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      Iranian Crystal: A misunderstanding of the crystal-meth

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          Abstract

          Sir, In Asia, Illicit opium and cannabis are produced mainly in Afghanistan, which makes major social and health problems for some countries, particularly Iran as the neighborhood.[1] In Iran, opium and hashish have been used for near 300 years,[2] but other drugs such as heroin, buprenorphine, cocaine, tramadol, and ecstasy are new drugs of abuse in this country.[3–6] Abuses of the new drugs in Iran are now a major health problem, particularly for the youth and young adults.[3 4] In Iran, drugs which have been named by substance abusers may have a similar western name, but with different chemical entity. For example, crack is one of the popular names among the substance abuser in Iran, but is totally different with the western crack. In the other parts of the world, the main ingredient of Crack is cocaine, but in Iran it is heroin which may also contain morphine, codeine, caffeine, noscapine, papaverine, dextromethorphan, and acetyl codeine or corticosteroids with different amounts that make it even more harmful than pure heroin or any other drugs.[7] “Crystal meth,” is the smokable form of methamphetamine hydrochloride. Crystal meth is more likely to cause dependence than other forms of methamphetamine. Crystal meth is a cheap and easily available drug in the western countries, which is a common abused drug among youths in these countries.[8] Nowadays, crystal is one of the most common abused drugs in Iran.[4 9] It is one of the newest drugs between the Iranian addicts that are spreading widely among youngsters. In eastern part of Iran, there is no difference between crack and crystal in term of ingredient, because both of them are heroin and urinary test for the substance abusers have been positive for morphine but negative for amphetamine and the other common abused substances.[9] The important point in this view for the physicians is to know that the slang word of drug abusers “Crystal” in the eastern of Iran is a misunderstanding of the crystal- meth and it is in fact heroin. Iranian Crystal is made in the illegal laboratory, with no standardization. Unfortunately, lack of awareness about the toxicity of this substance have caused health problem among adults or youngsters who used it freely with no fear. Even some Iranian addicts believe that the crystal is the crystal-meth (amphetamine base) because of similarity in name. What is behind this non-awareness and all these misunderstanding? High concentrate of heroin in Iranian crack and crystal may lead to acute intoxication and dependency with lots of physical and mental health effects of the addict, as well as social and economical problems. In this letter, we have tried to bring attention to all health professionals, particularly emergency physicians and clinical toxicologist, on the confused slang name of crack and crystal in Iran. Although it has been reported to the local health authorities, general awareness on the misunderstanding and toxicity of these substances are recommended.

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          Most cited references16

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          Factors related to seizure in tramadol poisoning and its blood concentration.

          This study examines the relation between seizure and plasma tramadol concentration in patients with tramadol poisoning, as a novel centrally acting analgesic used for the treatment of mild to severe pain. All patients admitted with a history of tramadol overdose accompanied by unconsciousness or seizures referred to Baharloo Hospital Poison Center, Tehran, Iran from March 2008 to March 2009 were included. Demographic information, clinical findings, and blood tramadol concentrations were studied. There were 401 patients with a history of tramadol overdose; 121 (30.2%) with a history of seizure and 14 (3.5%) with a history of unconsciousness were included. Most of overdoses involved men (83%). The mean age was 22.9 years (range, 14-50 years). Intentional overdose was the most common mode of poisoning (51.9%). The mean dose ingested was 1,511 mg (SD, 1,353; range, 200-7,000). Mean back-extrapolated tramadol blood concentrations were 3,843 ng/mL (3,715; 269-20,049). Back-extrapolated blood concentrations were correlated with dose (r = 0.313; P < 0.001) as well as blood concentration levels (r = 0.801; P < 0.001). Seizure was significantly correlated to higher reported dose (P < 0.001) and tramadol only to overdose (P < 0.001). However, it was neither related to higher tramadol blood concentrations, nor related to time elapsed, age, sex, history of addiction, and observed Glasgow Coma Scale of patients. Most patients experienced just one seizure (76%). The tramadol-induced seizure is dose dependent. Although higher doses of tramadol was related to higher blood concentration, blood tramadol concentrations was not associated with seizure.
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            The history of Ephedra (ma-huang).

            L. Lee (2011)
            Ephedra is a Chinese shrub which has been used in China for medicinal purposes for several thousand years. The pure alkaloid ephedrine was first isolated and characterised by Nagai in 1885. It was then forgotten until it was rediscovered by Chen and Schmidt in the early 1920s. Its actions on the adrenoceptors could be classified into separate alpha and beta effects--a defining moment in the history of autonomic pharmacology. Ephedrine became a highly popular and effective treatment for asthma, particularly because, unlike adrenaline (until then the standard therapy), it can be given by mouth. Ephedrine as a treatment for asthma reached its zenith in the late 1950s, since when there has been a gradual and inevitable decline in its therapeutic use. From mainstream medicine, ephedrine moved into the twilight zone of street drugs and nutritional supplements. Ephedra and ephedrine products are now banned in many countries, as they are a major source for the production of the addictive compound methamphetamine (crystal meth).
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              Patterns of drug use among a sample of drug users and injecting drug users attending a General Practice in Iran

              Aim This study aimed to examine drug use, drug treatment history and risk behaviour among a sample of Iranian drug users seeking treatment through a general practice clinic in Iran. Methods Review of medical records and an intake questionnaire at a large general practice in Marvdasht, Iran, with a special interest in drug dependence treatment. Records from a random sample of injecting drug users (IDU), non-injecting drug users (DU) and non-drug using patients were examined. Results 292 records were reviewed (34% IDU, 31% DU and 35% non-drug users). Eighty-three percent were males; all females were non-drug users. The mean age of the sample was 30 years. Of the IDU sample, 67% reported sharing a needle or syringe, 19% of these had done so in prison. Of those who had ever used drugs, being 'tired' of drug use was the most common reason for seeking help (34%). Mean age of first drug use was 20 years. The first drugs most commonly used were opium (72%), heroin (13%) and hashish/ other cannabinoids (13%). Three quarters reported having previously attempted to cease their drug use. IDU were more likely than DU to report having ever been imprisoned (41% vs 7%) and 41% to have used drugs in prison. Conclusion This study has shown that there is a need for general practice clinics in Iran to treat drug users including those who inject and that a substantial proportion of those who inject have shared needles and syringes, placing them at risk of BBVI such as HIV and hepatitis C. The expansion of services for drug users in Iran such as needle and syringe programs and pharmacotherapies are likely to be effective in reducing the harms associated with opium use and heroin injection.
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                Author and article information

                Journal
                J Res Med Sci
                J Res Med Sci
                JRMS
                Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences
                Medknow Publications & Media Pvt Ltd (India )
                1735-1995
                1735-7136
                February 2012
                : 17
                : 2
                : 203-204
                Affiliations
                [1 ]Department of Clinical Toxicology and Forensic Medicine, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
                [2 ]Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
                [3 ]Medical Toxicology Research Centre, (MTRC) and Department of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
                Author notes
                Address for correspondence: Omid Mehrpour, Department of Clinical Toxicology and Forensic Medicine, Faculty of Medicine, Birjand University of Medical Sciences, Ghaffari Avenue, Birjand, Iran. E-mail: omid.mehrpour@ 123456yahoo.com.au
                Article
                JRMS-17-203
                3525044
                23264800
                d1d0257e-8cbd-43db-824d-110cf8731c78
                Copyright: © Journal of Research in Medical Sciences

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 January 2012
                : 28 January 2012
                : 10 February 2012
                Categories
                Letter to Editor

                Medicine
                Medicine

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