ORIGINAL RESEARCH
Serum Zinc, Copper, Iron, and Magnesium Levels in
Iranian Drug Users: A Case Control Study
Ahmad Akbari, MD, Ghasem Mosayebi, MSc, PhD, Hassan Solhi, MD, Mohammad Rafiei, MSc, PhD,
Azam Asadi, MD, and Ali Ghazavi, MSc, PhD
Introduction: The changes in concentration of trace elements have
effects on many organ systems, including the immune system. There
have been conflicting reports on serum trace element levels in heroin
users. This study was carried out to compare serum trace element
concentrations in opium, heroin, and methamphetamine users.
Methods: The study was done on 90 chronically illegal drug users
(n = 30 per group) and 30 controls of the similar sex and age range
(from 20 to 40 years). The control group was healthy subjects with
no lifetime history of substance abuse or dependence. All of the sub-
stance users were selected from among those who had a history of
substance use, for a minimum of 1 year. Serum zinc (Zn), copper
(Cu), iron (Fe), and magnesium (Mg) were measured spectrophoto-
metrically using chemistry analyzer.
Results: Serum Fe concentration was decreased in heroin (P = 0.026)
and methamphetamine (P = 0.0001) users compared with healthy
subjects, whereas serum Cu was higher in opium, heroin, and metham-
phetamine users (P < 0.01). Copper was negatively and significantly
correlated with Fe in all groups (P < 0.05). There was no statisti-
cally significant difference between drug users and healthy subjects
in serum concentrations of Zn and Mg.
Conclusions: This study showed decreased in serum concentration
of iron and increase in serum copper in drug users when compared
with controls.
Key Words: heroin, methamphetamine, opium, trace elements
(J Addict Med 2015;9: 304–307)
From the Arak University of Medical Sciences, Arak, Iran (A. Akbari and
A. Asadi); Molecular and Medicine Research Center, Department of Im-
munology, School of Medicine (GM), Department of Forensic Medicine
& Toxicology (HS), Department of Biostatistics and Epidemiology (MR),
and Tuberculosis and Pediatric Infectious Research Center (TPIRC), De-
partment of Immunology, School of Medicine (AG), Arak University of
Medical Sciences, Arak, Iran.
Received for publication July 8, 2014; accepted April 7, 2015.
The authors do not have any financial/commercial conflicts of interest in the
study presented here.
Send correspondence and reprint requests to Ali Ghazavi, MSc, PhD, Tubercu-
losis and Pediatric Infectious Research Center, Department of Immunol-
ogy, School of Medicine, Arak University of Medical Sciences, PO Box
3848176941, Arak, Iran. E-mail: ghazaviali@arakmu.ac.ir.
Copyright C 2015 American Society of Addiction Medicine
ISSN: 1932-0620/15/0904-0304
DOI: 10.1097/ADM.0000000000000134
I
ncreasing rates of illegal drug use is one of the main chal-
lenges in most countries (Drugs UNOo, 2010). Among il-
legal drugs, opium, heroin, and methamphetamine have high
rate of consumption in Iran (Ghazavi et al., 2013). There are
several clinical reports showing an association between the
use of illegal drugs and infectious diseases (Friedman et al.,
2006; Drugs UNOo, 2010). Changes in trace element levels
are one of the possible mechanisms involved in alterations of
the immune system that increase susceptibility to infections.
The concentrations of serum trace elements have been of inter-
est to researchers for a number of years in many pathological
conditions such as various infections and multiple sclerosis
(El-Kholy et al., 1989; Ghazavi et al., 2011).
The importance of appropriate levels of trace elements
for protection against infections has been clearly established.
Deficiencies of a number of trace elements alter the secretion
of extracellular factors able to modulate the activities of im-
mune cells and other cell types involved in the host response to
infectious agents. However, it is also recognized that the needs
of the host must be balanced against the possibility that exces-
sive amounts of redox-active metals such as iron and copper
can induce free radical mediated damage, and that infective
agents also need the same trace elements for their survival and
replication as the host (Failla, 2003).
Zinc (Zn), copper (Cu), iron (Fe), and magnesium (Mg)
are essential trace elements for the immune system. Various en-
zymes that contribute to immune system responses require Zn
and Cu as trace elements for their activity, which include cata-
lase, superoxide dismutase, and glutathione peroxidase (Amini
et al., 2009; Lal et al., 2013). Mechanisms by which immune
cells kill microbes have been a subject of intense research in
recent years. One of the mechanisms, the serum redistribu-
tion of essential trace elements Zn, Cu, and Fe along with the
increase in synthesis of acute-phase proteins, that takes part
during most infections is now well established (Faryadi and
Mohebali, 2003). Zinc deficiency has also been demonstrated
to lead to a selective T helper type 1 deficiency in human
subjects (Beck et al., 1997).
Elevated Cu is thought to cause pathological changes
induced in tissues by stimulating the production of free rad-
icals, which damage multiple cells. Iron deficiency reduces
total activity of protein kinase C (PKC) in activated T-cells,
and therefore the carryover of PKC from the cytoplasm to
the cis face of the cell membrane (Kuvibidila et al., 1999).
Protein kinase C is crucial for phosphorylation of factors
Copyright © 2015 American Society of Addiction Medicine. Unauthorized reproduction of this article is prohibited.
304 J Addict Med
Volume 9, Number 4, July/August 2015