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Purpose: The aim of this investigation was to study the factors responsible for drug addiction amongst the inmates of Tabriz and Qom prisons.
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Official websites use. Share sensitive information only on official, secure websites. Corresponding author: Hemmat Maghsoudi, MD maghsoudih yahoo. Box , Tabriz , East Azerbaijan, Iran. Phone: , FAX: A five-year prospective study March March of burn victims hospitalized in a major burns centre in Iran was conducted in order to survey the aetiology and outcome of burns in patients who were drug addicts. Three hundred and thirty patients addicted to drugs were identified and stratified by age, sex, burn size, presence or absence of inhalation injury, kinds of abuse agents, and cause of burn. The mean patient age was There were 60 deaths overall The mortality rate was significantly higher in multi-drug abusers than in single-drug abusers. Except for burn incidence, there were no significant differences between males and females. The mean burn size, Inhalation injuries were strongly associated with large burns, and were present in all flame-burn fatalities. Flame burns were the most common type of burns in drug-addicted patients: incorrect use of a lighter and match and falling onto a brazier were the most common causes of flames. There were 11 deaths related to electrical injuries. Large burn size was the strongest predictor of mortality followed by the presence of inhalation injury. The most common agent of abuse was opium, followed by heroin and hashish; there was no difference between males and females in relation to the type of agent of which abuse was made. The principal effects of opioids opiate-like drugs are a significant damping of pain perception along with modest levels of sedation and euphoria. Tolerance of any one opioid is likely to be generated to others i. Each of these opioid substances is capable of producing physical addiction, and the withdrawal syndrome after abstinence from any one of the substances can be treated by administering any of the others. Stimulants are drugs that stimulate the central nervous system. These substances tend to increase alertness and physical activity. They include amphetamines, cocaine, crack, and some inhalants like amyl or butyl nitrites. Caffeine present in tea, coffee, and many soft drinks is also a mild stimulant drug. Different stimulants act on the body in different ways. For example, nitrate inhalants cause the blood vessels to dilate, cocaine and crack interfere with normal levels of the neurotransmitter serotonin, and amphetamines cause the release of adrenalin. Hallucinogens have no legal medicinal uses and are therefore all classed as drugs of abuse. The most commonly seen are LSD, ecstasy, and psilocybin magic mushrooms. Other hallucinogenic substances such as mescaline and DMT are not widely available on the illicit drug market in the United Kingdom. Cannabis is a central nervous system depressant obtained from the plant Cannabis sativa, which grows in many parts of the world. It is available for use as a drug in three main forms: as the dried leaves and buds known as grass or marijuana , as a solid resin hashish or hash which is collected from the buds and flower heads, and as a thick liquid prepared from the flowers or resin hash oil. The main psychoactive i. Hashish is made by taking the resin from the leaves and flowers of the cannabis plant and pressing it into cakes or slabs. It is usually stronger than herbal cannabis and may contain five to ten times as much THC. The attention paid by the general public, the government, and the media to heroin, cocaine, and ecstasy in recent years may have led some adults and young people to assume that cannabis is of less concern. Cannabis availability is at an all-time high. Among teenagers, those who smoke cigarettes are more likely to drink alcohol. Those who smoke and drink are more likely to use cannabis. And those who use all three are more likely to use other illicit drugs. Using cannabis exposes the young to the company and influence of those who use and deal in illicit drugs and may encourage other dangerous and illegal activities. Some estimates suggest that more road accidents are caused by the use of cannabis than by that of alcohol. Heroin is a powerful painkiller that depresses the central nervous system. This produces a feeling of relaxation, security, and well-being. Opium addiction in Iran has long historical roots and is a major social and health problem. Numerous publications have documented the association between alcohol and drug abuse, particularly between alcohol and motor vehicle crashes, injuries to pedestrians and cyclists, falls, burns, drowning, suicides, assaults, domestic violence, and even murder. Most studies have examined the association between alcohol consumption and injury using hospital emergency-department admissions data. In particular, in the case of burn injury, we hypothesized that multi-drug abuse represented a more powerful risk factor for burn injury than single drug abuse. We also hypothesized that, considering the most severely affected substance abusers amongst patients receiving care in a burns unit, opium was the main cause. In this study, we planned to conduct an aetiological survey of burns suffered by abusers of various kinds of opioids, stimulant drugs, hallucinogens, and cannabinoids in patients admitted to the burns ward at Tabriz Sina Hospital, Iran. From 20 March to 20 March , patients with burn injury including patients addicted to opium were admitted to the burns centre at Sina Hospital in Tabriz. Various kinds of abused drugs were classified as opium agents including opium, morphine, codeine, heroin, opium residue, crack, petedine, and methadone , stimulant agents amphetamine, crystal, cocaine, and ecstasy , and hallucinogenic agents LSD, PCD. Between these dates a prospective study of all drug-abusing patients with burn injuries presenting solely at the Tabriz Burns Centre was designed to analyse the association between age, percentage total body surface area TBSA burned, inhalation injury, causes of burn, type of opioid, the risk of death, and the epidemiology of burns. Survival was defined as discharge from the burns unit. A special dossier was prepared to study epidemiological, demographical, and therapeutic data. The patients were categorized by age, sex, percentage TBSA burned, presence or absence of inhalation injury, cause of burn, outcome, educational status, occupational status, length of hospital stay, type of opium addiction, and type of family. The diagnosis of the opiate abuser was made by one of two attending burns surgeons on the basis of the clinical history, which included the patterns of opiate usage, information regarding the possible existence of an antisocial personality disorder, history of chronic pain, search for physical stigmata of misuse e. A blood and urine screen was used to identify opiates in patients in whom misuse was suspected. The diagnosis of inhalation injury was made by one of the two attending burns surgeons, based on the history surrounding the burn event and the physical findings. The factors used to determine the presence of inhalation injury included burns sustained in an enclosed space, presence of facial burns, requirement of mechanical ventilation, carboxyhaemoglobin levels, and presence of carbonaceous sputum. We do not use bronchoscopy and the Xenon lung scan in our institution. There is no accepted way of quantitating the severity of inhalation injury other than by determining whether inhalation injury is present or absent. We chose to use the clinical criteria demonstrated by Shirani et al. Fluid requirements were estimated using the Parkland formula. Urine output was used as the principal resuscitation guideline. Burn cause was determined by history. Follow-up was obtained by examination in clinic. Follow-up examination was scheduled in all patients from 12 to 72 months. The findings were entered on a computer by means of a SPSS The statistical analyses were used to assess the relative predictive power of percentage TBSA burn, age, inhalation injury, type of opium, and cause of burn, as well as different combinations of these five variables, as predictors of mortality. The level of significance was set at 0. During the five years of the study, patients were admitted, of whom were drug addicts 9. In addicted patients, the mean age was The largest single group of patients was the yr age group in both addicted and non-addicted patients. The most common cause of burns among the addicted patients was flame Of the burn cases, There were 47 The mean burn size was The mean fatal size was The mean length of hospital stay was The mean length of hospital stay in addicted burn patients was There were 60 deaths, with an overall mortality rate of Sixty patients There were 31 deaths among the patients without inhalation injury mortality, Inhalation injury was present in 29 of the 60 deaths Inhalation injury was present in All patients with flame burns had associated inhalation injuries. However, inhalation injury was strongly associated with large burns. The distribution of patients by age group, average burn size, presence of inhalation injury, and mortality is shown in Table I. The distribution of patients by mean burn size, presence of inhalation injury, and mortality is shown in Table III. The mortality rate was significantly higher in multi-drug abuse than in single drug abuse Large burn size was the strongest predictor of mortality, while inhalation injury, strongly linked to large burns, was found to be an independent predictor of death. Patient gender when matched with burn size, age, type of agent used, and cause of burn was not predictive of mortality in either addicted or non-addicted patients. There was no difference between males and females according to the type of agent abused. The distribution of patients by type of agent used, inhalation injury, and mortality is shown in Table IV. This figure is more than five times the estimate 0. The government of Iran seems particularly concerned over the sharp increase in intravenous drug abuse. Most observers place the number of drug users in Iran at about 2,,, the great majority males. Opium smoking is the traditional manner of drug of abuse in Iran, but opium is also drunk, dissolved in tea. Opium and its residue are also injected, dissolved in water, by a small number of addicts. Heroin is sniffed, smoked, and injected. Ninety-three per cent of opiate addicts are male, with a mean age of In Iran the situation is exacerbated not only by rampant unemployment but also by general apathy and lack of confidence in the future. The quality of Iranian education is high compared to that of western countries, and the despair of highly skilled young graduates forced to accept menial jobs in small shops is thus reflected more in the drug addiction rates than in employment statistics. One study found that in a group of patients who were substance abusers or who were neurologically or mentally impaired, in-patient care was more costly, more complicated, and more protracted. To determine whether substance users SU differed from controls, burn patients were studied, of whom had a positive drug screen for ethanol, cannabinoids, cocaine metabolites, amphetamines, phencyclidine, or benzodiazepines. In our prospective study, the SU were significantly younger than non-addicted patients The greater incidence of inhalation injury in non-abusers may be due to the greater incidence of suicide in our patients, which presented a higher mean percentage of TBSA burned Burns in opiate-addicted patients have frequently been reported in the literature, which indicates in relation to opiate addiction that men are more likely to become addicts than women, as in our study. As expected, we found that increased burn size led to an increased risk of mortality among addicted and non addicted patients, a finding confirmed by other studies. The non-survivors with small burns in this series are an important reminder that addicted burn patients can die from small burns. The mortality in our overall patient population Like other researchers, 13 , 14 , 16 , 18 we found that the incidence of inhalation injury rose with increasing burn size, but not with advancing age. This is not surprising since, as has already been suggested, larger burns and inhalation injury are more likely to be seen in less mobile patients burned in fires. In the addicted burn population, most burns are flame burns and most are associated with inhalation of smoke. In addition, we demonstrated that in our series of addicted burn patients, the most important predictor of mortality following thermal injury was TBSA burned, with inhalation injury adding little to the accuracy of this in addicted patients. In our study, the mortality rate was significantly higher in multi-drug abusers than in single drug abusers. The most important factors influencing the incidence of thermal injuries are age, sex, and economic status. Addicted patients are the most prone to thermal injury. The greater amount of addiction in burn patients in our study may be due to the higher incidence of addiction in Iran, for various reasons: land routes across Iran constitute the single most important conduit for south-west opiates en route to European markets. The relationship between median family income and burn rate is strong and linear. Addicted burn patients from poor or low-to-middle income families are exposed to burns. We determined that the cause of burns was not an independent predictor of mortality i. We were surprised by the finding that there was no mortality among the 22 patients with scalds presenting a mean burn size of Other studies 13 , 16 , 17 , 18 concluded that the presence of inhalation injury significantly increased mortality and suggested that inhalation injury was the single most important determinant of mortality following thermal injury. In the present study, we too found that inhalation injury was important and that inhalation injury was significantly associated with mortality following thermal injury. However, we found that although inhalation injury was a significant predictor of outcome, it was less important than the size of the burn in predicting mortality. In our study, one key finding was that after burn injury more problems were associated with multi-drug use than with single drugs. The mortality rate was significantly higher in multi-drug abusers. We conjectured that personality traits in drug-abuse dependent persons accounted for the prevalence of the injury to a greater extent than the consumption itself. This is a clear finding, but the issue will require further study. Such individuals constitute a prime opportunity to focus on burn injury prevention within the confines of treatment programmes directly linked to substance abuse. The recognition of the burns centre as place to offer prevention is a unique contribution to this particular field of study. This includes educating patients about the risks of injury as well as making assessments of their living conditions, in order to prevent burn injuries. Identifying patients with depressive symptoms and impulsive behaviour may also be beneficial, so that additional counselling sessions can be provided. Future studies should look at the various prevention strategies offered in detoxification programmes in order to verify their capacity to decrease the consumption of abused drugs and the burn injury rate. In conclusion, our data suggest that although increases in the percentage of TBSA burned and the presence of inhalation injury were associated with increasing mortality, the most important single predictor of mortality in drug-addicted burn patients was the percentage of TBSA burned, while the presence of inhalation injury added little to the possibility of predicting mortality. In no addicted burn patient, no matter how large the burn, what sort of abuse agent, or what type of inhalation injury, could an accurate prediction be made at the time of admission as to whether the patient would live or die. Despite some differences in demographics, the same general rules for rehabilitation apply to the opiate abuser. The basic strategy includes detoxification and general family support. It is also important to establish realistic patient goals and a programme of counselling to increase motivation toward abstinence. A long-term commitment to rebuilding a life-style without the substance is essential for preventing recidivism. Since , public awareness campaigns and the attention of two successive Iranian Presidents, as well as cabinet ministers and the Iranian parliament, have given appeals for reduction of drug abuse a significant boost. Eighty-eight out-patient treatment centres are now operational. Some 30, people are treated per year, and some programmes have three-month waiting lists. Narcotics Anonymous and other self-help programmes can be found in almost all districts as well, and several NGOs focus on drug demand reduction. Understanding how opiates cause addiction could lead to greater insight into the brain processes of addiction to other dependence-producing drugs, and to discovering how to prevent dependence from occurring. Also, research into opiate addiction could increase understanding of the brain networks involved in pain, as opiates and opiate receptors in the brain and spinal cord are involved in pain processes. With a better knowledge of addiction and of pain - another urgent public health issue - scientists will be able to develop specific medication to treat these distinct disorders. Only continued funding for research will help develop better treatments that are selectively targeted, helping more addicts to stay drug-free. Health care practitioners - particularly family physicians and trauma personnel - play a valuable role in detecting substance-abusing patients, intervening on their behalf, and referring them to appropriate care. Addiction is a brain disease. There are many things that can place someone at risk of developing an addiction, and we now know that it can have a genetic basis. It is a chronic disease, just like heart disease, diabetes, and other diseases, and we should bring it out into the open, just as we have done with diseases such as breast cancer and heart disease. Owing to the wide variety of causes of burn injuries related to drug abuse, diverse interventions targeted at those at highest risk e. As public health workers are the most important people involved in such programmes, using them to their full capacity and also using the full capacity of the health system network in Iran are advised if these injuries are to be reduced. As a library, NLM provides access to scientific literature. Ann Burns Fire Disasters. Show available content in en fr. Find articles by H Maghsoudi. Find articles by R Raghifar. Received Sep 2; Issue date Dec Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.
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PDF | Purpose: The aim of this investigation was to study the factors responsible for drug addiction amongst the inmates of Tabriz and Qom prisons, to.
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