Thallium poisoning: one additional and unexpected risk of heroin abuse

Afshari, Reza; Mégarbane, Bruno; Zavar, Abbas

doi:10.3109/15563650.2012.713110

Cited by 23 publications

(17 citation statements)

References 4 publications

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“…This may lead to serious but subtle toxicities. Following a case report by Questel et al (14), an outbreak of Tl exposure in chronic opioid users was reported by Afshari et al (13) from Iran in which recurrent symptoms of thallotoxicosis were attributed to adulterated street drug use (13). There could be found a statistically significant difference between the case and control groups in both quantitative and qualitative analyses reports; nevertheless, inconsistencies were detected, making definitive diagnosis less likely if not impossible.…”

Section: Discussionmentioning

confidence: 99%

“…Based on semi-quantitative Tl-screening test, <50 μg/L was considered negative, trace (50–100 μg/L), +1 (100–200 μg/L), +2 (200–300 μg/L), +3 (300–400 μg/L), and +4 (>400 μg/L) (13). …”

Section: Methodsmentioning

confidence: 99%

“…Opioids constitute common drugs used at a national level in Iran, ranging from opioid (82%), to opium ashes (28%), methadone for non-medical usages (16.6%), heroin and heroin/cracked (16%), morphine (2.6%) (12). In this respect, thallium has been identified as an infamous adulterant added by street druggists to opioids, heroin and cocaine, leading to intoxication at varying levels (13–16). To date, drug adulteration such as lead, Tl and steroid concurrent toxicities have not been investigated in admitted opioid overdose cases with history of drug use (17).…”

Section: Introductionmentioning

confidence: 99%

“…In Iran, where people believe that opioid consumption may prevent cardiovascular diseases, hypertension, and diabetes, is a problem looming larger than ever (18, 19). In previous articles, we reported clinical and preclinical findings of opioid and heroin poisoned patients with thallium exposure as an adulterant (13, 16). Tl in urine could be measured in qualitative and quantitative terms.…”

Section: Introductionmentioning

confidence: 99%

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Qualitative thallium urinary assays are almost as valuable as quantitative tests: implication for outpatient settings in low and middle income countries

et al. 2017

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BackgroundThallium (Tl), lead and steroid exposures were reported as a result of street drug consumption such as heroin and cocaine.ObjectiveThis study aimed to compare the values of qualitative and quantitative assays for detecting Tl as an adulterant in opioid-like compound drug users.MethodsThis case-control study was conducted throughout a specified time bracket ranging from May 2015 to November 2015 in Imam Reza Hospital, Mashhad, Iran. In general, urine thallium samples for 100 opioid overdosed subjects with a history of chronic opioid use and 50 non-drug users were studied. Qualitative 24 hours-urinary-thallium-level (QL) and quantitative 24 hours-urinary-thallium-level (QT) were conducted in both groups. Independent-samples t-test and Spearman’s Coefficient were applied for analytical purposes. SPSS software 16 was used to conduct statistical analyses with P values less than 0.05 regarded as significant.ResultsA total of 150 cases were studied. Raw opium users accounted for 66% of the cases followed by mixed (28%) and heroin users (6%). Mean (SD) QT level for QL was 26.8 (1) μg/L, while it was 2.3 μg/L (0.4 μg/L) for negative QL, which was far below QL positive cases (p=0.002). The qualitative test showed more accuracy at higher quantitative levels. In all cases, qualitative test was fully sensitive (100%), highly specific (89%) with a positive likelihood ratio (PLR) of 9.1 and a negative likelihood ratio (NLR) of 0.ConclusionThese results suggest that qualitative assays could be used with confidence in assessing Tl exposure in drug users. Physicians may easily and confidently use Tl qualitative tests in rehabilitation centers, where toxicology laboratories may not be available.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Qualitative thallium urinary assays are almost as valuable as quantitative tests: implication for outpatient settings in low and middle income countries

et al. 2017

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“…Street drugs are being adulterated with lead, steroids, thallium and … for economical benefits [3,4]. This will lead to further complications.…”

Section: Dear Editormentioning

confidence: 99%

First scientific report of a new derivative of street heroin in east of Iran

Afshari

Tabeshpour

2013

DARU J Pharm Sci

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Long‐term misdiagnosis and neurologic outcomes of thallium poisoning: A case report and literature review

Liu¹,

Liao²

2021

Brain and Behavior

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Thallium is one of the most toxic heavy metals and is widely used in the manufacturing of highly regulated products (Baldwin, 1999). The hallmark symptoms of thallium poisoning are digestive issues, alopecia, and polyneuropathy, each of which present at different stages following poisoning (Galván-Arzate, 1998). Here, we present findings from a patient who was poisoned with thallium on two separate occasions. We followed up the patient for 6 years to determine the long-term outcomes of his thallium poisoning.

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Thallium poisoning: one additional and unexpected risk of heroin abuse

Cited by 23 publications

References 4 publications

Qualitative thallium urinary assays are almost as valuable as quantitative tests: implication for outpatient settings in low and middle income countries

Qualitative thallium urinary assays are almost as valuable as quantitative tests: implication for outpatient settings in low and middle income countries

First scientific report of a new derivative of street heroin in east of Iran

Long‐term misdiagnosis and neurologic outcomes of thallium poisoning: A case report and literature review

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