BACKGROUND
Opium is a substance that extracted from the opium poppy. Derivatives of this substance have useful effect in medicine. For example, opioids drugs derived from this substance have an analgesic application reducing pain in chronic disease like cancer. Moreover, some opioids like codeine have an anti-cough effect [1, 2]. High prevalence of opium use was reported in the Near and Middle East/South-West Asia, primarily in Afghanistan and I.R of Iran [3]. Opium use is considered a criminal behavior and have stigma. In addition, there are laws against its use and distribution in I.R. of Iran. Despite this legislation, prevalence of opium use and other drugs has increased in European countries and was reported 8.7 per 1000 in 50 states of the USA and district of Colombian in 2002-2003 [4-6]. Prevalence of the opium use and its derivatives in Kerman province, which is located in the southern part of Iran, was 17.1% in 2005 [7]. Opium is used in different shapes including Teriak (crude opium), Shire (refined opium extract), and Sukhte (residual opium dross after smoking it) in different part of the Iran [8, 9]. Teriak and Shire can be ingested or smoked, while Sukhte is usually consumed orally [10].

Epidemiologic studies have reported significant associations between opium use and the risk of different cancers including: lung[10-12], bladder[13-19], oral cavity, larynx, pharynx [20, 21], stomach[22-24] and esophageal [22, 25, 26] cancers. In a recent systematic review, all studies about the association of opium use and cancer have been reviewed. This study reported that there is a significant association between opium use and risk of esophageal, stomach, larynx, and lung and bladder cancer. Interestingly, most of these studies were case-control and were published by Iranian researchers. Only two studies reported the cancer-opium association from other populations, one from Hong Kong [20] and one from Singapore [11]. Two cohort studies, one from northeast and one from northwest Iran, has so far reported an association between opium use and cancer risk. [27].
Two mechanisms have been suggested for carcinogenic effect of opium use, including the exposure to opium smoke and the alkaloid component of opium. First, opium users heat the opium to a high temperature and inhale the smoke through particular tube (pipe), when the opium contents starts to vaporize. The opium smoke contains polycyclic aromatic hydrocarbons which is a known carcinogen. In addition, the residual component in the pipe is called Sukhte and can be eaten without any changes or after refinement. Studies have shown that this residual substance have mutagenic role after metabolic activation in Salmonella Typhimurium [28]. This effect can also be caused by morphine and opium pyrolysates [29]. The main carcinogen component of Sukhte consist of all nitrogen containing heterocyclic components derived from pyrolysis of morphine[30]. In the second mechanism, opium contains alkaloid compounds that are absorbed in the body and lead to cancer.
Notwithstanding the several publication on association between opium use and cancer risk, they are usually performed in a small region and could not control for confounding variables properly, In addition, because of small power they could not investigate dose- response relationship, role of starting time of opium use, type and methods of consumption on the risk of cancer. Because opium use is not socially acceptable in Iranian population, the results of epidemiological studies is subject to the selection or measurement bias. However, most of the previous studies did not report response rates and sensitivity and specificity of their questionnaire for assessment of the opium use. Furthermore, available opium products have some additives such as lead, selenium, acetic anhydride, dried blood of animals and addicted persons. Type and amount of additives may vary from region to region. Therefore it is important to consider the role of opium additives in the cancer risk and compare the opium-cancer association between different regions.

REFERENCES:

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