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The anti-narcotics police officers traced the haul of narcotics through extensive operations, arresting members of the drug trafficking cell while trafficking drugs, he explained. In this operation, the border guards succeeded in seizing 6 vehicles and arresting 7 smugglers and discovered kilograms of various drugs, including kilograms of heroin and kilograms of morphine. Iran, which has a kilometer border with Afghanistan, has been used as the main conduit for smuggling Afghan drugs to narcotics kingpins in Europe. Despite high economic and human costs, Iran has been actively fighting drug trafficking over the past decades. Iran seized some 1, tons of narcotics in the Iranian calendar year March March , putting the country in the first place in the world. UNODC World Drug Report estimates that in , 91 percent of world opium, 48 percent of the world morphine, and 26 percent of the world heroin were seized by Iran. Large drug trafficking gang disbanded in northwest Society. Your Message.

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Official websites use. Share sensitive information only on official, secure websites. This work is published and licensed by Dove Medical Press Limited. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4. Transdermal opioid intoxication has only been reported for pharmaceutical fentanyl and buprenorphine patches. Here, we report a rare case of heroin poisoning through damaged skin. A seven-year-old girl with an impaired level of consciousness and difficulty breathing was brought to a local hospital about one hour after burning with boiling water. She had a small second-degree burn on the right elbow. Clinicians were initially unable to obtain any reliable history from relatives about the cause of altered mental status. However, with a clinical suspicion of opioid poisoning, naloxone therapy started, and the patient was moderately improved. She underwent a coma workup; then she was referred to a tertiary care hospital. Further investigation revealed that after the burning, the mother left home to seek for a burn ointment from a neighbor, and the heroin-dependent father sprinkled some heroin powder over the burned area. Heroin was absorbed through the damaged skin and poisoned the child unintentionally. After three days of clinical management, the patient was discharged from the hospital in good condition without any complications. Heroin can be absorbed through damaged skin and cause poisoning. Diagnosis requires strong clinical suspicion, and an appropriate naloxone therapy may be life-saving. Keywords: heroin, opioid poisoning, damaged skin, transdermal absorption, naloxone. Heroin diamorphine or diacetylmorphine is a highly addictive semisynthetic opioid made from morphine. Among opioids, transdermal poisoning has only been reported for fentanyl and buprenorphine pharmaceutical patches. A seven-year-old girl was burnt by boiling water at home in a rural place in the Northwest of Iran. The burnt area was on the right elbow. Her mother left home to take a burn ointment from the neighbor and rubbed it over the burnt area. An hour later, the mother brought the girl to the local city hospital with an impaired level of consciousness and difficulty breathing. The family provided no more history than the burn. A general practitioner and afterward, a pediatrician visited the patient. She was unconscious without responding to any painful stimuli, had pinpoint pupils and apneustic respirations respiratory rate: 6 per minute. With a clinical suspicion of opioid poisoning, intravenous IV naloxone 0. The burn site was washed using normal saline, and the burn dressing resumed. Nonetheless, considering other differential diagnoses, the essential laboratory examinations, including a brain computed tomography CT scan without contrast, and a lumbar puncture were performed. Then, the patient was referred to a tertiary care pediatric hospital located in the center of the province for further management. Four hours later, the patient arrived at the destination hospital emergency room, and she was immediately admitted to the pediatric intensive care unit. A pediatric resident and a toxicologist visited the patient. She was in a light coma just poorly respond to painful stimuli and had meiotic pupils and apneustic respirations. Her level of consciousness and breathing became better after receiving a bolus of 0. Other treatments for the patient included: fluid therapy, continuous naloxone infusion 0. Laboratory studies of the patient are summarized in Table 1. Furthermore, a chest x-ray and a brain CT scan were unremarkable. Further investigation revealed that after burning, the mother left home to seek for a burn ointment from the neighbors, and the patient was left alone with her heroin-dependent father. By observing the agitation of his daughter, the father sprinkled some heroin powder over the burnt area. Then the mother, unaware of everything, rubbed the burn ointment on the burn. Heroin gradually penetrated the damaged skin and led to the unintentional poisoning of the child. On the third day of hospitalization, the patient was discharged in good condition without any complications. We reported an unusual case of heroin empoisoning through the damaged skin. However, during the four-hour route to the destination hospital, they forgot to schedule for naloxone maintenance therapy. The relatively short duration of action of naloxone 20 to 90 min must be borne in mind, because a severely-depressed patient may recover after a single dose of naloxone and appear healthy, only to relapse into a coma after 1—2 hours when naloxone effect dissipates. After IV injection or snorting, the duration of action of heroin is usually short half-life 3—6 minutes because it rapidly reacts to its metabolites 6-monoacetyl morphine, morphine, morphineglucuronide, and morphineglucuronide. However, the elimination of the metabolites depends on many factors such as the route of administration, dose, body weight, the time elapsed since the last dose, and inter-individual pharmacokinetics. Together with the diagnosis of opioid intoxication, the doctors considered other differential diagnoses in the local hospital and performed a brain CT scan, a lumbar puncture, and probably used hypertonic dextrose. As well as, in our hospital, the patient had leukocytosis and a positive C reactive protein CRP and received antibiotics with suspicion of infection. Considering the banning of poppy cultivation in Iran, dietary use is infrequent, and the child has no history of eating poppy seeds or opium. Therefore, the positive qualitative urine immunoassay screen for morphine was related to heroin. Unfortunately, the urinary assay for 6-monoacetyl morphine, which is specific for heroin, was not available in our hospital. While most opioids are not well- absorbed from intact skin, but percutaneous absorption of drugs eg, morphine will significantly increase if the epidermal barrier is damaged or diseased. Among opioids, there are only fentanyl and buprenorphine that possess ideal characteristics for transdermal delivery. It means they are small molecules molecular weight: As well as, there is only one report of buprenorphine overdose by using transdermal patches. Although heroin is a small lipophilic molecule MW: Our patient has been the first case report of heroin poisoning through the damaged skin that was fortunately diagnosed and appropriately treated. In many situations like the reported case, the diagnosis of opioid intoxication requires strong clinical suspicion. In other words, taking a precise history, using confirmatory urine toxicological screen, and an appropriate naloxone therapy could be life-saving. Whether covering the burnt area with the burn ointment in our patient may lead to more entrapment, and absorption of heroin transdermally is unclear for us. However, the possibility of transdermal absorption as a new route for pharmaceutical heroin deserves attention in further investigations. There was no cost or harm to the patient for the study. All of the stages of the study were under supervision and confirmation of the ethical committee of Taleghani Teaching hospital and Urmia Medical Sciences University. As a library, NLM provides access to scientific literature. Int Med Case Rep J. Find articles by Mohammad Delirrad. Find articles by Amin Sedokani. Received Apr 22; Accepted Aug 19; Collection date 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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