Opium Smoke: The Study of Second- and Third-Hand Exposure in Women and Children of Afghanistan

Bruce A. Goldberger, David M. Martin, Mark S. Gold

First Published: 2009-2017  Brief Technical Report 

Abstract

Photo of poppy field © KIKETXO | Shutterstock.com

It is well-documented that Afghanistan produces 90% of the world’s supply of opium, but there is little known about the opium and other drugs being abused by the Afghan population. The continued production and abuse of opium and abuse of other drugs and prescription medications degrade the long-term political, social, and economic stability of Afghanistan. 

The United States Department of State, Bureau of International Narcotics and Law Enforcement Affairs (INL) has been working with the Afghanistan Ministry of Counter Narcotics to reduce demand and prevent drug abuse. The International Demand Reduction Program (IDR) under INL funds programs on demand reduction training (education, prevention, treatment, research) and public awareness. As part of this program, in 2008, the U.S. State Department contracted with a team of scientists led by two of the world’s leading experts on drug abuse, Mark S. Gold, MD, the Donald Dizney Eminent Scholar and chairman of the department of psychiatry, University of Florida College of Medicine, and Bruce A. Goldberger, Ph.D., professor of pathology and psychiatry with the University of Florida College of Medicine and director of the William R. Maples Center for Forensic Medicine. The Scientific Team Director was David M. Martin, Ph.D., JMJ Technologies, Inc. In consultation with INL, the team designed a study to evaluate the indoor environment of homes in Afghanistan where opium and opium products (e.g., heroin) are abused. Research has documented the dangers of passive tobacco smoke, especially to children, but little is known about passive exposure to opium smoke. Air, surface, and hair samples taken at these homes were tested to determine whether the non-smoking residents were unwilling victims of exposure to opium products by drug-abusing members of the household.

Samples were collected, coded, and shipped for testing to a commercial toxicology laboratory in the United States (United States Drug Testing Laboratories, Des Plaines, Illinois). Hair samples were collected according to standard protocol, and surface samples were obtained by wiping a target area with a 1-inch. square of polyester filtering material. Air samples were obtained by drawing air through a specially designed column attached to an air pump operating at 1000 mL/minute for 30 minutes. Opiates were isolated from the hair and wiped samples by solid-phase extraction followed by liquid chromatography–tandem mass spectrometry.

The results of the study are stunning. Not only were opium products detected in indoor air samples, but the concentrations found in the air were also significant. Wipe samples collected from a variety of surfaces had equally significant amounts of opium products, and some of the surface samples were obtained from bedding, eating
utensils, toys, and other items with which children come into direct, regular, and repeated contact. The data from the study suggests that inhalation of second-hand smoke
and contact with contaminated surfaces (i.e., third-hand exposure) are endangering women and children living in households where opium or other drugs are abused.
For example, a 10-year-old girl’s hair sample contained 8350 pg/mg of morphine, 4652 pg/mg of codeine, and 5607 pg/mg of a heroin metabolite (6-diacetylmorphine). For comparison, samples obtained from heroin addicts have demonstrated similar concentrations, making these findings remarkable, especially in a child. The same hair sample contained hydrocodone and hydromorphone, synthetic opioid compounds, raising the question of whether prescription drug abuse is also a problem in Afghanistan.

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