Abstract
No countrywide data exists on the patients’ characteristics of lead exposure in Iran. We aimed to evaluate the demographic characteristics and blood lead level (BLL) of these patients in the country scale during five consecutive years, including the epidemic outbreak year (2016). Between 2014 and 2018, records of all patients who had referred to two reference laboratories in Tehran, Iran, to check BLL were evaluated. Of 58,642 patients, 48,589 were male. Mean age was 44.9 ± 20.7 years. Males had higher BLLs and were significantly older. Median BLL was 16 µg/dL (0.3 to 263 µg/dL). Median BLL was significantly higher in 45- to 60-year-old patients. The highest median BLL was reported in May 2016 confirming our records about the peak of the epidemic. Although the frequency of high BLL declined after 2016, it never returned to the measures before that. Considering the ongoing high prevalence of increased BLLs after 2016 and similar environmental and occupational exposures as before, lead-contaminated opium still seems to persist in the Iranian opium black market. Substitution of this lead-contaminated opium by Opioid Maintenance Therapy (OMT)-prescribed opium tincture is recommended.
Highlights
Heavy metal poisoning has been an issue in ancient countries, including Iran[1]
Of the 58,642 patients whose blood lead level (BLL) had been checked by these two reference laboratories, 48,589 (82.9%) and 10,053 (17.1%) were male and female, respectively
Mann Whitney U test showed that median BLL was higher in males (z = 4834, P < 0.001). 18,369 (31.3%), 29,401 (50.1%), and 10,872 (18.5%) patients had BLLs less than 10, 10-50, and over 50 μg/dL, respectively. 27.6% of the males and 49.4% of the females had BLLs < 10
Summary
Heavy metal poisoning has been an issue in ancient countries, including Iran[1]. Lead can be absorbed inhalationally and/or through gastrointestinal route especially in children[2,3]. Opium impurities and lead-contaminated opium were recognized as a possible cause of lead poisoning in Iran[3,11] After recognizing this health threat, some studies evaluated lead-contaminated illicit drugs in Iran. Heroin and Iranian crack samples had 48.8 μg/g and 30.8 μg/g lead, respectively This was again an endemic problem in Iran until 2016 when an epidemic of lead poisoning due to lead-contaminated opium peaked[14]. Studies during this period mentioned the possibility of existence of more than 42,000 lead-poisoned patients[15]. This study aimed to determine the basic characteristics and mean BLL of the patients during a five-year period of the study including the year of the epidemic outbreak to see any changes in the Iranian BLL trend in the country
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