Lead poisoning and its clinical manifestation in opium users: a case series

The practice of adding lead to opium to increase its weight resulted in lead poisoning among opium user, especially those who consume it orally. This study aims to examine patients with symptoms of lead poisoning who are opium users.

We retrospectively investigated the records of 20 Iranian patients who were opium users and presented with symptoms and signs of lead poisoning. Regarding the route of opium administration, 3 patients (15%) reported smoking only, 2 patients (10%) reported oral ingestion only, and the majority of cases (15 patients, 75%) reported combined use of smoking and oral ingestion. All were married and 85% were male, with a mean age of 57.8. The average duration of opium dependence was 19.7 years, with a mean daily consumption of 2.1 g. They reported severe abdominal pain, with or without central nervous system symptoms. Blood lead levels in the patients ranged from 30 to 833 µg/dL, with two patients exceeding 600 µg/dL. Chelation therapy was used for 80% of patients, resulting in 45% having full recovery, 40% partial recovery, and a fatality rate of 15%.

This case series emphasizes the importance of awareness among both opium users and medical staff regarding the risks related to lead poisoning due to contaminated opium. Patients should be informed about the potential contamination of opium, which can cause serious gastrointestinal and neurological symptoms, and even death. Healthcare providers should maintain a high index of suspicion for lead poisoning in opium-addicted patients presenting with compatible symptoms, ensuring early diagnosis and timely treatment, such as chelation therapy.