Opium use and mortality in Golestan Cohort Study: prospective cohort study of 50 000 adults in Iran

Abstract

Objectives To investigate the association between opium use and subsequent risk of death.Design Prospective cohort study.Setting The Golestan Cohort Study in north-eastern Iran collected detailed validated data on opium use and other exposures at baseline. Participants were enrolled between January 2004 and June 2008 and were followed to May 2011, with a follow-up success rate of over 99%.Participants 50 045 participants aged 40-75 at baseline.Main outcomes Mortality, all cause and major subcategories.Results 17% (n=8487) of the participants reported opium use, with a mean duration of 12.7 years. During the follow-up period 2145 deaths were reported. The adjusted hazard ratio for all cause mortality associated with ever use of opium was 1.86 (95% confidence interval 1.68 to 2.06). Opium consumption was significantly associated with increased risks of deaths from several causes including circulatory diseases (hazard ratio 1.81) and cancer (1.61). The strongest associations were seen with deaths from asthma, tuberculosis, and chronic obstructive pulmonary disease (11.0, 6.22, and 5.44, respectively). After exclusion of people who self prescribed opium after the onset of major chronic illnesses, the associations remained strong with a dose-response relation.Conclusion Opium users have an increased risk of death from multiple causes compared with non-users. 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.

Dairy Food Intake and All-Cause, Cardiovascular Disease, and Cancer Mortality

“…Cox proportional hazards models were used to estimate unadjusted and adjusted hazard ratios and 95% confidence intervals for risk of all-cause and disease-specific mortality in a given quintile of consumption of total dairy products, low-fat dairy foods, high-fat dairy foods, milk, yogurt, and cheese, compared with persons in the lowest quintile. In multivariate models, we controlled for measured known confounders (36,(39)(40)(41), including age, sex, ethnicity, educational level, marital status, place of residence, cigarette smoking, opium use, alcohol intake, body mass index (BMI; weight (kg)/height (m) 2 ), systolic blood pressure, occupational physical activity, family history of cancer, wealth score, medication use, and total energy intake (see table footnotes for their categorizations). The median value for each quintile was modeled as a continuous variable and used to estimate the hazard ratios and 95% confidence intervals for a 1-serving/day increase in intake, as well as for tests for trend.…”

Tuberculosis report among injection drug users and their partners in Kazakhstan

“…4 In the nation's largest city, Almaty, there were an estimated 17,000 IDUs in 2011 out of a population of 1,413,526. 5,6 Unsafe injection practices, 7 duration and other drug use, 3,8 and contextual environmental factors 9,10 have been shown to increase IDUs' negative health outcomes, specifically the risk of hepatitis B 11 and C 12 and HIV/AIDS. 13 Duration 3,14,15 and type of drug use, 8,15,16 age at first injection, 15 recent drug treatment, 17 exposure to TB cases, 18 incarceration, 3,19 food insecurity, 20 and co-infections (mental health disorders 16 and HIV/AIDS 17 ) among IDUs have been associated with an increase risk of incident TB.…”

The need to address increasing opioid use in elderly COPD patients

“…Respiratory-specific adverse outcomes were not evaluated in this study [1]. Another large populationbased study found a fivefold increased risk of COPDrelated mortality among users of inhaled and orally consumed recreational and medicinal opium versus nonusers [20]. Older adults who receive opioids are also well-known to be at increased risk for several adverse psychomotor and gastrointestinal outcomes (including falls and fractures, dizziness, delirium, somnolence, constipation and nausea and vomiting) and COPD largely afflicts older adults.…”

“…Despite this, opioid use in diverse clinical situations is common among older adults with COPD [1] and recent 'real-world' pharmacoepidemiologic studies raise serious concerns about the safety of this therapeutic approach in this vulnerable population [1,2,20]. Moreover, the current practice of potentially excessive opioid use in patients with COPD [1,2] and opioid use during periods of clinical instability [2] needs careful reexamination.…”