The role of the Ministries of Health or Departments of Health in countries where opiates use is prevalent is crucial to establish health campaigns that can address adequately the issue of opiate use and its effects on the heart
By Junior Bazile MD, MPH
Program Director at New York Harm Reduction Educators
Research Consultant and Online Community Moderator at Global Health Delivery Project, Harvard University
Opium and its Association with Cardio-Vascular Disease
The opioid epidemic that is established in the United States and part of Europe has already claimed hundreds of thousands of lives. According to the CDC, opioids -prescription and illicit- are the main drivers of drug overdose death. In the United States, opioids were involved in 42, 249 deaths in 2016 and opioid overdose were 5 times higher in 2016 than in 1999.
Opium is a powerful drug, also called opioid that is used as medicine and also for recreational purpose. Morphine for instance is a type of opioid that is used in medical settings. Heroin is another type of opioids that is mostly used recreationally and most of the times heroin is used intravenously by intravenous (IV) drug users.
For thousands of years, opium has been called balm. The analgesic effect of morphine, the main ingredient of opium, explains this traditional belief to some extent but only justifies limited use of opium. On the other hand, patients have attained a gradual awareness of pharmaceutical products that contain morphine and are widely used in cardiac settings. Seemingly, these have led to a misunderstanding in the public that the analgesic effect can be generalized to other situations such as ischemic heart diseases (IHD) and their risk factors, even in the absence of pain. Added to that is the previously mentioned recreational use which makes opium dependency a high possibility.
The opioids have the capacity to suppress the respiratory system by acting on receptors located in the brain and block the respiratory center that is located in the medulla oblongata at the base of the brain. That process causes death very quickly in an individual using opioids. Until recent years primary investigation of opioids such as morphine and its derivatives has been focused on their effects on the central nervous system (CNS) thoroughly. However it has been determined that opioids have effects on various physiological systems.
Besides the effects of opium or opioids on the brain leading to their deleterious impact on the respiratory system, there are numerous research studies showing their effects on the cardiovascular system as well. Those studies show that opioids have the capacity to cause coronary artery disease (CAD) and ischemic heart disease (IHD)[3-5].
Opium or opiates are a variable mixture of substances that extensively impact the cardiovascular system. Opium addiction is by far more prevalent in patients with ischemic heart disease (IHD). They impact the heart in such a way that can lead to blatant myocardial infarction, a condition in which the heart muscle doesn’t receive enough blood to supply it with enough oxygen so that it can continue with its contraction capacity.
Smoking and opiates abuse are very often associated and drug users hardly quit smoking. That put them at risk for more cardiovascular events related to opiates use. In the general public there is a belief that opium has beneficial effect particularly on the heart. That will tend to bring more people to use opium. Some studies have shown that long-term opium use has protective effect on the heart and opium is particularly effective on post-acute myocardial infarction (AMI)[6-8]. However, those studies had serious limitations that should not be ignored. Their sample sizes (the number of people enrolled in the studies) were very small and the mechanism of the protective effect of opium that was offered was controversial. Besides that, some of them only utilize animal data from pathologic laboratory.
Opiates have been shown to cause decreases in plasma testosterone levels by inhibiting the secretion of gonadotropin releasing hormone (GnRH). Plasma testosterone level has a significant inverse correlation with the extent of CAD. Increases in plasma levels of adrenalin, noradrenalin, corticosterone, and glucagon are among the other endocrine effects of this family of drugs. These substances have a depressing effect on the autonomic nervous system, resulting in decreased enkephalin production in cardiomyocytes.
Based on several studies it is clear that the prolonged use of opium has deleterious effect on the heart, having the potential to cause CAD or IHD. It is therefore important for Policy Makers, Program Director and Managers in hospitals, and all health professionals to keep that in mind in designing programs so that the education component can be strong enough to convince drug users and any other individual abusing of opium to change their behaviors. The role of the Ministries of Health or Departments of Health in countries where opiates use is prevalent is crucial to establish health campaigns that can address adequately the issue of opiate use and its effects on the heart.
1) Center for Disease Control and Prevention. Drug overdose death data. (March 9, 2018). Retrieved from https://www.cdc.gov/drugoverdose/data/statedeaths.html
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