Alteration of Abused Drugs Should be Added to the Medical Curricula

Document Type : Editorial

Authors

1 Department of Addiction Studies, School of Medicine, Kashan University of Medical Sciences, Kashan, IRAN

2 Addiction Research Centre, Mashhad University of Medical Sciences, Mashhad, IRAN

3 British Columbia Center for Disease Control, Vancouver, Canada

Abstract

Drug abuse is prevalent in all countries across the world and  induces variety of adverse effects (1). Health problems arising from drug abuse commonly cause significant health challenges in the affected population and deteriorate many aspects of the patients’ performance and quality of life. Comorbidities are discovered in 60 to 75% of addict patients, suffering from various drug-related disorders (2).
Drug dependences and its consequences are of important health problems in Middle Eastern region including Iran(1, 3, 4). Based on a report released in summer 2013 by the Iranian campaign for drug abuse - a national study of prevalence of drug abuse amongst Iranian citizens- the prevalence of the consumption of narcotics and psychotropic substances in the 15-64 year population in Iran is 2.65%. In the studied population, the most commonly abused substances included: opium and its derivatives, crystal meth, crack, heroin, cannabis and ecstasy, respectively. The main consumption routes amongst the users were smoking, eating, snuffing and injection, respectively (5).
Drug suppliers and dealers might add various heavy-weight metals to these substances in their preparation process to increase the weight and potential effects (6). Subsequently, drug dependent subjects complain from clinical manifestations which are not related to the abused substance, and could be explained by the additives, such as stomachache and neuropathy (7-10).
Economic and pharmacologic adulteration of drugs is common and the most prevalent additives include lead (11, 12), thallium (13, 14) and different mediations including steroids (15, 16) and so the consequences might be extensively variant (17, 18).
While controlling or preventing the exposure to intoxication by added impurities to illicit drugs is seemingly impossible, the harms of intoxication by them just can be partially controlled. The timely process of diagnosis of high levels of them in urine and blood, and proper management before is important. Therefore, it is essential for the first-line health respondents and clinicians who manage the admitted poisonous patients to understand the importance of early and accurate diagnosis of these patients.
Training on how to manage substance abuse and its toxicological aspects is an interdisciplinary field; while current course plans are focused on clinical, psychological and social domains (19). It seems that modification of the future medical syllabus is required by adding the current paradigm of economic and pharmacological adulteration of the street drugs.
Current medical curriculum is adopted from developed countries.  Pattern of drug abuse is different in the developing countries (20), which are not fully considered (21).  Paradoxically, while there is suitable knowledge and attitude for conducting the high-quality research in Asia, applicable research are not funded (22). Research on large populations and substances in Asia needs regional understandings of the issue as well as incorporating international scientific evidence (23-28). Therefore, an effective curriculum that gives appropriate perspective to the future clinicians should be developed (1, 29-31) to be accountable for the target population (32, 33). 
Introducing drug adulteration should be added to Iranian medial syllabus.  Furthermore, we need to conduct multicenter studies(24) to monitor the current trend to provide the appropriate training contents to the students and medical instructors as well as decision-makers (34). Most updated health technology assessments in regard to the management of these patients are recommended (25, 32, 35, 36). 
 

Keywords

Full Text

Drug abuse is prevalent in all countries across the world and  induces variety of adverse effects (1). Health problems arising from drug abuse commonly cause significant health challenges in the affected population and deteriorate many aspects of the patients’ performance and quality of life. Comorbidities are discovered in 60 to 75% of addict patients, suffering from various drug-related disorders (2).

Drug dependences and its consequences are of important health problems in Middle Eastern region including Iran(1, 3, 4). Based on a report released in summer 2013 by the Iranian campaign for drug abuse - a national study of prevalence of drug abuse amongst Iranian citizens- the prevalence of the consumption of narcotics and psychotropic substances in the 15-64 year population in Iran is 2.65%. In the studied population, the most commonly abused substances included: opium and its derivatives, crystal meth, crack, heroin, cannabis and ecstasy, respectively. The main consumption routes amongst the users were smoking, eating, snuffing and injection, respectively (5).

Drug suppliers and dealers might add various heavy-weight metals to these substances in their preparation process to increase the weight and potential effects (6). Subsequently, drug dependent subjects complain from clinical manifestations which are not related to the abused substance, and could be explained by the additives, such as stomachache and neuropathy (7-10).

Economic and pharmacologic adulteration of drugs is common and the most prevalent additives include lead (11, 12), thallium (13, 14) and different mediations including steroids (15, 16) and so the consequences might be extensively variant (17, 18).

While controlling or preventing the exposure to intoxication by added impurities to illicit drugs is seemingly impossible, the harms of intoxication by them just can be partially controlled. The timely process of diagnosis of high levels of them in urine and blood, and proper management before is important. Therefore, it is essential for the first-line health respondents and clinicians who manage the admitted poisonous patients to understand the importance of early and accurate diagnosis of these patients.

Training on how to manage substance abuse and its toxicological aspects is an interdisciplinary field; while current course plans are focused on clinical, psychological and social domains (19). It seems that modification of the future medical syllabus is required by adding the current paradigm of economic and pharmacological adulteration of the street drugs.

Current medical curriculum is adopted from developed countries.  Pattern of drug abuse is different in the developing countries (20), which are not fully considered (21).  Paradoxically, while there is suitable knowledge and attitude for conducting the high-quality research in Asia, applicable research are not funded (22). Research on large populations and substances in Asia needs regional understandings of the issue as well as incorporating international scientific evidence (23-28). Therefore, an effective curriculum that gives appropriate perspective to the future clinicians should be developed (1, 29-31) to be accountable for the target population (32, 33). 

Introducing drug adulteration should be added to Iranian medial syllabus.  Furthermore, we need to conduct multicenter studies(24) to monitor the current trend to provide the appropriate training contents to the students and medical instructors as well as decision-makers (34). Most updated health technology assessments in regard to the management of these patients are recommended (25, 32, 35, 36). 

 

References

1.         Zavar A, Afshari R, Alidoust M, Pourandi R, Dadpour B. Curriculum development in regard to illicit drug abuse. Future of medical education journal 2012; 2(2): 31-6.
2.         Sadock BJ, Sadock VA. Kaplan and Sadock's pocket handbook of clinical psychiatry. Philadelphia: Lippincott Williams and Wilkins; 2010.
3.         Afshari R, Majdzadeh R, Balali-Mood M. Pattern of acute poisonings in Mashhad, Iran 1993-2000. J Toxicol Clin Toxicol 2004; 42(7): 965-75.
4.         Mehrpour O, Karrari P, Afshari R. Recreational use and overdose of ingested processed cannabis (Majoon Birjandi) in the eastern Iran. Hum Exp Toxicol 2012; 31(11): 1188-9.
5.         Sarrami H, Ghorbani M, Minooei M. Survey of four decades of addiction prevalence researches in Iran; 2013: 29-52.
6.         Aghaee-Afshar M, Khazaeli P, Behnam B, Rezazadehkermani M, Ashraf-Ganjooei N. Presence of lead in opium. Arch Iran Med 2008; 11(5): 553-4.
7.         Salehi H, Sayadi A, Tashakori M, Yazdandoost R, Soltanpoor N, Sadeghi H, et al. Comparison of serum lead level in oral opium addicts with healthy control  group. Arch Iran Med 2009; 12(6): 555-8.
8.         Afshari R, Shafaeeyan H, Afshari R. An epidemiologic study of opioid dependent subjects who were volunteered for opioid detoxification in Iran, 2005. Clin Toxicol 2006; 44(4): 581.
9.         Beattie A, Mullin P, Baxter R, Moore M. Acute lead poisoning: an unusual cause of hepatitis. Scott Med J 1979; 24(4): 318-21.
10.       D'Alessandro GL, Macri A, Biolcati G, Rossi F, Cirelli A, Barlattani A, et al. An unusual mechanism of lead poisoning. Presentation of a case. Recenti Prog Med 1989; 80(3): 140-1.
11.       Afshari R, Emadzadeh A. Short communication: case report on adulterated opium-induced severe lead toxicity. Drug Chem Toxicol 2010; 33(1): 48-9.
12.       Khatibi-Moghadam H, Khadem-Rezaiyan M, Afshari R. Comparison of serum and urine lead levels in opium addicts with healthy control group. Hum Exp Toxicol 2015: 0960327115607947.
13.       Afshari R, Mégarbane B, Zavar A. Thallium poisoning: one additional and unexpected risk of heroin abuse. Clin Toxicol (Phila) 2012; 50(8): 791-2.
14.       Ghaderi A, Vahdati-Mashhadian N, Oghabian Z, Moradi V, Afshari R, Mehrpour O. Thallium exists in opioid poisoned patients. Daru 2015; 23(1): 1.
15.       Afshari R. Non-medical use of medications in middle and low income countries. Asia Pac J Med Toxicol 2014; 3(2): 49.
16.       Koushesh HR, Afshari R, Afshari R. A new illicit opioid dependence outbreak, evidence for a combination of opioids and steroids. Drug Chem Toxicol 2009; 32(2): 114-9.
17.       Mokhtarifar A, Mozaffari H, Afshari R, Goshayeshi L, AkavanRezayat K, Ghaffarzadegan K, et al. Cholestasis and seizure due to lead toxicity: a case report. Hepat Mon 2013; 13(11): e12427.
18.       Khosrojerdi H, Monzavi SM, Afshari R. Blood products used in exchange transfusion should also be screened for opioids. J Pak Med Assoc 2014; 64(3): 363.
19.       Carroll J, Goodair C, Chayor A, Notley C, Ghodse H, Kopelman P. Substance misuse teaching in undergraduate medical education. BMC medical education 2014; 14(1): 34.
20.       Monzavi SM, Afshari R, Rehman N. Alcohol related disorders in Asia Pacific region: Prevalence, health consequences and impacts on the nations. Asia Pac J Med Toxicol 2015; 4(1): 1-8.
21.       Afshari R. A new horizon to medical toxicology in Asia Pacific region. Asia Pac J Med Toxicol 2012; 1(1): 2.
22.       Hoffman RJ. Knowledge, not funding is the most important research resource. Asia Pac J Med Toxicol  2013; 2(2).
23.       Afshari R. Dissemination of Research in Medical Toxicology; the Way Forward. Asia Pac J Med Toxicol 2013; 2(4): 120.
24.       Afshari R. Empowerment of medical toxicology in Asia Pacific region. Asia Pac J Med Toxicol 2013; 2(2): 36.
25.       Afshari R. What is the “Best Research” for low income countries? Asia Pac J Med Toxicol 2013; 2(1): 1.
26.       Asadi R, Afshari R. Applying global burden of diseases in medical toxicology. Asia Pac J Med Toxicol 2014; 3(1): 1.
27.       Afshari R. Medical (clinical) toxicology education in Asia Pacific region. Future of medical education journal 2011; 1(1): 2.
28.       Alberts B. Science, education and the world’s future; by Prof. Bruce Alberts. Future of medical education journal 2012; 2(2): 2.
29.       Afshari R, Zavar A, Alidoust M, Pourandi R. Knowledge and attitude of health network staff toward illegal drug use. Addict Health 2015; 7(1-2): 96.
30.       Mousavi SR, Zeraati AA, Jafari M, Akhavan Rezayat K, Jokar MH, Allahyari A, et al. How to improve the quality of morning report; Department of Internal Medicine, an action research. Future of medical education journal 2015; 5(1): 75-8.
31.       Afshari R, Beiraghi Toosi A, Azizi H. Process of scholarship of teaching has been successful in Mashad University of Medial Sciences. Future of medical education journal 2012; 2(1): 27-31.
32.       Ghoushkhanei H, Afshari R, Marouzi P. Knowledge of social accountability in medical education among faculty members at medical sciences of Mashhad University. Future of medical education journal 2013;3(3):20-3.
33.       Afshari R, Bellinger D. Socially responsive toxicology; looking outside the windows of medical wards: A tale of lead exposure. Asia Pac J Med Toxicol 2015; 4(3): 95-6.
34.       Braund R, Pan B, Sheffelbien L, Temple W. What can we learn from 21 years of school poisonings in New Zealand? Asia Pac J Med Toxicol 2012; 1: 10-13.
35.       Afshari R. Integration of medical education and health services meets accountability challenges and excellence of education? Future of medical education journal 2012;2(1):2-.
36.       Abedi F, Lari S, Afshari R, Nouri Tarazkhaki S, Nemati Karimoi M, Talebi M. Evaluation of E-learning system to the performance of family medicine MPH (Master of Public Health) students. Future of medical education journal 2015; 5(2): 38-41.
 
Future of Medical Education Journal
Volume 6, Issue 1 - Serial Number 1
Spring
March 2016
Pages 3-4

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