Tramadol overdose: review of the literature

Prevalence and health consequences of nonmedical use of tramadol in Africa: A systematic scoping review

Tramadol is a widely prescribed painkiller around the world. As a synthetic opioid, it offers a valuable substitute for morphine and its derivatives in African countries. However, the adverse health effects of tramadol use resulting from illicit trafficking, like those caused by fentanyl and methadone in North America, have not been well-documented in Africa. This scoping review aims to shed light on the nature and scope of the nonmedical use (NMU) of tramadol in Africa and its associated health consequences. To carry out our scoping review, we used Arksey and O'Malley's (2005) five-step approach for exploratory analysis and followed Joanna Briggs Institute guidelines for scoping reviews to ensure systematic and replicable studies. We then searched six databases: Medline, Global Health (EBSCO), Scopus, Web of Science, the African Journals online database, and for grey literature via Google Scholar without any time restriction. The articles were imported into Covidence and reviewed by two independent researchers. Eighty-three studies on NMU of tramadol's prevalence or health consequences were selected from 532 titles/abstracts screened, including 60 cross-sectional and six qualitative studies from 10 African countries. Findings from the included studies highlighted five distinct groups significantly affected by the NMU of tramadol. These groups include: 1) young adults/active populations with varying degrees of prevalence ranging from 1.9% to 77.04%, 2) professionals, where drivers exhibit a relatively high prevalence of tramadol NMU, ranging from 7.2% to 35.1%, and commercial motorcyclists, with a prevalence of 76%, 3) patients, who have a high rate of tramadol NMUs, with prevalence rates ranging from 77.1% to 92%, 4) academics, with a considerable rate of tramadol misuse among substance-using undergraduates (74.2%) and substance-using high school students (83.3%), and 5) other individuals impacted in various ways. The health consequences are classified into four distinct types: intoxication, dependence syndrome, withdrawal syndrome and other symptoms. Despite providing a comprehensive global overview of the phenomenon described in the African literature, this systematic scoping review's main limitations stem from the relatively limited exploration of various consequences of the NMU of tramadol, notably those of a social and economic nature. Our review shows that tramadol misuse affects diverse populations in Africa. The prevalence of misuse varies within sub-populations, indicating the complexity of the issue. Professional and academic groups have different rates of misuse across regions. This highlights the need for targeted interventions to address unique challenges contributing to tramadol misuse. Future studies should focus on the social and economic costs of abuse on households to better understand the impact on well-being. Systematic review registration: Open Science Framework: https://osf.io/ykt25/.

Application of oxidized multi-walled carbon nanotubes and zeolite nanoparticles for simultaneous preconcentration of codeine and tramadol in saliva prior to HPLC determination

In this work, a dispersive micro-solid phase extraction technique along with high-performance liquid chromatography-UV detection was developed for simultaneous preconcentraion and determination of trace levels of codeine and tramadol in human saliva. This method is based on the adsorption of codeine and tramadol on a mixture of oxidized multi-walled carbon nanotubes and zeolite Y nanoparticles with 1:1 ratio as an efficient nanosorbent. Various analytical parameters influencing the adsorption step including the amount of adsorbent, the pH of the sample solution, the temperature, the stirring rate, the contact time of the sample solution, and the adsorption capacity were investigated. Based on the results, 10 mg adsorbent, sample solutions with pH = 7.6, temperature of 25 °C, stirring rate 750 rpm and contact time 15 min, in the adsorption step shows the best results for both drugs. Then the effective parameters on the analyte desorption stage such as the type of desorption solution, pH of the desorption solution, desorption time and desorption volume were investigated. Studies have shown that water/methanol (50:50 v/v) as desorption solution, pH = 2.0, desorption time of 5 min and desorption volume of 2 ml gives the best results.Chromatographic separation was performed on a RP-Shim-pack CLC-ODS-C18 column (250 mm × 4.6 mm, 5 µm) with isocratic mode. The mobile phase contained of acetonitrile:phosphate buffer (18:82, v/v) at pH = 4.5 and the flow rate was 1 ml.min^-1. The wavelength of UV detector was adjusted at 210 nm and 198 nm for codeine and tramadol, respectively.Under optimum conditions, the extraction efficiencies of 98.5% and 99.2% were achieved for codeine and tramadol respectively. Enrichment factor of 13, detection limit of 0.3 μg L^-1, relative standard deviation of 4.07 for codeine; and an enrichment factor of 15, a detection limit of 0.15 μg L^-1, and standard deviation of 2.06 for tramadol were calculated. The linear range of the procedure for each drug was 1.0 to 1000 μg L^-1. This method was successfully applied for the analysis of codeine and tramadol in saliva samples.

Protocol for a scoping review study on the prevalence and public health consequences of non-medical use (NMU) of tramadol in Africa

BACKGROUND

Tramadol is one of the most prescribed painkillers in the world. It is a synthetic opioid that is an excellent alternative to morphine and its derivatives in African countries. It is an essential drug due to its low cost and constant availability. However, the health consequences of tramadol use due to illicit trafficking, like those caused by fentanyl and methadone in North America, are poorly documented. This scoping review aims to understand the nature and extent of the use and health consequences of the Non-Medical Use (NMU) of tramadol in Africa to guide future research.

METHODS

Due to the perceived lack of African literature on the subject, our search strategy is based on the simultaneous use of the keywords "tramadol" and Medical Subject Heading (MeSH), such as "Drug abuse," "illicit drugs," or "Prescription Drug Misuse," combined with the term "Africa" and Boolean operators (and, or not) to form our search equations. Two researchers will independently select studies from literature searched in several databases such as Medline, Embase, the Scopus database, Web of Science, the African Journals online database, and for grey literature Google Scholar without any time restriction. All research, in various formats, conducted in Africa, will be included in our study on the prevalence of use in different African population groups or on evidence of addiction, intoxication, seizures and mortality related to NMU of tramadol.

RESULTS

Through this study, we aim to map consumers and identify risk factors, health consequences, and prevalence of the NMU of tramadol in African countries.

DISCUSSION

We are conducting the first scoping review study to investigate the prevalence and consequences of NMU of tramadol in Africa. Upon completion, our findings will be published in a peer-reviewed journal and presented at relevant conferences and workshops. However, since health is not limited to the lack of disease, our study is likely incomplete without incorporating the studies of the social impact of NMU of tramadol.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework: https://osf.io/ykt25/.

A review on tramadol toxicity: mechanism of action, clinical presentation, and treatment

Aims

As an analgesic that acts upon the central nervous system (CNS), tramadol has gained popularity in treating moderate to severe pain. Recently, it has been increasingly reported as a drug of misuse with intentional overdoses or intoxications. This review focuses on tramadol intoxication in humans and its effects on different systems.

Subject and method

This narrative review provides a comprehensive view of the pharmacokinetics, mechanism of action, and incidence of tramadol toxicity with an in-depth look at its side effects. In addition, the main approaches to the management of tramadol poisoning are described.

Results

Tramadol poisoning can affect multiple organ systems: gastrointestinal, central nervous system (seizure, CNS depression, low-grade coma, anxiety, and over time anoxic brain damage), cardiovascular system (palpitation, mild hypertension to life-threatening complications such as cardiopulmonary arrest), respiratory system, renal system (renal failure with higher doses of tramadol intoxication), musculoskeletal system (rhabdomyolysis), endocrine system (hypoglycemia), as well as, cause serotonin syndrome. Seizure, a serious nervous disturbance, is more common in tramadol intoxication than with other opioids. Fatal tramadol intoxications are uncommon, except in ingestion cases concurrent with other medications, particularly CNS depressants, most commonly benzodiazepines, and ethanol.

Conclusion

With the increasing popularity of tramadol, physicians must be aware of its adverse effects, substantial abuse potential, and drug interactions, to weigh its risk–benefit ratio for pain management. Alternative therapies might be considered in patients with a previous overdose history to reduce risks for adverse outcomes.