The use of opium is linked with a sharply increased risk of death, particularly among women, according to a new study.

Researchers at Teheran University (Iran) conducted a large prospective cohort study involving 50,045 participants (ages 40-75) in the northeastern Iran province of Golestan, where ingestion or smoking of various forms of opium is common and considered acceptable. More than half the participants were women, with the majority married, living in rural areas, and nonsmokers (83%); more than two-thirds had no formal education. A total of 17% had used opium, beginning at a mean age of 40 and for a mean duration of 13 years. The most common form of opium used was teriak--raw opium that can be either ingested orally or smoked--at a mean quantity per day of 0.6 g, considered a relatively small amount. The main outcomes measure was all cause mortality.

The results showed that during a median follow-up period of 4.7 years, there were 2,145 deaths. Aside from female sex, factors associated with a higher risk of mortality were urban residence, with a hazard ratio (HR) of 2.32; obesity, HR 2.25; and never having smoked cigarettes, HR 2.07. The researchers also identified the major causes of death among opium users, which included infections (HR 5.47), respiratory conditions (HR 3.78), digestive disorders, (HR 3.12), ischemic heart disease (HR 1.90), and lung cancer (HR 2.27).

Respiratory causes of death were of particular interest, according to the researchers, because opium has multiple negative effects on the respiratory system, including decreases in breathing frequency and tidal volume, upper airway constriction, and histamine release from mast cells. For participants with asthma, the hazard ratio of death was 11, while the hazard ratio for individuals with chronic obstructive pulmonary disease (COPD) was 5.44; in addition, the hazard ratio with tuberculosis was 6.22. The study was published on April 17, 2012, in BMJ.

“Based on the overall adjusted hazard ratio for opium use of 1.86, and assuming this represents a causal association, we calculate the fraction of deaths attributable to opium in this population as 14.9%,” concluded lead author Reza Malekzadeh, MD, and colleagues. “Increased risks were also seen in people who used low amounts of opium for a long period and those who had no major illness before use.”

Opium is the dried latex obtained from the opium poppy, and contains up to 12% morphine, an alkaloid that is frequently processed chemically to produce heroin for the illegal drug trade. The latex also includes codeine and nonnarcotic alkaloids such as papaverine, thebaine, and noscapine. The use of opium for medicinal or recreational purposes has a long history in many parts of the world and continues to be common. In 2008 an estimated 13-22 million people worldwide used opium or its derivatives as illicit drugs; of these, 6.5-12.5 million were in Asia; 3.3-3.8 million in Europe; 2.3-2.4 million in the Americas; and the rest in Africa and Oceania.

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