What is the issue?
Four cases of lead poisoning have been confirmed in the Melbourne area since June 2018. All were male, smoked or ingested illicit opium contaminated with lead and presented with very high blood lead levels (greater than 90 micrograms per decilitre). The illicit opium is thought to have come from overseas but was purchased in Australia and is in the form of a dark resin or paste. The illicit opium is a non-pharmaceutical product.
Lead poisoning from this opium can be hard to diagnose as patients may present with non-specific gastrointestinal symptoms. Patients may not initially disclose their opium use and this can delay diagnosis.
It should be noted that a large outbreak of lead poisoning associated with use of contaminated opium occurred in Iran in 2016/2017.
Who is at risk?
People who have used opium recently, especially since early 2016, are at increased risk.
Opium use is relatively uncommon is Australia and poisoning to date has been limited to people from countries where there is a much higher level of use. Countries where opium use is more common includes but is not limited to Iran, Iraq, Afghanistan, Pakistan, and India.
Have a raised index of suspicion in patients presenting with unexplained abdominal pain, constipation, anorexia, nausea and vomiting. Other effects can include headache, lethargy, irritability, ataxia, impaired concentration, drowsiness, seizures, coma, arthralgia, myalgia, renal impairment, interstitial nephritis and anaemia. Blood changes, including basophilic stippling, may also be present. Severe cases can be fatal.
Lead exposure affects people differently. Symptoms depend on how much they've been exposed to and for how long, as well as their age and comorbidities.
Severe health effects, including encephalopathy or death can occur at blood lead levels of 100--120 micrograms per decilitre.
Undertake blood lead testing when symptoms or health effects suggestive of lead exposure are present and/or a source of lead exposure is suspected, including the use of illicit opium. Identifying patients who use opium may require prompting or direct questioning. Discuss the risks associated with using illicit opium and recommend withdrawal options if use is confirmed.
For management of acute lead poisoning, contact the Poisons Information Centre on 13 11 26 (all hours). Clinical management of elevated blood lead may require hospitalisation.
Better Health Channel: Lead exposure and your health
Community fact sheets in English, Arabic, Pashto, Persian, Urdu and Dari are available from the Health Translations Directory.
For more information about lead poisoning please call Environmental Health at the Department of Health and Human Services on 1300 761 874.
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