Overall, 80 subjects (10.6%) had a positive history of substance abuse, of whom 70 (9.3%) were still with the condition. Based on the results, 59 (7.8%) subjects had a history of smoking, of whom 46 (6.1%) were still smoking in the past 30 days (P=0.04). Previous history of substance abuse in the immediate family members was present in 85 patients (11.2%).
We found that 23.6% of all diabetic men and 3.4% of all diabetic women were substance abusers (Table 2). The frequency of substance abuse was highest among diabetics aged 50-59 years (42.5%).
Opium was the most commonly abused substance (90%), while it was used in combination with other drugs in seven cases (9.7%).
Out of 70 diabetic patients who were uffering from substance abuse in the past 30 days, 61 cases (87.1%) used opium, six cases (8.6%) used poppy juice, one case (1.4%) used codeine tablets, one case (1.4%) was alcoholic and another case (1.4%) used stimulants. Moreover, 65 cases (92.9%) were using drugs every day.
The predominant methods of substance abuse were inhalation (52.5%), oral consumption (37.5%) and smoking (10%). Starting substance abuse was more common at age of 45-49 years (25.7%), followed by age of 55 years and older (22.9%) and 40-44 years (21.4%).
Of 80 diabetics with history of substance abuse, 45 (56.3%) started substance abuse after being diagnosed with diabetes. Among current substance abusers, 52 cases (74.3%) reported diabetes and its complications as the reason for substance abuse (Table 2).
In the present study, we found that 9.3% of all diabetic patients were suffering from substance abuse. This rate in similar studies conducted in Iran varied between 10.4% and 11.2% (9,11,15).
In a study in Pakistan (16) and Malaysia (17), 27% and 8% of diabetics were smokers, respectively. In this regard, factors such as age, sex, social status, underlying diseases, place of residence, etc., can affect this rate (9). Given that the majority of participants in the present study were women (70.9%) and the fact that the rate of substance abuse is lower in women (18), it seems that the frequency of substance abuse among diabetic patients may be higher than the estimated rate in our study.
In our study, 76.3% of all individuals with a history of substance abuse were men. In line with this finding, a similar study in Tehran found that diabetic men were more likely to abuse illicit drugs compared to diabetic women (11). A study in Pakistan also found that smoking was more frequent among diabetic men (16).
More than 80% of diabetic substance abusers were 50 years of age and older. We also found that substance abuse was more common among married individuals, farmers, people with primary education and those who had diabetes for 2-5 years.
The most commonly abused substances were opium and its derivatives. It is known that older people in Iran generally have a higher tendency toward consumption of traditional drugs such as opium. In addition, the high frequency of substance abuse among this age group could be related to the high frequency of diseases such as cardiovascular disease, hypertension and diabetes in this age group. In a study in Bojnord, one out of every four elderly people consumed opium, which is more than 8-fold higher than the national average rate
of opium consumption among the elderly population (19). In a study in an African country, the most commonly abused
substances among diabetics were khat and alcohol (5). The frequent opium abuse among diabetic patients could be related to cultural and social factors as well as easy access to opium, belief in its beneficial effects and its arbitrary use (7).
Nearly three-quarters of diabetic patients who currently suffered from substance abuse used it solely to control diabetes and its side effects. Substance abuse, particularly opium abuse, with the aim to control or alleviate pain has been frequently observed in patients with chronic diseases. In a study in Mashhad, 9.3% of patients used opioids to relieve pain (20). Considering the adverse effects of drug abuse on the treatment outcome in diabetic patients, it is essential to pay extra attention to this group of patients and raise awareness about the health consequences of drug abuse (13-15).
The basis for diagnosing substance abuse in diabetic patients was self-reporting, and conventional laboratory tests were not used for this purpose, which could be a limitation of the present study.
CONCLUSION
The prevalence of substance abuse is 9.3% among diabetic patients living in rural areas of Bandar-e-Gaz. Based on the results, substance abuse is more common among middle-aged men, farmers, married individuals as well as people with primary education and those with diabetes for 2-5 years. Furthermore, opium is the most commonly abused drug in the study area.
ACKNOWLEDGEMENTS
The results of the study have been derived from results of a research project approved and supported by the Golestan University of Medical Sciences (project code: 97060699).
The authors would like to thank the Health
Management and Social Development Research Center and the staff of health centers in Bandar-e-Gaz.
DECLARATIONS
Funding
This study received financial support from the Golestan University of Medical Sciences, Iran.
Ethics approvals and consent to participate
Written informed consent was obtained from all patients prior to participation in the study. The subjects were assured that their personal information remain confidential. The study received approval from the ethics committee of the Golestan University of Medical Sciences, Iran (ethics code: IR.GOUMS.REC. 1397.113).
Conflict of interest
The author declares that there is no conflict of interest regarding publication of this article.
REFERENCES
1. Kohian H, Sohrabi MB, Zolfaghari P, et al. The prevalence and related factors of diabetic retinopathy in Shahroud. J Knowledge Health. .2012;7(4):179-84.
2. Harrison's Endocrinology, 4E / Edition 4. McGraw-Hill Professional Publishing; 2016.
3. Olfatifar M, Karami M, Hosseini S M, et al. Prevalence of Chronic Complications and Related Risk Factors of Diabetes in Patients Referred to the Diabetes Center of Hamedan Province. Sci J Hamadan Nurs Midwifery Fac. 2017; 25 (2) :69-74.
https://doi.org/10.21859/nmj-25029
4. Guariguata L. By the numbers: new estimates from the IDF Diabetes Atlas Update for 2012. Diabetes Res Clin Pract. 2012;98(3):524-5.
https://doi.org/10.1016/j.diabres.2012.11.006
5. Kohian H, Sohrabi MB, Zolfaghari P, et al. The prevalence and related factors of diabetic retinopathy in Shahroud]. J Knowledge Health. 2012;7(4):179-84.
6. Amare Tizazu, Yimam Hussien, Salim Mebratu, et al. Substance ues among
diabeticpatients in dessie referral hospital, northeast. Ethiopia. Research Desk, 2012; 1(1).40-46.
https://doi.org/10.1186/2049-9957-2-6
7. Mohammadinia A, Jalilian J, Shayeste Y.Characteristics of Patients Hospitalized with drug and substance abuse in Gorgan, Iran, 2008-2015 . IJEC. 2017; 1 (1) :69-76.
8. Razzaghi E, Rahimi A, Hosseini M, Chatterjee A. Rapid Situation Assessment (RSA) of drug abuse in Iran. Prevention Department, State Welfare Organization, Ministry of Health, IR of Iran and United Nations International Drug Control Program. 1999.
9. Fatehi R, Hashemnejad M, Mirdamadi M, et al. he Frequency of Opium Addiction and Cofactors in Diabetic Patients Referred to Karaj Shariati Hospital in 1389-90. International Journal of Medical Toxicology and Forensic Medicine. 2013;3(3): 75-79.
10. Dehghani K, Zare A, Dehghani H. Drug abuse prevalence and risk factors in students of shaheed Sadougi university of medical sciences, Yazd. J Shaeed Sadoughi university of Medical Sciences Yazd. 2010;73:164.
11. Sadr S, Mahmoudinia S, Bakhtiari M. Frequency of Opium Use among Diabetic Patients and Their Attitude. IJPBS.2009;3(2): 33-38 .11
12. .Longo DL, Fauci AS, Kasper DL. Harrison's principles of internal medicine. 18th ed. U.S.A. Mc Graw Hill. 2012;2980- 2988 .
13. Ramsey SE., Anglers PA. Review: At-Risk Drinking Among Diabetic Patients. Substance. Abuse: Research and treatment. 2009;3:15-23 .
https://doi.org/10.4137/SART.S2243
14. .Kebede Y, Abula T, Ayele B, et al. Module on substance abuse: For the Ethiopian Health Center Team. University of Gondar In collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the
Ethiopia Ministry of Health, and the Ethiopia Ministry of Education; April 2005.
15. .Shiri R, Hassani KF, Ansari M. Association between opium abuse and comorbidity in diabetic men. Am J Addict. 2006;15(6):468-72 .
https://doi.org/10.1080/10550490601000421
16. Naila K, Ejaz A, Shifa S, et al. Prevalence and Associated Factors of Cigarette Smoking among Type 2 Diabetes Patients in Pakistan. International Journal of Collaborative Research on Internal Medicine & Public Health. 2014;6(4).
17. Ali Q Blebil1, Syed A, Mohamed A. et al. Evaluation of Smoking Status among Diabetes Patients in the State of Penang, Malaysia. .Tropical Journal of Pharmaceutical Research. 2013; 12 (3): 445-448
https://doi.org/10.4314/tjpr.v12i3.26
18. Khademi H, Malekzadeh R, Pourshams A. Opium use and mortality in Golestan cohort study: prospective cohort study of 50,000 adults in Iran. BMJ. 2012;344:2502.
https://doi.org/10.1136/bmj.e2502
19. Ghavam P, Sharifi F, Fakhrzadeh H, Motlagh M, Nazari N. Health status of elderly people in north khorasan: a cross-sectional study. Iranian Journal of Diabetes and Metabolism. 2017;16(4):219-30.
20. Saeidian SR, Ashrafizadeh S, Pakseresht S. Opium Abuse among Patients with Chronic Physical Pain as a Misleading Cause in Addiction Treatment Center. medical journal of mashhad university of medical sciences. 2011;54(2):83-93..
How to Cite: Shokrzadeh M, Savarolia A, Jafari D, Hoseinpoor R, Serayeloo H, Masodi E, et al . Prevalence of Substance Abuse and Related Factors in Type 2 Diabetic Patients Living in a Rural Area in Northern Iran. jcbr. 2020; 4 (4) :41-49