Determination of thallium in urine, blood, and hair in illicit opioid users in Iran

Abstract

Context: Heavy metals, including thallium and lead, are introduced to illicit drug users’ body as a result of using drugs such as cocaine and heroin. Objective: This study aimed to determine urine, blood, and hair thallium (Tl) concentrations in illicit opioid users along with the relevant clinical signs and symptoms consistent with thallotoxicosis and to compare them with the corresponding variables in the control non-opioid user group. Materials and Methods: This case–control study was conducted on 50 illicit opioid users who had abused opioids continuously for more than a year, referred to Amirie Drug Abuse Treatment Clinic in Kashan, Iran. The control group included 50 non-opioid users. Thallium concentrations in urine, blood, and hair were assessed in both groups ( n = 100) using electrothermal (graphite furnace) atomic absorption spectrometry (ET AAS, GF AAS). Results: In the studied group, the median (interquartile range) concentrations of thallium in urine, blood, and hair were 54.8 ± 79.9 μg/L, 14.5 ± 11.1 μg/L, and 5.4 ± 3.7 µg/g, respectively; these values were 4.8 ± 5.2 μg/L, 2.5 ± 2.4 μg/L, and 1.4 ± 1.1 µg/g, respectively, in the control group. There were significant differences in urine, blood, and hair thallium concentrations between the study group and the control group ( p < 0.001). There were significant correlations between duration of illicit opioid use and urine thallium concentrations ( r = 0.394, p = 0.005) and hair thallium concentrations ( r = 0.293, p = 0.039), but not with blood thallium concentrations ( r = 0.246, p = 0.085). Urine and blood thallium concentrations of illicit opioid users with clinical signs and symptoms consistent with thallotoxicosis of weakness ( p = 0.01), depression ( p = 0.03), and headache ( p = 0.03) were higher than users without these problems. Discussion and conclusion: The results of the study showed that thallium concentrations in urine, blood, and hair in illicit opioid users were significantly higher than the comparable concentrations in the control group. This can be due to the use of illicit opioids adulterated with thallium. Also, this study showed long-term illicit opioid use may lead to thallium exposure. In addition, cigarette smoking was associated with increased thallium exposure.