It is well documented that Afghanistan produces 90% of the world’s supply of opium, but there is little known about opium and other drug abuse in the Afghan population. The continued production and abuse of opium as well as 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, the U.S. State Department contracted with a team of scientists in 2008 led by David M. Martin, PhD, Scientific Team Coordinator. Dr. Martin’s team includes two of the world’s leading experts on drug abuse, Mark S. Gold, MD and Bruce A. Goldberger PhD. In consultation with INL, the team designed a study to evaluate the indoor environment of homes in Afghanistan where opium and opium products (heroin) are abused. Air, surface and hair samples from inhabitants of those homes were tested to determine if they were unwilling victims exposed to opium products by drug abusing members of the household.
The results of the study are alarming. Not only were opium products detected in indoor air samples, the concentrations found were significant. Wipe samples collected from a variety of surfaces had equally significant amounts of opium products. Some of the surface samples were collected from bedding, eating utensils, toys and other surfaces that children come into direct and regular contact. The data from the study suggest that inhalation of second-hand smoke, as well as contact with contaminated surfaces (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 8,350 pg/mg of morphine, 4,652 pg/mg of codeine, and 5,607 pg/mg of a heroin metabolite. In comparison, tests of heroin addicts in the United States have reported values many times lower making these findings remarkable, especially in a child. The same young girl also had the synthetic opium compounds of hydrocodone and hydromorphone in her hair raising the question if prescription drug abuse is also a problem in Afghanistan.
The study was continued for two years with hair, air and surface samples collected in the homes of Afghan families who smoked opium and heroin and a group of ten non-smoking homes used as a control group.
In Year One, 20 homes with active opium use were sampled and tested;
- 12 out of 13 air samples collected from the homes tested positive - 92%
- 19 of 20 homes had contaminated surfaces - 95%
- 19 of 20 homes had a non-using resident’s hair tested positive - 95%
- 17 of 28 children’s hair tested positive - 61%
The team tested children ranging in age from 14 months to 12 years old, the 14 month-old girl had 534 pg/mg of morphine, 122 pg/mg of codeine and 1,388 pg/mg of heroin metabolite in her hair sample. These results were so high Drs. Gold and Goldberger sent the samples to a second independent laboratory for verification. The second set of analyses confirmed the first set of results.
Year Two focused on collecting similar samples from 20 different homes to determine if the results could be duplicated, or if they were just an isolated phenomenon. Five homes from Year One were repeated as well. The results from Year Two are similar to Year One:
- 21 of 21 air samples tested positive - 100%
- 24 of 25 homes had a variety of contaminated surfaces - 96%
- 22 of 24 homes had at least one resident’s hair tested positive - 91%
- 31 of 42 children’s hair tested positive - 74%
The most startling finding from Year Two is the high concentrations of opium products, as well as synthetic opioids found in the hair of a 5 year-old boy. This child’s hair sample contained 15,554 pg/mg of morphine, 8,360 pg/ mg codeine, 1,490 pg/mg heroin metabolite, 476 pg/mg hydromorphone (synthetic opioid), 182 pg/mg hydrocodone (synthetic opioid) and 41 pg/mg oxymorphone (synthetic opioid). The pillow, blanket and bedding of the child was also contaminated by opium products suggesting that direct contact and hand-to-mouth transfer from these items in the home may also be a significant route of exposure to opium for children.
The scientific team also collected urine and saliva samples on all the residents who had hair tested in Year 2 and breast milk samples from nursing mothers. These samples will be tested to more fully elucidate the distribution of opium products in the hair of Afghan Children in Year 3. This study is the first of its kind demonstrating passive exposure through the second- and third-hand exposure to opium products in the air and/or contaminated surfaces such as bedding materials and eating utensils. This leads to exposure of children and other household members to dangerous amounts of the opium products. The long-term consequences to this exposure on the mental, physical and emotional development to children are unknown. Like exposure to second and third-hand cigarette smoke, children of opium smokers may be expected to be at high risk for use, abuse and dependence. The study may expand to provide culturally appropriate drug education and prevention programs to help Afghan women and children as well as their husbands, fathers and siblings live in a safe, drug-free environment.