other factors [11][12][13][14] .…”

Section: Resultsmentioning

confidence: 99%

Analysis of Intoxication Deaths: Causes and Manners of Death

Akhgari¹,

Kahfi²,

Akha³

2019

pharmaceutical-sciences

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Drug poisoning related deaths are considered as deaths in which at least one drug or poison is detected in postmortem samples and attributed to death. Drug could be a causative agent and poisoning with that drug a contributory factor leading to death [1]. Type of drug used, health status, licit and illicit drug availability and geographic position are factors affecting the pattern of poisoning. Therefore, epidemiologic studies can help to define intoxication deaths and its pattern [2]. Various approaches and studies are available for estimating intoxication deaths. United Nations Office on Drugs and Crime (UNODC) estimated that 264 million people (one out of twenty) aged 15-64 y had used one illicit drug in 2013. In this report it was indicated that 187/100 deaths were related to drug use [3]. According to the investigation of European Drug Markets Report in 2016, some countries that use protocols and practices of substitution treatment, face drug related deaths too [4]. Social Affairs Bureau damage of Ministry of Cooperative, Labour and Social Affairs of Iran reported changes in the pattern of drug abuse. There was a 28 % increase in the seizure of clandestine methamphetamine laboratories from 2005 to 2013 [5]. United Nations reported that Iran ranked fifth behind Mexico, United States, China and Thailand in methamphetamine seizure between 2010-2012 [6,7]. Drug related deaths were investigated by American and European researchers [8,9]. Iranian Legal Medicine Organization documented that 551, 627, 599 and 747 cases of drug poisoning related deaths were investigated during 2010-2013 [10]. There are informal reports that drug related deaths have surged in some provinces in Iran. Assessment and documenting drug related deaths is of crucial importance in every province in Iran. To accomplish this goal all assumed death poisoning cases in Qom province, Iran are subjected to forensic autopsy and forensic toxicology investigation to establish the

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Street Level Heroin, an Overview on Its Components and Adulterants

Cited by 23 publications

References 56 publications

Forensic Toxicology Perspectives of Methadone‐associated Deaths in Tehran, Iran, a 7‐year Overview

Forensic Toxicology Perspectives of Methadone‐associated Deaths in Tehran, Iran, a 7‐year Overview

Histopathological study of cardiac lesions in methamphetamine poisoning-related deaths

Analysis of Intoxication Deaths: Causes and Manners of Death

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