Opium Research Articles

Drugs and the Addiction Aesthetic in Nineteenth-Century Literature, by Adam Colman

Reviewed by: Drugs and the Addiction Aesthetic in Nineteenth-Century Literature by Adam Colman Mike Jay (bio) Drugs and the Addiction Aesthetic in Nineteenth-Century Literature, by Adam Colman; pp. vii + 209. Cham: Palgrave Macmillan, 2019, €72.79, $84.99, £59.99. At the beginning of the nineteenth century, the term drugs referred to any medicine one might buy in a pharmacy, and the term addiction to the habitual enjoyment of any pleasure, often edifying ones such as reading or long walks. By the century's end, both terms had taken on their modern senses, more specialized and more censorious. This transition usually is described in medical terms, as involving the arrival of newly potent substances such as morphine and cocaine and methods of administration such as the hypodermic needle; the pathology of so-called morbid craving developed by clinicians from the 1870s onward; and the procession of statutory controls, beginning with the 1868 Pharmacy Act, that created a medico-legal category of the drug addict. Adam Colman proposes an alternative view: the development across the same period of an "addiction aesthetic" through which similar preoccupations were explored from a literary perspective. Colman defines the "addiction aesthetic" as a "repetitive, experimental" process that constantly "drives towards possible understanding" while never satisfying the desire that underpins it (17). It is a mode of scientific investigation, but equally of literary experiment, a hybrid form associated with the Brunonian theories of the maverick Edinburgh doctor John Brown (1736–88), who held that the body's energies can be stimulated or exhausted by the intellect and the imagination just as they can be by drugs. Brunonian theory was influential for many of the writers Colman examines, and Brown's ideas were recapitulated in cultural debates about the "literary addiction" of the Romantic era and the enervating thrills of late- Victorian sensationalism (168). Samuel Taylor Coleridge, an avid reader of Brown, is identified in this scheme as a pivotal figure in the transition from the digressive, picaresque eighteenth-century mode of literary exploration to more focused, iterative approaches that advertised the kinship between literature and science. Percy Shelley's interest in the formative power of habits, both medical and intellectual, is reflected in the patternings and recurrences that structure The Cenci (1819). Thomas De Quincey literalized these metaphors by writing directly about his drug habit and connecting it explicitly to his aesthetic patterning, framing his discovery of the self through opium as an obsessive pursuit that he compared to the labyrinths and cul-de-sacs of Giovanni Battista Piranesi's prison drawings. De Quincey was explicit, too, in presenting his work to the reader as a form of scientific investigation in which the experimental method was expanded to include memories, dreams, and visions. By mid-century, addictive drugs commonly were deployed as subject matter for literary meditations on consumption, temptation, and desire. Colman reads Alfred Tennyson's The Lotos-Eaters (1832) as a cautionary fable of opium addiction, whereby habituation to the drug is driven home with linguistic repetitions, though it could be interpreted equally as a nostalgic plea for rustic simplicity and refusal of the obsessive pursuits of the addiction aesthetic. Christina Rossetti's Goblin Market (1862) is less ambiguous in using the goblins' wares as a parable of uncontrolled consumption, reinforced by incantatory repetitions, as when Laura "sucked and sucked and sucked the more" in a doomed effort to quench her desire (127). Charles Dickens's Bleak House (1852–53), which was informed by his reading of Robert Macnish's study The Anatomy of Drunkenness (1827), develops the addiction aesthetic [End Page 343] through the form of the detective's quest, an iterative series of attempts to unlock the narrative's mystery. Many of the novel's characters and themes resonate with Macnish's theories, most obviously the endless lawsuit of Jarndyce and Jarndyce, a repetitive pursuit that continues until it has exhausted all available resources. The sensation novel, when it emerged in the second half of the century, often used drug addiction and the pursuit of knowledge as metaphors for one another. In The Strange Case of Dr. Jekyll and Mr. Hyde (1886), Robert Louis Stevenson sets Dr. Jekyll and his potion...

Effect of Educational Intervention Based on Health Belief Model on Prevention of Substance Abuse Among the Students of Khatam Al-Nabieen University in Afghanistan

Background: Addiction in Afghanistan, as the largest opium producer in the world, is relatively high, and limited studies have indicated that the youth, especially students are the majority of the addicted cases in this country. Objectives: This quasi-experimental study aimed at designing and evaluating the effect of educational intervention based on the Health Belief Model (HBM) on drug abuse prevention among the students of Khatam Al-Nabieen University in Afghanistan. Methods: In this quasi-experimental study, 120 students of Khatam Al-Nabieen University residing in Ghazni city, Afghanistan, were randomly divided into two groups of the intervention and control (60 students per group). The HBM-based educational intervention was performed for the intervention group. The data in both groups were collected and evaluated at four time points, including before intervention, and immediately, 3, and 6 months after the intervention using a valid researcher-made questionnaire. Results: Although there was no significant difference between the mean score of the HBM constructs (P > 0.05) before the intervention, the results of repeated measures ANOVA showed significant differences in the intervention group in HBM constructs and also intention toward substance abuse preventive behavior (P < 0.001). There were significant inter- and intra-group differences, as well as the group-time interaction in all HBM constructs mean scores (P < 0.001). Also, as the valuable finding, the preventive behavioral intention significantly (P < 0.001) improved following a 3- and 6-month follow-up in the intervention group (17.63 ± 1.34 and 17.66 ± 1.42, respectively) compared with the control group (10.95 ± 1.33 and 10.87 ± 1.22, respectively). Conclusions: The results showed that the HBM-based educational program by preventing substance abuse can help students adopt proper behaviors.

Pains, Guns and Moves: The Effect of the US Opioid Epidemic on Mexican Migration

The opioid epidemic and migration along the US–Mexico border are two of the most-debated policy issues in recent US politics. We show how these two topics are interlinked: the US opioid epidemic generated large Mexican migration flows. We exploit the fact that in 2010, a series of reforms to the US health care system resulted in a shift in demand from legal opiates to heroin. This demand shock had considerable effects on Mexico, the main supplier of heroin consumed in the US. Violence and conflicts increased in Mexican municipalities suitable for opium production, as they became highly valuable to drug cartels. People migrated out of these municipalities to escape this violence, mostly to areas close to the US border and into the US. The rise in US demand for heroin increased internal migration by an estimated 90,000 individuals and migration across the border at least by 12,000.

Abdominal pain related to adulterated opium: An emerging issue in drug addicts.

Lead may contaminate opium, heroin and illicit opiates and is particularly observed in Iran. Lead, a natural heavy metal is able to interfere with several organ functions after ingestion or inhalation. Lead poisoning manifestations are non-specific and thus lead poisoning remains difficult to diagnose. Among the manifestations, abdominal pain is almost the most frequent symptom causing patients to seek medical care. In patients with a history of opium addiction presenting with moderate-to-severe abdominal pain, lack of diagnosis of lead toxicity may thus result in time-consuming and unnecessary medical work-ups that can end up in invasive surgery. This paper aims to briefly review abdominal pain as an emergency issue and the leading symptom of lead poisoning that brings most of the patients to healthcare facilities. All published adult cases and case series of opium addicts admitted with abdominal pain due to lead-adulterated opium consumption have been reviewed. A trend of increasing numbers of lead poisoning cases has recently emerged among opium addicts in Iran. Due to the non-specific manifestations and hazardous effects, psychiatrists and emergency physicians should consider lead poisoning in patients with a past or present history of opium addiction referred for acute abdominal pain, particularly in case of colicky abdominal pain.

Lead poisoning; a neglected potential diagnosis in abdominal pain

BackgroundAbdominal pain may be a presenting symptom of lead poisoning and is often difficult to diagnose. This study aimed to determine the prevalence of abdominal pain in patients seen in the Laghman Hakim Hospital ED and GI clinic who were lead-intoxicated, with or without opiate use disorder.MethodsBetween July 2017 and January 2018, patients seen in the ED and GI clinic of Loghman Hakim Hospital with unexplained abdominal pain or abdominal pain resistant to treatment were enrolled. Informed consent was obtained from potential enrollees. For standardization, a pre-designed data collection tool was developed for uniform data acquisition. Opiate use was determined historically. For this study, lead poisoning was defined as a blood lead level (BLL) greater than or equal to 30 μg/dL (1.45 μmol/L) with concomitant GI symptoms.ResultsOf 125 patients admitted, 28 (22.4%) had BLLs higher than 30 μg/dL. None of the patients had signs and symptoms of opioid withdrawal syndrome during evaluation. Elevated BLLs were significantly correlated with oral opium use/abuse, history of addiction for over the preceding 12 years. The daily opium use was more than 2.75 g. There was a statistical correlation between lead toxicity and abdominal pain consistency and intensity, constipation, and paresthesias. Anemia, leukocytosis, and abnormal liver enzyme tests were laboratory findings associated with lead toxicity. Four patients died, one of whom was diagnosed with lead toxicity.ConclusionLead toxicity should be considered in the potential differential diagnosis of severe and resistant abdominal pain in patients referring to general EDs or GI clinics if a positive history of opium abuse exists.

Smoking Water-Pipe, Opium Use and Prevalence of Heart Disease: A Cross-sectional Analysis of Baseline Data from the Pars Cohort Study, Southern Iran.

Associations between hookah and opium use and an increased risk of ischemic heart disease (IHD) have been suggested in a few studies, but more research is needed on the nature of these associations. We aimed to investigate the association between hookah and opium use and the prevalence of IHD in a population with relatively high prevalence of these exposures in Iran. Using baseline data from the Pars Cohort Study (PCS), a prospective study of individuals aged 40-75 years in Fars province, southern Iran, we calculated adjusted and crude odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the independent association of hookah and opium use with prevalence of IHD. Of 9248 participants, 10.2% (95% CI: 9.5, 10.9) had self-reported IHD. Prevalence of ever use of hookah and opium was 48.9% (95% CI: 44.6, 53.6) and 10.2% (95% CI: 8.3, 12.5) among those with IHD, and 37.0% (95% CI: 35.7, 38.3) and 8.1% (95% CI: 7.5, 8.7) among those without IHD, respectively. Adjusted OR for the association with prevalence of IHD was 1.26 (95% CI: 1.08, 1.46) for hookah use and 1.71 (95% CI: 1.30, 2.24) for opium abuse. No dose-response association was found between hookah and prevalence of IHD. Hookah and opium abuse were associated with prevalent IHD in this study. Although more research is needed on these associations, particularly in prospective settings, reducing hookah and opium use could potentially reduce IHD risk.

Gandhi, De Quincey and Hali: The pleasures and pains of opium

This essay explores Gandhi’s representations of opium as indicative of the addictive nature of the colonial relationship in India. It also shows how the opium trade had an impact on Gandhi’s redefinition of food. Some submissions to the 1893–94 Royal Commission on Opium in India refer to De Quincey and reading De Quincey’s Confessions alongside Gandhi’s Hind Swaraj and Guide to Health reveals how both authors grappled with questions of dependency and selfhood in relation to modernity. I also discuss Gandhi’s representations of pleasure and opium alongside Altaf Hussain Hali’s (1837–1914), whom Gandhi admired as a reformist Urdu poet. Opium and intoxicants were a site on which colonial and postcolonial agency were both imagined and compromised in Gandhi, De Quincey and Hali.

Pelaksanaan Opiumpacht: Monopoli Perdagangan Opium Melalui Perantara Bandar di Keresidenan Kediri, 1833-1900

The opium trade in Kediri Residency was monopolized by Dutch East Indies government. The problem discussed in this study regarding opium trade monopoly at Kediri Residency through bookie intermediary (opiumpachter) in 1833-1900. The methods used in this research is historical methods which includes heuristics, criticism, interpretation and historiography. The result showed that the opium trade monopoly through bookie intermediary (opiumpachter) in Kediri Residency included auction and distribution processions also the sale of raw opium to opium dealers. Generally, the opium trade in Kediri Residency was controlled by Chinese. They become intermediary traders who sell government opium to people in Kediri Residency. The high tax offer at opium auction in Kediri Residency gave high profits to the country. On the contrary, that puts a great deal of pressure on the opium port. The crisis which occurred at the end of the 19th century, caused a setback in the opium trade monopoly through bookie intermediary (opiumpachter) in Kediri Residency.

Blood Lead Level and Toxicity in Opium Smokers; a Comparison between inhalation and Ingestion of Opium

Objectives: During the recent years, risk of lead poisoning has increased in Iranian’s opium users. A few researches showed that the most common route were ingestion of lead contaminated opium in these patients. However, some use of inhaler opium and data on lead poisoning through this route is scarce. The aim of the current study was to determine lead poisoning in opium users who consume it inhalational. Methods: In this case-control study, blood lead level (BLL) and clinical Lead poisoning assessed and compared between pure inhalational and pure ingestionally chronic opium users and healthy controls. Results: There were totally 90 cases, 30 patients in each group (pure inhaler opium users, pure oral opium users, and control group). In chronic opium users (case group), mean age of the patients was 48.91±13.14 yeas (range; 22 to 79 years). Eighty-four (85%) patients were male (Male to Female ratio; 5.6/1). Mean BLL was 10.6 ±4.2, 126.1 ±52µg/dl, in inhalational opium users and ingestional users, respectively (P=0.001). The mean of BLL in healthy control group was and 4.78 µg/dl ± 1.83. Conclusions: In contrast to chronic ingestion of opium, the probability of absorption of lead via lungs is low when opium used by smoking and inhalation route. So, lead toxicity is not common in acute or chronic inhalational users of lead-contaminated opium.

The Prevalence and 5-Year Incidence Rate of Low Physical Activity in an Urban Population of 10,000 in Southeastern Iran: Relationship With Other Cardiovascular Risk Factors.

Because of high prevalence of coronary artery diseases (CADs) in Iran and their relationship with low physical activity (LPA), this study aimed to measure the epidemic size of LPA, its incidence rate, and its relationship with other CAD risk factors in Kerman, Iran. About 10,000 adults were randomly recruited through single-stage cluster sampling. Demographic characteristics, biochemical variables, smoking, opium use, mental status, and physical activities were assessed. The relationship between LPA and 7 other CAD risk factors was measured. Five-year incidence rate of LPA was calculated according to the data from the physically active participants in the first phase of the study (n = 3416) who attended the second phase after 5 years. The prevalence of low, moderate, and intense physical activity was 47.2%, 34.8%, and 18.0%, respectively. LPA rose from 45.1% to 62.2% after the age of 25 years. Women had higher LPA than men. Participants with LPA had significantly higher chance of cigarette smoking, diabetes, overweight/obesity, hypertension, and opium addiction. Five-year incidence rate of LPA was 5.1 persons/100 person-years among physically active population. Almost half of the studied population suffering from LPA was at risk of CAD. Such risky lifestyle pattern while worsened in the last 5 years makes the emerging of CAD epidemic unavoidable, if appropriate timely interventions not being in place accordingly.

A National survey on substance use among Iranian industrial workers.

Background: Recent evidence shows that the prevalence of substance abuse is 2.1% in Iranians aged 15-64 years, while reported rates are higher in studies that target industrial workplaces. Our study intends to provide a national picture of substance use among industrial workers in Iran. Methods: This survey was designed to collect data through interviews and dipstick urine tests. Using a multi-stage sampling approach, we recruited our study subjects from a representative sample of industrial workers from all provinces in 2015. Data were weighted to estimate the prevalence rate of substance use. Odds ratios were calculated through adapting logistic regression to test the strength of association between substance use (based on self-report and urine test) and sociodemographic factors including sex, age group, education level, marital status and worker’s professional training status. All statistical analyses were conducted using SPSS Version 22. P <0.05 was considered significant. Results: We analyzed the data collected from 13,128 participants; both self-reported use and urine test results. Majority of the respondents were male (n=12077, 92%), aged 21-40 years old (n=9491, 72.3%), had finished middle/secondary school (n=8353, 63.6%) and were married (n=11012, 83.9%). Opium was the most popular abused substance (n=352, 2.7%) followed by alcohol (304, 2.3%), based on self-reports. Urine tests showed that 23.8% (n=3105) of the participants had a positive result for the use of opiates/opioids, crystal meth and/or cannabis. The highest rate of substance use reported from a province was 60.50%; the lowest provincial rate was 9.0%. Conclusion: Nearly a one-fourth of Iranian industrial employees are engaged in use of substances with significant geographical distribution. Urine test is the recommended method to assess the prevalence of drug use among industrial workers in Iran.

CRT-100.52 Opium Addiction Has No Effect on Outcome in Patients Presenting With ST Elevation Myocardial Infarction

Myocardial infarction is one of the most important causes of mortality worldwide. To date, multiple risk factors have been described; however, the role of opium addiction is not yet clarified and there are many unproven beliefs surrounding it. This study was performed to evaluate the effects of

Illegal Markets and the Formation of a Central Asian Borderland: The Turkestan–Xinjiang opium trade (1881–1917)

AbstractThis article utilizes material from archives in Kazakhstan, Russia, Kyrgyzstan, and Uzbekistan as well as published Chinese sources to explore the opium trade between Tsarist Turkestan and Xinjiang from the early 1880s to 1917. It focuses on two different levels: the borderlands economy and society, and state policies towards illegal (or ‘grey’) markets. The main groups active in the trade were Hui/Dungan and Taranchi migrants from China, who had fled Qing territory after the repression of the great anti-Qing Muslim revolts during the 1860s and 1870s. After settling in Tsarist territory, they grew poppies and exported opium back across the border to China. This article shows how the borderland economy was influenced by the late-Qing anti-opium campaign, and especially by the First World War. During the war, the Tsarist government tried to create a state opium monopoly over the borderland economy, but this attempt was botched first by the great Central Asian revolt of 1916, and later by the 1917 revolution. Departing from the prevailing historiography on borderlands, this article shows how the international border, far from being an obstacle to the trade, was instead the main factor that made borderland opium production and trade possible. It also shows how the borderland population made a strategic use of the border-as-institution, and how local imperial administrators—in different periods and for different reasons—adapted to, fostered, or repressed this most profitable borderland economic activity.

Status of clinical toxicology education and ethics in medical care of poisoned patients in the Islamic Republic of Iran and a comparison with other countries.

Clinical toxicology is not recognized as a clinical speciality in Iran. After the chemical war gas attack by the Iraqi army against the Iranian troops in the 1980s, health professionals and Iranian authorities noticed the importance of this field in clinical medicine. Collaboration between the clinical toxicologists and toxicologists of pharmacy schools resulted in the establishment of the Iranian Society of Toxicology and Poisonings in 1991 and the National Board of Toxicology in 1993. Clinical toxicology fellowship was also formed as a joint collaboration between the toxicology and internal medicine boards in 2010. Medical doctors who specialized in clinical medicine are eligible to take the entrance examination of the fellowship. In spite of the advancement of clinical toxicology and increased number of acute poisonings and drug abuse, undergraduate teaching in this field is still lacking and being taught as part of the forensic medicine curriculum since 1952. There is a lack of an efficient national poison information and control centre (s) in Iran, and no action plan and practical efforts have been done for poisoning prevention. Therefore, the number of drug abuse and acute poisonings has increased over the past four decades and induced cultural, social and health problems. According to Iranian legal medicine organization reports, poisoning is the second-most occurring cause of unnatural death. The suicidal attempt is the most common method of acute poisoning in adults. Suicidal attempt including self-poisoning is not accepted in the Islamic point of view, and thus self-poisoning is mostly neglected and may not be treated appropriately in time in some regions of Iran. Accidental poisoning in children is also common in Iran and estimated to be between 20000 and 25000 cases annually over the recent years. In addition, social, cultural and economic problems have induced more health problems such as drug abuse and addiction even in children. Adulterated opium to lead for economic gaining has produced thousands of cases of lead poisoning over the past few years in nearly all opium addicts, which is still a major health problem in Iran. Ban on alcoholic beverages leads some people to make their own home-made spirits, which is unfortunately contaminated with methanol. Thousands of cases of methanol poisoning and even some epidemics have occurred over the past four decades in some parts of the country. Lack of availability of essential antidotes such as succimer and fomepizole has been a major problem for the effective treatment of poisoned patients. Despite the well-known fact that cases of poisoning and drug overdose constitute a significant proportion of hospital admissions in some developing countries, clinical toxicology education and medical care of the poisoned patients are lacking. Therefore, policymakers and health authorities should realize the importance of toxicology in clinical medicine. The Iranian Ministry of Health, medical care and Medical Education should implement clinical toxicology courses for medical students; establish effective national poisons information and control centres and advance clinical toxicology services for appropriate management of poisoned patients to improve public health and the overall health policy goals.

Towards Global Governance: The Inadequacies of the UN Drug Control Regime

Human rights and the UN drug control regime have long had an uneasy relationship, which is evident today in the tensions that exist between criminal justice reform advocates, the institutions of the UN drug control regime, and economic interests that stand to benefit from decriminalization and legalization efforts. The UN drug control regime's relationship with human rights cannot be properly discussed without acknowledging its colonial and racist roots. From the earliest agreement on drug control in 1909, born out of the crisis of opium dependency caused by the forced opening of China to trade in opium by the British, to the 1988 United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, which was a product of America's war on drugs, international efforts to regulate drugs have never been for the benefit of those who have suffered the most from both the supply of drugs and its criminalization. The war on drugs has been a global war from the beginning, arising out of colonial structures that centered white/European racial dominance. The inadequacies of the international drug regime and current efforts to reform it are rooted in this historical legacy. In light of this, we argue that efforts by international bodies to center human rights in the discussion on reforming the UN drug control regime are, so far, insufficient. Only through recognizing the power imbalances at play can we advance the possibility of a system that values individuals and responds to a changing landscape where corporate interests are coming to the table in the context of decriminalization and legalization.

A 29-year-old man presented with acute upper gastrointestinal bleeding.

[1] A 29-year-old man was admitted to the emergency department of Taleghani hospital; a teaching referral hospital in Tehran, Iran, with an acute upper gastrointestinal (GI) bleeding. On admission, he was found to have severe hematemesis since 6 hours before his arrival following an episode of intractable nausea and vomiting. He was single, residing in Tehran, Iran. He had a history of a 10 pack-year smoking, opium addiction and social alcohol consumption but denied usage of other illicit drugs, other medications including NSAIDs and other over-the-counter drugs. He had a history of stab wound 5 years ago leading to pneumohemothorax requiring a chest tube insertion. He did not mention any melena, defecation and gas passing since 2 days ago. He was not found to have any significant abdominal pain on admission. Four hours post admission, he was still conscious and oriented to the questions we were asking and he was still complaining about severe nausea. He had a temperature of 37.8o C. His blood pressure was 110/75mmHg. He had tachycardia of about 100 beats per minute. Resuscitation with IV fluids started. His physical examination was notable for a mild tenderness in left upper quadrant of the abdomen, dullness to percussion in the left thorax and decreased lung sounds on auscultation in the left lung but the examination of other organs was unremarkable. NG (nasogastric) tube was inserted and fresh bleeding was detected in the tube. His laboratory tests revealed an Hb of 12 gr/dl which was significantly lower than his previous Hb which was documented 18 gr/dl. No leukocytosis and thrombocytopenia was detected. His VBG was within normal limits. Kidney function tests, serum electrolytes, liver function tests, pancreatic enzymes and other biochemical tests were all unremarkable. Being hemodynamically stable but with an ongoing blood loss which demonstrated a serious risk for making him unstable in the near future, an emergent upper GI endoscopy was performed which revealed a completely congested and inflamed mucosa of fundus unable to be inflated in retroflex view. No active bleeding and source of bleeding was detected. Scope could not be passed into the distal part of stomach (figure-1). Abnormal auscultation of the lungs urged evaluation of thoracic field. Chest x ray (figure-2) and thoracic spiral CT scan (figure-3) were demanded. Six hours post admission, he was found to have tachypnea and shortness of breath. He spiked a heart rate of 120. What is your diagnosis? What is the next step? Received: 28 May 2020 Accepted: 18 July 2020 Reprint or Correspondence: Pardis Ketabi Moghadam, MD. Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail: ketabimoghadam.p@gmail.com ORCID ID: 0000-0001-7110-2950

Diagnostics of Dysthymic Disorders and Therapy of Patients with Opium Addiction with AnxietyDepressive Variant of Post-Withdrawal Syndrome

Diagnostics of Dysthymic Disorders and Therapy of Patients with Opium Addiction with AnxietyDepressive Variant of Post-Withdrawal Syndrome

Cerebrospinal Fluid and Spinal Anesthesia Parameters in Healthy Individuals versus Opium-addict Patients during Lower Limb Surgery.

BackgroundStudies have reported lower pain threshold, spinal anesthesia duration, and level of sensory block in addicts compared to non-addict patients undergoing spinal anesthesia for surgery. Moreover, blood gas and cerebrospinal fluid (CSF) were likely to be affected as well. The aim in the present study is to evaluate CSF and spinal parameters in addict versus non-addict patients during lower limb surgery.MethodsIn this case-control study, 22 opium addicts and 22 sex- and age- matched non-addicts undergoing lower limb surgery under spinal anesthesia were included. The CSF parameters, venous blood gas (VBG), and sensory and motor block findings were compared between the groups.FindingsThe addict and non-addict patients were similar regarding CSF and blood gas parameters except higher pH in VBG (7.39 ± 0.06 vs. 7.33 ± 0.11, P = 0.030) and CSF (7.39 ± 0.06 vs. 7.33 ± 0.11, P = 0.030) for addict patients. The addict patients had significantly later onset of sensory block (5.72 ± 1.57 vs. 3.16 ± 0.93 minutes, P < 0.001) and shorter motor block duration (137.72 ± 11.51 vs. 149.09 ± 14.44 minutes, P = 0.006), with no significant difference in the sensory block duration and motor block onset.ConclusionAddict patients have delayed onset of sensory block with shorter duration of motor block and lower sensory block level. Among the blood gas and CSF markers, only pH was significantly higher in addict patients, needing further evaluations; however, it seems that addiction has no significant effect on these parameters.

Colonial Diaspora in the Ibis Trilogy of Amitav Ghosh

The Ibis trilogy of Amitav Ghosh, which comprises three historical fictions, Sea of Poppies(2008), River of Smoke(2011), and Flood of Fire(2015), is a documentary of the opium trade between India and China and the trafficking of people as indentured labors by the East India Company during mid nineteenth century. Diaspora and enigma of crossing the ‘shadow lines’, the geographical boundaries between countries and continents, find room in the trilogy which is a common feature of Ghosh. The merchants, the sailors, or the trading company agents, who crosses the ‘black water’ out of their own interests, share some common experiences of homesickness, anxiety, anguish and adversity with those of the unwilling overseas transporters like the coolies and convicts. Along with these effects, they also share some common grounds, an influential concern, the British colonization as well as the role of East India Company. Almost all the characters of the trilogy are diasporic, who undertake voluntary or forcible movement from their homelands into new regions, are revealed to be somehow connected with the colonization. This paper intends to trace out those functions of the British colonization, specially the opium trade run by the East India Company that constructed the socio-economic life of India and Canton, and how they are responsible for all these enigma of border crossings found in Ibis trilogy.

Opium poppy in Afghanistan: The determinants of cultivation

In this article we examine increasing opium poppy cultivation in Afghanistan since 2001. First, we discuss the historical background for the emergence and spread of opium production in Afghanistan in the 20th century and its current spatial distribution. Then we proceed with our statistical analysis. Our results show that the intensity of violent conflict (which we proxy by the number of military casualties in a calendar year) and the farm gate price of opium are positively correlated with the increase in opium cultivation. We find that a 1% increase in conflict intensity leads to 0,2% increase in the land under opium poppy cultivation the following season. Given the magnitude of the increase in the intensity of conflict in Afghanistan in 2010s these effects seem to be very significant. Our findings are in line with existing research on the topic. Higher conflict intensity and the expansion of the conflict zone may create conditions, where opium cultivation is a low-risk activity and may be preferable to the production of other agricultural goods, with southern regions of Afghanistan being particularly affected both by higher conflict intensity and opium production. However, we note that our analysis is constrained by data quality and availability and should be viewed as capturing some of the interconnection between the variables of our choice, but not strictly causal.