The Insurgence of Tramadol Abuse among the Most Active Population in Jirapa Municipality: A Study to Assess the Magnitude of the Abuse and Its Contributory Factors

Topical Formulation of Tramadol 5% in the Management of Osteoarthritis of the Knee: A Double-Blind, Randomized, Prospective, Placebo-Controlled Clinical Trial

The goal of the present study was to evaluate the efficacy of topical tramadol in the management of knee osteoarthritis pain. Sixty patients with moderate to severe pain of knee osteoarthritis were enrolled. Patients were randomized to receive tramadol 5% or placebo along with oral diclofenac 100 mg/day. They were instructed to apply the ointment every 12 h on the knee for three weeks. To control breakthrough pain, the patients were allowed to take acetaminophen up to 650 mg per day. The measured variables were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analog Scale (VAS). Sixty patients completed the study. At the end of follow-up period, VAS decreased by 21% (from 7.2 ± 2.1 to 5.7 ± 2.4, p-value < 0.05) and WOMAC score decreased by 23% (from 49.6 ± 17.4 to 38.4 ± 18.1, p-value < 0.05) in intervention group. Topical tramadol was significantly effective in reducing the intensity of pain and osteoarthritis symptoms in comparison to placebo considering VAS (5.7 ± 2.4 vs. 8.0 ± 2.9, p-value = 0.001) and WOMAC score (38.4 ± 18.1 vs. 46.0 ± 18.6, p-value = 0.007). Topical tramadol 5% appears to be effective in moderate to severe knee osteoarthritis pain.

A consideration of CYP2D6 genetic variations in the Ghanaian population as a potential 'culprit' for the tramadol 'abuse crisis'

BACKGROUND

Cytochrome P450 2D6 is involved in the metabolism of several important medicines including opioids. Variations in CYP2D6 have been implicated in drug response and according to the Clinical Pharmacogenetics Implementation Consortium Guideline (CPIC) for CYP2D6, dosing for CYP2D6 substrates should be based on variants carried by individuals. Although CYP2D6 variations in Ghana had been previously recorded, not all variants have been reported in the Ghanaian population. In this exploratory study we set to investigate certain unreported variations in the Ghanaian population in addition to the previously reported ones and use that to understand the tramadol 'abuse' crisis that is currently being experienced in Ghana.

METHODS

This study employed a convenience sampling approach to include 106 unrelated participants who were recruited as part of the PHARMABIOME project. We successfully genotyped 106 samples using Iplex GOLD SNP genotyping protocol after extracting DNA from these individuals. Allele and diplotype frequencies were undertaken by counting from observed genotypes. Comparison of alleles reported from various studies were done.

RESULTS

Unreported alleles such as *3, *9 and *41 which are classified as no function and decreased function were observed in our study cohort. In addition, variants such as (*1, *2, *4, *5, *10, *17 and *29 were observed with different frequencies. Our study showed 26% representation of intermediate metabolizers (IM) and 2% poor metabolizers (PM) in the study population.

CONCLUSION

The implications for informal sector workers who use tramadol for recreational purposes, is that IMs and PMs will overdose as they may have reduced analgesic effects which will translate into increased risks of unforeseen adverse events. We therefore propose that CYP2D6 should be considered in opioid dosage while making use of these observed variations to implement new approaches to tackle the tramadol 'abuse crisis' in Ghana.

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/.

Prevalence and correlates of substance use among school-going adolescents (11-18years) in eight Sub-Saharan Africa countries

BACKGROUND

Substance use constitutes a major public health issue especially among adolescents as it has associated adverse behavioural, health, social and economic outcomes. However, there is a paucity of comprehensive evidence on the prevalence and associated factors of substance use (alcohol, marijuana and amphetamine) among school-going adolescents in sub-Saharan Africa (SSA). This study examined the magnitude of substance use and its associated factors among school-going adolescents in eight eligible sub-Saharan Africa countries.

METHODS

Data for the study were obtained from the Global School-based Health Survey (2012-2017) of 8 countries in SSA (N = 16,318).

RESULTS

Findings showed overall prevalence rates of 11.3% (95%CI = 10.8 - 11.8%), 2% (95%CI = 1.8 - 2.2%) and 2.6% (95%CI = 2.3 - 2.9%) for current alcohol use, current marijuana use and lifetime amphetamine use, respectively between 2012 and 2017. Late adolescence (15-18 years), being male, anxiety, bullying, fighting, truancy, having close friends, current cigarette smoking and tobacco use are significant risk factors for alcohol use. Anxiety, truancy, current cigarette smoking, tobacco use and suicidal attempt are significant risk factors for marijuana use. Anxiety, bullying, truancy, current cigarette smoking, tobacco use and suicidal attempt are significant risk factors for amphetamine use. Parental knowledge of activity, supervision and respect of privacy are significant protective factors of substance use.

CONCLUSION

There is the need for comprehensive public health policies beyond school-based psycho-behavioural interventions targeting the significant risk factors of substance use among school-going adolescents in SSA.

Pre-emptive analgesia efficacy of piroxicam versus tramadol in oral surgery

Background

This double-blind randomized controlled trial (RCT) was conducted to evaluate the pre-emptive analgesia and anti-inflammatory efficacy of piroxicam compared with tramadol in patients undergoing oral surgery.

Methods

Seventy-eight patients who required extraction of impacted mandibular third molars were randomized into three treatment groups of 26 patients each: group I received 100 mg of tramadol, group II received 20 mg of piroxicam, and group III received a placebo. Drugs were administered intramuscularly 30 min prior to the extraction procedure.

Results

Pain intensity, time to first analgesic administration, total analgesic consumption, facial edema, and trismus were the outcomes of interest. The group receiving 20 mg of piroxicam showed significantly lower pain intensity, increased time to first analgesic, and reduced edema from preoperative to postoperative day seven than those in the tramadol and placebo groups.

Conclusion

The findings of this study showed that piroxicam had significant pain relief efficacy after third molar surgery compared with that in tramadol.

Where is the pain? A qualitative analysis of Ghana's opioid (tramadol) 'crisis' and youth perspectives

Over the last five years, media reports in West African countries have suggested a tramadol abuse 'crisis' characterised by a precipitous rise in use by youth in the region. This discourse is connected to evidence of an emerging global opioid crisis. While the reported increase in tramadol abuse in West Africa is likely true, few studies have critically interrogated structural explanations for tramadol use by youth. Nascent academic literature has sought to explain the rise in drug use as a function of moral weakness among youth. This Ghanaian case study draws on primary and secondary data sources to explore the pain that precedes tramadol abuse. Through a discourse analysis of 295 media articles and 15 interviews (11 with youth who currently use tramadol and 4 with health system stakeholders), this study draws on structural violence and moral panic theories to contribute to the emerging literature on tramadol (ab)use in West Africa. The evidence parsed from multiple sources reveals that government responses to tramadol abuse among Ghanaian youth have focused on arrests and victim blaming often informed by a moralising discourse. Interviews with those who use tramadol on their lived experiences reveal however that although some youth use the opioid for pleasure, many use tramadol for reasons related to work and feelings of dislocation. A more complex way to understand tramadol use among young people in Ghana is to explore the pain that leads to consumption. Two kinds of pain; physical (related to strenuous work) and non-physical (related to anxiety and the condition of youth itself) explain tramadol use requiring a harm reduction and social determinants of health approach rather than the moralising 'war on drugs' approach that has been favoured by policy makers.