are commonly used on the other hand an opioid consumption is traditionally common in iran .
the effects of different addictives on body systems have been reported ; however , there is not enough information about different blood parameters ( 2 ) .
the effect of some psychoactive substances on commonly observed diseases like coronary artery disease , diabetes mellitus and some psychiatric disorders has been investigated , but effects of long - term use of these substances on endocrine system have not been studied enough ( 3 ) .
studies have demonstrated controversial results about effects of psychoactive substances on hypothalamic - pituitary axis and thyroid function ( 4 ) .
psychoactive substances have many different effects on physiologic and neuroendocrine functions in humans ( 5 ) .
it has been demonstrated that endogenous opioids like -endorphin , enkephalins and opiate receptors influence neuroendocrine regulation ( 6 ) .
previous studies showed that some psychoactive substances modulate immune function and affect resistance to bacterial , viral and protozoan infections ( 7 , 8) .
monitorization of the psychoactive substance use can be done objectively by urine analysis . since substance concentrations in urine are higher than blood , urine is the preferred material for determination of substance use .
testing schedules and determination of cut - offs are important for confirmation of the psychoactive substance use ( 9 ) .
since polydrug abuse is common worldwide , determination of the effects of only one drug is difficult ( 10 ) .
recent studies demonstrated controversial results about the effects of opium on serum electrolytes , lipid markers and glucose metabolism .
defining the real side effects of these psychoactive substances may increase awareness about disadvantages of consumption ( 11 ) .
studies about the effects of psychoactive substances on different biochemical and hematological parameters were limited in number ( 2 , 12 ) .
this study was conducted to determine the effects of different psychoactive substances on serum biochemical parameters .
this study was conducted on 324 patients and 69 controls admitted to erenkoy mental health and neurology training and research hospital between january 2013 and january 2014 .
patients were determined according to the  diagnostic and statistical manual of mental disorders , fourth edition 
dependent group involves subjects determined as at least one or more than one type of psychoactive substance users . in the control group urine toxicology results were negative .  
levels of toxicology parameters were determined using a hitachi model 902 automatic analyzer ( hitachi high - technologies corporation , roche diagnostics ) with an enzyme immunoassay ( microgenics cedia fremont , california , usa , for urine toxicology ) .
after hospitalization , each patient s first urine and blood sample before treatment were taken into account for comparison .
cases and controls with accompanying diseases like diabetes , cancer , metabolic disorders etc . are excluded from the study .
urine samples were tested simultaneously for heroin , cannabinoids , cocain , benzodiazepins , opiates , buprenorfine , amphetamines , extacy and ethyl glucuronide .
routine biochemistry parameters were measured using the architect ci 4100 ( abbott diagnostics products ) automatic biochemistry analyzer .
this study was approved by the ethics committee of erenkoy mental health and neurology training and research hospital .
spss ibm 20.0 software ( chicago , illinois , usa ) was used for statistical analysis .
spss ibm 20.0 software ( chicago , illinois , usa ) was used for statistical analysis .
a total of 324 patients ( 316 males and 8 females ) and 69 controls ( 64 males and 5 females ) were involved in this study .
the median ages of psychoactive substance users and controls were 26.5 ( 23 - 34 ) and 27 ( 20.5 - 34.5 ) years , respectively ( table 1 ) .
the concentration of biochemical parameters in the serum of the substance - dependent group was compared to the control group ( table 2 ) .
we found a statistically significant difference in gamma - glutamyl transferase ( ggt ) , uric acid , creatinin , urea , albumin , aspartate aminotransferase ( ast ) medians between the patient and control groups ( p < 0.05 ) .  
abbreviations : alp , alkaline phosphatase ; alt : alanine aminotransferase ; ast : aspartate aminotransferase ; crp , c - reactive protein ; ggt , gamma - glutamyl transferase ; hdl , high density lipoprotein ; ldh , lactate dehydrogenase ; and ldl , low density lipoprotein .  
forty - six out of 424 addicts tested positive for only opium ( cut - off , 300 ng / ml ) . several biochemical parameters in the opium - dependent group were compared to the control group ( table 3 ) .
there was a statistically significant difference in the serum concentrations of sodium and albumin between the opium - dependent and the control groups ( p < 0.05 ) .
moreover , sixty - nine patients were tested positive for only cannabinoids ( cut - off , 50 ng / ml ) .
biochemical parameters did not show any significant difference in the cannabinoid - dependent group compared to the control group ( p > 0.05 ) .
thirteen out of all addicts were tested positive for only benzodiazepine ( cut - off > 300 ng / ml ) .
there was a statistically significant difference in ggt , urea , glucose , sodium , total protein , and ast levels between the benzodiazepine - dependent group and control group ( p < 0.05 ) .
also , 12 patients were tested positive for only ethyl glucuronide ( cut - off > 500 ng / ml ) .
a statistically significant difference was found in triglyceride and ggt levels between the ethyl glucuronide and control groups ( p < 0.05 ) .
clinical observations demonstrated that adverse effects of psychoactive substances were associated with the addiction period and route of administration .
psychoactive substance users commonly have nutritional problems since they spend their money largely for drugs ( 13 ) .
coexistence of psychiatric disorders in drug addicts is also important since some psychiatric disorders may cause loss of appetite and poor nutritional status and changes in biochemical parameters ( 14 ) .
clinical studies showed that long - term use of opium and heroin can affect serum glucose , potassium , calcium , uric acid and cholesterol levels ( 12 ) . in our study
, we found a significant difference in ggt , uric acid , creatinine , urea , albumin , and ast medians between the dependent and control groups ( p < 0.05 ) .
studies about the effects of opium addiction on blood glucose showed that the opium - dependence decreased fasting blood glucose temporarily without any effect on hemoglobin a1c ( 15 ) .
we found a statistically significant decrease in glucose levels only in patients tested positive for benzodiazepine ( p < 0.05 ) .
some psychoactive substances may affect gluconeogenesis so that blood glucose levels may decrease , especially in cases with poor nutrition .
some people believe that psychoactive substances like opium can have beneficial effects on blood lipid profile and cardiovascular disease , but clinical observations demonstrated that opium can increase risk of atherosclerotic plaque formation and adversely affect lipid profile in animal models ( 16 ) .
we found a statistically significant increase in triglyceride levels in ethylglucuronide group ( p < 0.05 ) . in our study , we did not found statistically significant difference in total cholesterol , low density lipoprotein ( ldl ) , and high density lipoprotein ( hdl ) levels between dependent and control groups ( p > 0.05 ) .
cardiovascular side effects of some psychoactive substances may not be attributed to changes in lipid profile .
there is a need to conduct a prospective study with the larger sample size for the prevalence of the cardiovascular disease .
another study , which was performed on opium addicts showed that serum adiponectin levels were decreased but no significant change was observed in serum leptin levels .
it was also indicated in previous studies that a decrease in adiponectin levels can be associated with an increased risk of metabolic disorders like insulin resistance and cardiovascular disease since it has known antidiabetic and antiatherogenic effects ( 17 ) .
changes in nutritional patterns may also be related with changes in albumin levels in these patients ( 18 ) .
we found a statistically significant difference in albumin levels between the drug - dependant and control groups . in our study , the amount of total protein showed a significant difference only in the benzodiazepine dependent group ( p < 0.05 ) . since in our study , patients with significant derangements were referred to specialized medical centers for further assessment and excluded from the study , changes in their albumin levels may not be due to viral infections or metabolic disorders . in a previous study , it has been demonstrated that morphine consumption for long period in animal models increases uric acid and creatinine levels ( 19 ) .
we found a statistically significant decrease in uric acid and creatinine levels in the dependant group compared to the control group ( p < 0.05 ) .
poor living conditions and nutritional factors like low protein intake may likely to contribute to changes in biochemical parameters in psychoactive substance users .
these effects on renal system include changes in urinary output and urinary sodium excretion ( 20 ) .
divsalar et al . showed that a sodium level in the heroin - dependent group did not change ; however , it was significantly high in the ex - heroin dependent group compared to the control group
. however , no significance difference was found in potassium and calcium levels between the ex - heroin dependent and control groups ( 14 ) .
we found that the concentration of sodium in the serum of the opium - dependent and benzodiazepine dependent groups was significantly increased compared to the control group ( p < 0.05 ) .
no statistically significant difference was observed in calcium levels between the dependent and control groups ( p > 0.05 ) .
routine biochemistry , and hematology parameters , and vitamin , and mineral levels are affected by nutritional factors .
determining the differences in biochemical parameters , vitamin and mineral levels between addicts and healthy subjects may help to define individuals at nutritional risk and provide these patients with the corrective nutritional programs ( 18 ) . in this study we tried to describe the extent of changes in various blood parameters due to psychoactive drug use .
our study involves a range of psychoactive substances like heroin , cannabinoids , cocaine , benzodiazepine , opiate , buprenorphine , amphetamine , extacy , ethyl glucuronide and their potential effects on many biochemical parameters . raising awareness about potential adverse effects of psychoactive substances
health problems associated with physiological side effects of these substances may increase economic burden on health care resources .
therefore , in psychoactive substance users defining the real need for intensive monitoring and treatment programs are extremely important .
 background : psychoactive substances affect mainly central nervous system and brain function causing changes in behavior.objectives:the purpose of this study was to determine the effects of different psychoactive substances on serum biochemical parameters.patients and methods : the study included 324 drug dependents , and 69 controls . 
 the patient group was determined according to dsm - iv ( the diagnostic and statistical manual of mental disorders , fourth edition ) criteria . 
 all patients and control subjects were tested for routine biochemical parameters and urine toxicology parameters for psychoactive substance use . 
 cases and controls with accompanying diseases like diabetes , cancer , metabolic disorders etc . are excluded from the study . moreover , 
 an association between urine toxicology results and changes in biochemical parameters was evaluated for statistical significance.results:there was a statistically significant difference in the gamma - glutamyl transferase ( ggt ) , uric acid , creatinine , urea , albumin , aspartate aminotransferase ( ast ) medians between the dependent and control groups ( p < 0.05 ) . 
 we found a statistically significant difference in sodium and albumin levels between the opium - dependent and control groups ( p < 0.05 ) . in the benzodiazepin 
 dependent group , we found a significant difference in ggt , urea , glucose , sodium , t protein , and ast levels ( p < 0.05 ) . 
 moreover , a statistically significant difference was observed in triglyceride and ggt levels between the ethyl glucuronide and control groups ( p < 0.05).conclusions : in psychoactive substance dependents , serum routine biochemistry parameters can be used to predict the need for intensive monitoring and treatment programs . 
1. Background
2. Objectives
3. Patients and Methods
3.1. Statistical Analysis
4. Results
5. Discussion