Characteristics of participants in the study.

Increasing illicit drug use is one of the main problems in most countries or societies. Monitoring heavy metals and trace elements in this vulnerable group seems to be necessary. Therefore, we assessed the urinary trace element and toxic metals/metalloids concentrations (Zinc (Zn), Iron (Fe), Copper (Cu), Chromium (Cr), Lead (Pb), Cadmium (Cd), Arsenic (As), Nickel (Ni), and Mercury (Hg)) in opium, tramadol, and cannabis users compared to healthy subjects. In this cross-sectional study, patients with substance use disorder (SUD) (n = 74) were divided into four groups: cannabis, tramadol, opium, and mixed (simultaneous use of more than one of the three studied substances), along with a healthy group (n = 60). Urine samples were prepared by dispersive liquid-liquid microextraction method so that heavy metals/metalloids could be measured by ICP-MS. The mean urinary concentration of Cu (48.15 vs. 25.45; 89.2%, p<0.001), Hg (1.3 vs. 0.10; 1200%, p < 0.001), and Zn (301.95 vs. 210; 43.8%, p < 0.001) was markedly lower among patients with SUD. The mean urinary concentration of other elements including As (1.9 vs. 4.1; 115.8%), Cd (0.1 vs. 1.10; 1000%), Cr (6.80 vs. 11.65; 71.3%), Ni (2.95 vs. 4.95; 67.8%), and Pb (1.5 vs. 7.9; 426.6%) were significantly higher among patients with SUD compared to healthy subjects. When sub-groups were compared, no significant differences were observed between their trace element levels (Kruskal-Wallis test, p > 0.05). This can be an indication that regardless of the type of drug, the levels of trace elements are changed with respect to healthy individuals. Our results showed that illicit drug use causes changes in urinary trace element/heavy metal/metalloid levels and highlights the need for monitoring heavy metals and trace elements in individuals with substance use disorder. Assessment of different elements in biological samples of drug dependents may be useful for implementing new prevention and treatment protocols. In case of changes in their levels, complementary recommendations, attention to diet, and periodic assessment of toxic metal levels within treatment programs will be needed.

非法药物滥用问题愈演愈烈，已成为多数国家及社会面临的主要公共卫生难题之一。对此类易感人群开展重金属与微量元素监测具备重要现实必要性。为此，本研究针对阿片类、曲马多及大麻使用者与健康对照人群，检测评估其尿液中微量元素与有毒金属/类金属浓度，涵盖锌（Zinc, Zn）、铁（Iron, Fe）、铜（Copper, Cu）、铬（Chromium, Cr）、铅（Lead, Pb）、镉（Cadmium, Cd）、砷（Arsenic, As）、镍（Nickel, Ni）及汞（Mercury, Hg）。本项横断面研究共纳入74名物质使用障碍（Substance Use Disorder, SUD）患者，分为四组：大麻使用组、曲马多使用组、阿片类使用组及混合使用组（同时使用本次研究涉及的三种物质中的两种及以上），另设60名健康对照人群。尿液样本经分散液液微萃取法进行前处理后，采用电感耦合等离子体质谱法（Inductively Coupled Plasma Mass Spectrometry, ICP-MS）完成目标物检测。与健康对照人群相比，物质使用障碍患者尿液中铜、汞及锌的平均浓度显著降低，两组对应检测值分别为48.15 vs. 25.45（差异幅度89.2%，p<0.001）、1.3 vs. 0.10（差异幅度1200%，p<0.001）及301.95 vs. 210（差异幅度43.8%，p<0.001）；而砷、镉、铬、镍及铅的尿液平均浓度则在患者组中显著升高，对应检测值分别为1.9 vs. 4.1（差异幅度115.8%）、0.1 vs. 1.10（差异幅度1000%，p<0.001）、6.80 vs. 11.65（差异幅度71.3%，p<0.001）、2.95 vs. 4.95（差异幅度67.8%，p<0.001）及1.5 vs. 7.9（差异幅度426.6%，p<0.001）。亚组间比较结果显示，不同物质使用亚组的微量元素水平无显著差异（克鲁斯卡尔-沃利斯Kruskal-Wallis检验，p>0.05），提示无论滥用何种非法药物，受试者的微量元素水平均会相对于健康人群发生改变。本研究结果证实，非法药物滥用会导致尿液中微量元素、重金属及类金属水平发生改变，同时凸显了对物质使用障碍患者开展重金属与微量元素监测的必要性。对药物依赖者生物样本中的各类元素进行检测分析，可为新型预防与治疗方案的制定提供参考依据。若患者体内相关元素水平出现异常，则需在治疗方案中补充相关健康建议，关注患者饮食结构，并定期开展有毒金属水平检测评估。