From the international departures of a local airport, the official security personnel brought a 51-year-old, asymptomatic woman to the emergency department with the suspicion of ingested opium packets. She had ingested 30 packs of opium, each of 50 grams.
A review of the symptoms and the physical examination were unremarkable.
On the abdominopelvic computed tomography scan, several oval structures (Panel A, circle) were revealed with visible opacities shown by an arrow. No signs of bowel obstruction were identified on CT scan.
Ingestion of lead-contaminated drug packs was suspected.
The patient was given polyethylene glycol orally, which resulted in the passage of all the packages without any complications (Panel B).
The obtained packages were sent for laboratory analysis, and the contents of one of the packs confirmed the presence of opium with the lead concentration of 3200 ppm in an opium sample. The analysis did not reveal the presence of any other drugs.
The woman remained asymptomatic throughout and even at the time of discharge, although there is a high risk associated with ingested opium, let alone lead-contaminated opium.
Opium abuse is a health hazard that has resulted in many deaths over the years but opium contaminated with lead is even more dangerous. Opium is mixed with lead to increase the weight of opium for monetary benefits as opium is sold according to its weight. There have been reports of elevated lead levels in individuals using opium obtained through illegal means. The use and smuggling of lead-contaminated drugs is a public health concern.
Lead exposure or lead toxicity can lead to neurologic and gastrointestinal signs and symptoms, including encephalopathy, altered mental status, headache, seizures, irritability, abdominal pain, vomiting, constipation, and anorexia. Chronic lead toxicity can lead to behavioral problems, fatigue, high blood pressure, lack of coordination, etc.
Physicians and medical personnel should be aware of the fact that people who are exposed to illegally obtained opium are at risk of lead toxicity too.
References
Nasim Zamani, M. a.-M. (2018, November 8). Ingestion of Lead-Contaminated Packs of Opium. Retrieved from The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm1807901
