• Hooman Khademi, Reza Malekzadeh, Akram Pourshams, Elham Jafari, Rasool Salahi, Shahryar Semnani, Behrooz Abaie, Farhad Islami, Siavosh Nasseri-Moghaddam, Arash Etemadi, Graham Byrnes, Christian C Abnet, Sanford M Dawsey, Nicholas E Day, Paul D Pharoah, Paolo Boffetta, Paul Brennan, and Farin Kamangar.
• Digestive Disease Research Centre, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
• BMJ. 2012 Jan 1;344:e2502.

ObjectivesTo investigate the association between opium use and subsequent risk of death.DesignProspective cohort study.SettingThe Golestan Cohort Study in north-eastern Iran collected detailed validated data on opium use and other exposures at baseline. Participants were enrolled between January 2004 and June 2008 and were followed to May 2011, with a follow-up success rate of over 99%.Participants50,045 participants aged 40-75 at baseline.Main OutcomesMortality, all cause and major subcategories.Results17% (n = 8487) of the participants reported opium use, with a mean duration of 12.7 years. During the follow-up period 2145 deaths were reported. The adjusted hazard ratio for all cause mortality associated with ever use of opium was 1.86 (95% confidence interval 1.68 to 2.06). Opium consumption was significantly associated with increased risks of deaths from several causes including circulatory diseases (hazard ratio 1.81) and cancer (1.61). The strongest associations were seen with deaths from asthma, tuberculosis, and chronic obstructive pulmonary disease (11.0, 6.22, and 5.44, respectively). After exclusion of people who self prescribed opium after the onset of major chronic illnesses, the associations remained strong with a dose-response relation.ConclusionOpium users have an increased risk of death from multiple causes compared with non-users. Increased risks were also seen in people who used low amounts of opium for a long period and those who had no major illness before use.

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