Tramadol Abuse Among Yeloyelo Drivers in the Tamale Metropolis

doi:10.21203/rs.3.rs-3911713/v1

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Research Article

Tramadol Abuse Among Yeloyelo Drivers in the Tamale Metropolis

https://doi.org/10.21203/rs.3.rs-3911713/v1

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Background

Tramadol abuse has become a major public health concern in many countries and Ghana as well. This study was carried out among tricycle drivers (Yeloyelo drivers) in the Tamale metropolis. This study sought to discuss the factors that influence the use of tramadol among tricycle drivers in the Tamale metropolitan area in the Northern Ghana.

Methods

The study employed qualitative approach. Purposive and snowball sampling techniques were used to select six terminal stations and 30 participants were selected from the six tricycle terminals stations in the Tamale Metropolis. 60 participants were also selected for FGDs. The results were analyzed using the Nvivo 10 software.

Results

The results of the study found that majority of the participants were engaged in the use of tramadol, some participants were found using tramadol and other substances such as alcohol mixed energy drinks, tramadol mixed with alcohol and snuffing of moringa powder mixed with cocaine without prescription from a physician. The study revealed that most participants abuse tramadol by taking in unapproved dosages of 500, 250, 200 and 150 (mg) dosages respectively as mentioned by some participants in the interviews conducted.

Conclusion

The study revealed that the three most compelling reasons why tricycle drivers use tramadol are; to energize themselves and become physically active, to relieve pains and peer group pressure. The study equally found the following side effects supporting the use of tramadol. Nausea, road accidents, sleeping while driving, anxiety, aggressiveness and dizziness are possible effects of tramadol use as was mentioned by participants. In addition, respiratory failures, anxiety, depression, aggressiveness, seizures, inattentiveness and inability to focus are equally the side effects of tramadol use among the yeloyelo drivers in the Tamale Metropolis.

Commercial tricycle operations (yeloyelo) have taken over the taxi operations in many cities in Ghana in recent years. However, majority of these operators use illegal substances, which put the passengers and other road users at risk. Psychoactive substance use constitute to cause 59.5% of road traffic accidents among commercial tricycle operators (1). This supports the reports from the national road safety commission that the introduction and use of tricycles in the Tamale metropolis has contributed to an increase in traffic accidents in the Northern region (Mohammed A., 2022)

A study conducted in Port-Harcout, Nigeria, revealed a strong correlation between the use of psychoactive substances including tramadol and accidents among commercial tricycle drivers (3). It has been intimated that psychoactive drugs, particularly tramadol is often recommended to new entrants into commercial tricycle operation as remedies for stress and fatigue(4).

In the late 1970s, the German pharmaceutical manufacturer, Grünenthal, launched and promoted tramadol under the brand name "Tramal" (5), and it has since been released in over 100 countries in different forms including drops, sustained and oral preparations, rectal suppositories, and injectable (6). Since 1980s, it has been approved in several nations and has become the most often prescribed opioid in the planet (4).

Different authorities have defined tramadol in various ways. For example, tramadol is a pain medication that is commonly accepted for the management of pain that ranges from mild to severe (7). Also, Grond and Sablotzki, (6) asserted that, tramadol is a pain reliever that is both effective and well tolerated in treating labor pain, trauma, and renal or biliary colic, as well as persistent discomfort from infectious or non-infectious causes, especially neurological discomfort. Similarly, tramadol, like many other prescription painkillers, stimulates opioids receptors in the brain and interacts with the serotonin and nor-epinephrine neurotransmitter systems in a manner similar to that of several opioids(8). Tramadol, also known as Ult-ram, is a painkiller that is taken orally to help alleviate mild to severe discomfort (7). It is intimated that trammadol belonged to the opioid analgesics class of medicine and is usually administered by a doctor to aid with pain management following surgery (9). A suggested that, tramadol is an opioid agonist drug with a potency estimated to be 10% compared to that of morphine. Conclusively, tramadol is a unique type of prescription pain reliever used to relieve mild to moderately and severe pain (10).

As being compared to other opiates that serve the same purpose, tramadol was formerly thought to be the cheapest and safest medicine with a minimal risk of addiction (11). However, in many circumstances, persons who require medical treatment and have been prescribed tramadol by a physician begin to use it in excess of the recommended medical dose, resulting in tramadol abuse. This is because, individuals who use tramadol may build a body tolerance to it with time, implying that they now require more tramadol than before, to have the same effects(10). Tramadol has substantial medicinal advantages when used properly, but when used without medical supervision, in higher doses than recommended, or in conjunction with illegal substances, alcoholic beverages, as well as various prescribed or over-the-counter (OTC) drugs, it can have serious health implications (12). According to medical specialists, the abuse of Tramadol, acts similarly to heroin and can create mental disorders as well as harm some important organs in the human body (10).

The main reason advanced for tramadol abuse is that, it produces a wonderful surge of exhilaration, which is why most users abuse the medication from time to time (13).

Tramadol is sometimes taken in combination with other drugs, a practice known as poly-drug abuse. A study showed that 204 high school pupils using drugs and discovered that 18 (8.8%) were taking tramadol, as evidenced by a urine test. 15 (83.3%) of those who used tramadol did so solely, while 3 (16.7%) used it in combination with another substance (marijuana, alcohol and tramadol) (14).

It has been observed that, users frequently mix tramadol with certain other medications to heighten the user’s euphoria or to self-medicate (15). Sedatives, alcohol, and other painkillers such as sleeping pills and benzodiazepines medications, and medications for cold are all regularly mixed with tramadol (16). In Wassa Amenfi, Ghana, a survey of young people conducted by Kwasi Elliason, (2018), found that the majority of respondents 62.3% take tramadol with an alcoholic beverage, while 29% mix tramadol with an energy drink and consume it. Only 8.7% respondents said they swallow tramadol with water. Interestingly, tramadol together with some other opioids may have pharmacokinetic and pharmacodynamic interactions that increase their toxicity and lead to death (18), tramadol is a mild opioid with a pharmacological effect comparable to codeine, its use has a possibility of tramadol addiction (4) (8). as such it has a major adverse effects such as psychotic convulsions and deadly overdoses (19).

Tramadol abuse has been linked to risk-taking activity and other addiction disorders, according to UK data (20). Almér Herrnsdorf et al.(20) examined the illegal use of buprenorphine and methadone among adolescents and young adults in Sweden and found that benzodiazepines and tramadol were considerably more commonly used by teenagers, implying that tramadol abuse has grown in recent years. Tramadol is the second most commonly confiscated medicinal drug in Sweden, according to data from police agencies (21). Since 2008, tramadol use has skyrocketed in Egypt, resulting in a surge in admissions to drug treatment centers (14). Despite the fact that drug addiction is not a new problem in Egyptian culture, tramadol abuse has become a growing public health concern in Egypt during the last four years (22).

In Ghana, there is a scarcity of data regarding tramadol abuse. However, records from the Food and Drugs Authority shows that tramadol addiction is widespread in Ghana, as evidenced by the Food and Drugs Authority's findings on the drug's widespread use (15), and multiple media publications on society’s difficulties related to use of illicit drugs.

Despite factual indications of a high rate of tramadol use among young people, no scientific rigorous study has been conducted to determine the scope of the problem in the Northern region. As such, there is growing perception among the population in Tamale regarding the use of tramadol and careless driving, resulting in rampant accidents among Yellow Yellow drivers in the Tamale metropolis. Hence, the aim of this paper is to examine the factors responsible for the use of tramadol by tricycle (yeloyelo) drivers.

The goal is to determine tricycle drivers’ knowledge and attitude towards tramadol use and to assess the perceived effects of tramadol use among tricycle drivers.

Definition of key terms.

Tramadol. This is a drug prescribed as a pain killer by physicians to patients. But people sometimes use it over the counter without physician’s prescription.

Yeloyelo Drivers are the tricycle drivers using it for the purpose of commercial activities

Terminal points are the stations where yeloyelo drivers stationed to load their passengers at the various points in the Metropolis.

Soobu is a substance made from a mixture of moringa leaves, cocaine, tobacco etc and use.

Contribution to the field.

Despite public health concerns regarding tramadol use and its possible side effects, academic data on the reasons for the growing use of tramadol in Ghana is lacking, making evidence-based policy difficult to implement. The overarching goal of this study is to provide qualitative evidence on narrations of the use of tramadol in Ghana especially among the Yeloyelo drivers (tricycle drivers) within the Tamale metropolis and its environs. The study is necessary owing to a scarcity of research data and its significance for health of young people in particular.

The findings of this study will aid policymakers in finding solutions to tramadol abuse. The study's goal is to acquire a better understanding of the reality of tramadol use by interviewing persons who have used it. It will also offer a thorough understanding of any socio-economic determinants that may exist in this group, as well as measures that might reduce tramadol abuse prevalence. Furthermore, it is anticipated that this study will assist for better understanding of the variables that influence tramadol abuse among tricycle drivers. It will also add to the corpus of knowledge and understanding of public health ideas among academic issues regarding tramadol abuse.

Theoretical frame-work.

Theory of Planned Behavior was used to guide this study. The theory of Planned Behavior is a paradigm that is frequently used among public health practitioners to investigate factors that influence behavioral decision-making (23). It is asserted that there is an additional aspect to examine in addition to attitudes and normative views, making the domains that impact behavioral intentions three(24). He called it "Self-efficacy," which refers to a person's perception of how easy or difficult it is to execute a task (24). Self-efficacy, the theory of planned behavior assumes that individuals act rational according to their attitudes, subjective norms, and perceived behavioral control. The theory holds three main parts, they are attitudes, subjective norms and perceived behavioral control, summed up shapes individual behavioral intentions. This theory performs a fundamental and impartial function in influencing behavioral intentions, so that an individual’s intention to perform what seem beyond their capacity or control is little, even if they have positive feelings towards the actions and assume acceptance by others(25). The theory places great emphasis on individual’s subjective norms and perceived behavioral control. This theory is linked to this study in the sense that the behaviors of the Yeloyelo drivers is influenced by several factors including pleasure they drive from consuming the drug, peers’ pressure and individual subjective behavior and others.

Study setting.

The study was conducted in the Tamale metropolitan area located in the Northern Region of Ghana. Tamale is the administrative capital of the norther region. The Metropolis is boarded to the north by the Savelugu Municipal and to the south by the Central Gonja district and to the East by Yendi municipal and west to the Kumbungu district.

The Tamale metropolitan area has a population of 293,881 people, with 146,979 males and 146,902 females, according to the Ghana Statistical Service (2000).

Tamale is a cosmopolitan society but the Dagomba constitute majority of the population. There is a wide range of religious beliefs, with Islam being the most prevalent religion. The major occupation of the people is farming. Commercial activities form part of the major occupation among the population. As such, Yeloyelo driving is seen as a lucrative venture in the metropolis, majority of the youth are engaged in this business.

Research design and sampling technique.

The study employed qualitative research design using ethnographic approach and executed in the Northern Region of Ghana from May to September 2022. In all 30 yeloyelo drivers and 60 passengers were recruited from six terminal stations within Tamale and its environs employing purposive and snowball sampling techniques. Thus, the recruited yeloyelo drivers were subjected through in-depth interviews in order to ascertain their role in tramadol intake. Observation was also employed to observed and elicit group pattern of behavior of the yeloyelo drivers in the Metropolis. In addition, 60 people who patronize yeloyelo transport were selected for focus group discussions to ascertain their views on substance intake by the yeloyelo drivers and the role they play in their daily performance as drivers.

Study participants.

The study participants included yeloyelo drivers, yeloyelo passengers and key informants, (station masters). In order to be part of this study, a driver needed to been operating in a terminal for at least 3 years or more and be a current driver in a particular terminal or station. Passengers also needed to have been patronizing yeloyelo services for at least two years and have knowledge of the operations of the yeloyelo drivers and their behaviour.

The research was conducted using the most popular language (Dagbani) and later transcribed and translated in to the English language.

Data collection tools.

Qualitative data collection techniques were used for the study. Interview guide, Focus Group Discussions (FGDs), observation and key informants’ approaches were used for data collection. All these tools were used to collect primary and secondary data.

In the focus Group Discussions, a tape recorder was used by the researchers to record the conversation. Permission was obtained from the participants for the conversation to be audio-taped. All participants of the discussions were giving a unique participation number instead of their original names. Each participant started contribution by first mentioning their tag numbers to ensure data were identified with participants. Conversations were transcribed and interpreted. The transcription was done orderly and verbatim reproduction of every utterance including stutters, pauses, mannerisms, and other gestures/nonverbal cues all were equally captured.

In addition, observation was used by the researchers to observe attitude and demeanor, body language and emotions during the data collection process. This provided the researchers information whether participants facial expression corresponds with the spoken words.

Data analysis

The data was coded and analyzed using thematic content analysis. Thematic content analysis was employed using both the deductive and inductive analysis. The interviews that were taped recorded were listened to carefully for approximately three times and then transcribed by two different researchers and juxtaposed as a means of checking for accuracy and controlling inconsistencies. The transcripts were read over and over to obtain more comprehensive knowledge before being analyzed.

Rigor

The study was guided by Guba and Lincoln’s evaluative practice. To ascertain data reliability and accuracy, including dependability, credibility, transferability and conformity.

Data reliability, here, authorities in the relevant areas were contacted for the preparation of focus group discussion guide, interview guide and in-depth interview guide for data analysis to be dependable.

Credibility, in this area too interviews were conducted with appropriate time frame provided.

To ascertain transferability, the snow ball and purposive sampling techniques were used for data collection from sampled participants with much diversity taking in to consideration (26). At the close of the interviews, participants were assured of debriefing on transcripts for each member checking after data transcription.

It has been explained that in an attempt to deal with ethical issues in social science research, several problems do crop up (27). One of such issues the author claims was whether in conducting secrete study was a smart idea. He intimated covert research is worthy receiving exhaustive hold of social issues. Researching in to a phenomenon such as prostitution, drug dealing and drug peddling are examples. As such, participants were giving the free will to participate or not participate and were assured of secrecy.

Perceived factors resulting in the use of Tramadol

Tramadol abuse was defined in this study as inappropriate use of tramadol without a physician's approval. Tramadol dosage limits of 50 mg and 100 mg in tablets and capsules, as well as 50 mg/ml-2 ml in injections, have been approved by the FDA for use in Ghana, therefore any intake over these levels is deemed abuse.

The findings of this study revealed that, majority of the participants used tramadol in their daily operations. The narrations of the yeloyelo drivers from the various stations revealed the following results.

The following is a narration by a yeloyelo driver from the Aboabo terminal as:

‘’ I take tramadol to keep me active and awake to charter passengers from Aboabo to Nyohini, and to Lamashegu who arrive late hours of 2am. I make a lot of money during the night. A destination that normally cost a passenger 2 cedis in day time will cost the passenger 15 cedis during the night. Because tricycles drivers are not available during those hours and thus passengers will have limited options’’ (Number 10, FGD, Aboabo tricycle terminal).

It was disclosed that psychoactive drugs, particularly tramadol, are often recommended to new entrants into the tricycle operation as solutions to stress and fatigue. A participant observed in an FGDs thus:

‘’Tramadol gives me energy; I am a hustler. I hustle on the street to get my daily bread. Tramadol invigorates me to work more’’

(Number 1, FGD, CBG terminal).

It was also identified that; some tricycle drivers abuse tramadol based on their personal experiences. A participant made the following observation as to why he takes tramadol without the prescription by a physician:

‘’I had an accident with my tricycle and I was experiencing intense pains I was unable to sleep, so my doctor prescribed tramadol for me. And when I took it, it reduced my pains. I didn’t know such drug can make your pains go away like that. So anytime I feel some small pain in any part of my body, I just go to the pharmacy and get some tramadol to buy’’

(Number 3, FGD, CBG terminal).

Knowledge, Attitude and Practice of Tramadol

The majority of the individuals in the research, learned about tramadol via their peers. The researchers performed in-depth interviews to examine where the tricycle drivers get information about tramadol.

The results showed that tricycle drivers within the Tamale Metropolis had a fair general knowledge on Tramadol. Many of the participants indicated that Tramadol is not an illicit drug, but few of them could not indicate whether it is an Illicit drug or not.

This finding is supported by a key informant at the Motor traffic and transport unit, he indicated that the rising incidence of accidents in the Tamale Metropolis is as a result of high illiteracy among yeloyelo riders, most of whom he said are into drugs and lack the knowledge of the effects of such drugs. He observed thus:

“Tramadol has a litany of effects to our health. The small boys here just take it to give them the energy to work, in no time, they would not only be affected, but they will be in a situation they could have avoided if they had a foreknowledge of the outcome of this drug. Many of these accidents you see on the road is as a result of the tramadol use by yeloyelo drivers. If you arrest them today, you will be threatened by their leaders and politicians but we are not perturbed by that … We will continue to do our legitimate duty”

(KI, MTTU, Ghana police service).

In addition, some participants misconstrue all painkillers to be the same as tramadol. This was confirmed during a focus group discussion when a participant was asked the quantity of tramadol he takes after responding yes to using tramadol, he observed thus:

(Number 10, FGD, ADB)

In the same FGD, a participant asserted that:

‘’When I take it with the capsule it makes me depressed and inattentive and makes my cheeks scratchy. That’s how come people will be scratching their checks because the capsule makes the cheeks itchy’’

(Number 1, FGD, Access Bank)

A participant at the GCB terminal observed thus:

‘’I mix cream cracker with the tramadol powdered content and stir with hot water until it gets starchy and then take it in. It is the most effective way of enhancing sexual performance’’ (Number 1, FGD, CBG terminal).

Also, it was noticed that some modes of intakes have various jargon names attached to them. Mixing tramadol with Marijuana was identified as ‘’Tar’’ and unplugging the capsule and taking the powdered content after throwing the coats is called ‘’Leaning’’, this was confirmed from the following participants:

‘’I take tramadol by ‘’Leaning’’ it. Because, it is effective and the easiest. You only need to unplug the capsule and putting the powdered content in your palm and licks it. And you are good to go’’

(Number 9, FGD, ADB terminal).

Sources of Tramadol.

From the results, it was noticed that majority of the participants get the drug from the Tamale Forest. Out of fear of being incarcerated majority of the participants opt to acquire the tramadol in the forest. One tricycle driver reported that he always goes to the forest daily to get the tramadol because he felt he could be harassed or arrested if he goes to the pharmacy shop without a prescription, he made the following observation:

‘’ The first time I went to the pharmacy to get some tramadol, everyone in the pharmacy watched at me very oddly. They asked about the prescription, who was going to use it and what the user was using it for. It was such an embarrassment that I had to lie. I vowed never to go to the pharmacy to buy the drug again. So, anytime I need it, I drive my tricycle to the Gumani forest to get some’’ (Number 2, FGD, Aboabo terminal).

Also, those who are able to acquire it in the pharmacy shops, when asked how they are able to acquire the drug from the pharmacy without a prescription, a participant made it clear that the pharmacists may put up restraining attitude when they highly suspect you as a spy.

A participant illustrated thus:

‘’As a result of Anas’s exposure everybody is on guard. They fear that you may be secretly filming the entire episode, so if you are not a regular client or you are not known, it is likely that they will give you a tough time. But if they know you, you don’t have any cause to worry at all’’ (Number 5, FGD, CBG terminal).

Another person added that:

‘’You don’t even need to mention to them you need tramadol, you only need to mention the dosage you need and they understand. For example, I want to buy 250 or 150. They know you are talking about Tramadol and they will get it for you’’ (Number 8, FGD, CBG terminal).

Dosages Taken by Users.

The search for an initial experience or pleasure is what makes tramadol users ensconce comfortably on using stronger dosages of 250 and 500 milligram. A Key Informant confirmed this and further explaining that:

‘’When you take tramadol for the first time, the feeling is so different. The more frequent you get used to tramadol; you no longer experience that feeling again. This makes users graduate to a stronger dosage or milligram that before, fully renewed in their conviction that they will get the first feeling they had before’’ (Number 1, KII, CBG terminal)

Frequency of Using Tramadol.

The fact that majority of the participants take in Tramadol daily gives credence to its dependence propensity. (28), point out that signs of psychological dependence on drugs is an increase in the frequency of use. The drug is used specifically to get high, and the need for the effect increases by the frequency of use and once you don’t get it, you feel very uncomfortable, a participant in a focus group discussion explained that:

‘’When I don’t take it for a day, it makes me tremor’’

(Number 1, FGD, ADB terminal).

Also, another participant observed thus:

‘’ When you take tramadol every day and one do not get it, you will be stiff and you will be falling down’’

(Number, KII Aboaboo Terminal).

Perceived Effects of Tramadol.

This study found that, individuals who use tramadol were not aggressive people, even in circumstances of a justified aggression, they resort to non-aggression. According to some participants during a focus group discussion one participant observed thus:

‘’… I can have a fierce argument right now which can lead to throwing fists against each other, but as soon as I take tramadol, I would come to you to apologize and seek to make amends’’

(Number 12, FGD Participants, Aboabo).

Also, it was reported that seizures occur to users based on the circumstance they find themselves and how their systems respond to such circumstances. These was confirmed by participants in a Focus Group Discussion. One of them has this to say:

‘’I always experience seizures when after taking in Tramadol, I don’t get food to it’’ (Number 5, FGD, Access Bank terminal)

Another participant said that:

‘’It can also lead to seizures and even death eventually when you take tramadol and you stay long hours in the sun’’

(Number 9, FGD, CBG terminal).

In a related development a key informant revealed that the effects occur differently to different people based on the nature of their systems. He explained thus:

‘’The under-lining fact is that the effects apply to individuals differently based on how their systems responds to the drugs. some will take it and sleep. Others will take it and get charged.’’

(Number 2, KII, CBG terminal).

The MTTU Directorate in Tamale indicated that 8 out of 10 accidents is as a result of tramadol use among yeloyelo drivers, The in charge reported incidents when relatives of accident victims frequently obstructed the police from transporting the deceased's bodies to the mortuary for autopsy as another difficulty for the Metropolis's police.

He observed thus:

“I cannot give you exact figures of the number of fatal accidents occasioned under the influence of tramadol because, we all know that this community is a Muslim town, so if one dies, they hurriedly go and bury the person. If we were allowed to take the victims to the mortuary for autopsy, you will see that 8 out of 10 accidents will be the result of tramadol use”

(KI, MTTU, Ghana police service).

Perceived Psychological Effects of Tramadol.

Investigations regarding the effects of tramadol use revealed blare vision of the operators. Two tricycle accidents victims who were key informants at the Tamale teaching hospital's accident ward asserted that tramadol impairs the rider's vision on the road. They indicated that having a clear view of the road is crucial for safe riding, therefore a rider with impaired vision runs at risk of involving himself in an accident. They shared their personal experiences, regarding how tramadol or psychoactive substances may impair a rider's ability to perceive road signs, pedestrians, or oncoming vehicles.

One of the key informants opined that:

“If you take tramadol now and go out on the road, ego hard for you to see road. If your body no strong you go see road two. When I take tramadol and ride out, it is hard said I go see bends and curves on the road or see other vehicles that are coming in front of me. My friends one time crash with another vehicle and one day I hit those who walk on foot.”

(Number 2, KII, TTH, Accident ward).

Tramadol use has been linked to altered cognition and coordination in riders. Tricycle riding is a delicate activity that demands extreme concentration, according to key informants. They claimed that in order to avoid getting into an accident, the rider must continually plan his movements. Psychoactive substances impair the rider's capacity to reason and plan his movements while riding. Participants believed that the probability of getting in a traffic accident increased when the ability to calculate and navigate was impaired by the use of psychoactive substance. A participant stated:

“When you take tramadol and ride, you will not be able to think and analyze things very well because of the way the drug affects your mind and thinking. You fit make wrong moves that can lead to accident for road. You no go fit to take tramadol and ride on the road and it will not affect your riding. That is why we dey call am drug. They affect everybody.”

(Number 1, KII, TTH, Accident ward).

The study examines factors responsible for the use of tramadol by tricycle drivers in the metropolis, then discussed about the perceived effects of tramadol use among tricycle drivers. It then talked about tricycle drivers’ knowledge and attitude towards tramadol use and finally examining the perceived psychological state of tricycle drivers regarding tramadol abuse.

Factors Responsible for the Use of Tramadol by Tricycle Drivers.

Discussing the reasons why participants use tramadol, the findings revealed that majority of them use tramadol. Some participants take tramadol for physical activeness. This was revealed when drivers were asked to list reasons that made them to take tramadol. This supports Fuseini et al. (29) who also reported that tramadol energizes most users who frequently use the drug to reduce stress after a long day hard work or to gain the energy to do their regular activities without being tired. In line with this assertion. Alhassan, (30). revealed that tramadol improves task performance in a randomized controlled study.

Nonetheless, the findings sharply contrast with Waheed et al. (3) who revealed in his study that tramadol causes much dizziness and sleepiness with a lower risk of chronic depression. Similarly, Balogun et al. (28) cited that tramadol, particularly when used in high dosages would result in tiredness and dizziness rather than activeness.

The findings also revealed that majority of the participants were engaged in the use of the drugs such as pain killers to relieve pains. This conforms with Terman, (12) who suggested that people take in tramadol to relieve off acute and long-term pains. He reported that, tramadol, is utilized by clinicians as a powerful therapy for both acute (including post-surgery or post-trauma) and long term (cancer, for example) pain. In addition, a systematic study confirmed the unquestionable result tramadol has on relieving pains after outlined two cases where respondents saw a considerable improvement in their mood following the consumption of tramadol for pain treatment (31). Similarly, Uppal & Jayatunga, (32) reported in their study that patients in regular wards that are without intensive continuous monitoring do take in tramadol at the blind sight of the physician to avert labor discomfort, and catastrophic pain.

This study also revealed that participants were engaged in the use tramadol simply because their friends or peers are into the tramadol taking business. In agreement to this finding, a qualitative study conducted by Elwy & Tabl, (33) indicates how peer influence is a crucial driver in tramadol use. The author reported that the influence of peers is a significant factor in many teens' tramadol use and is critical in the formation of behavior. Additionally, Alhassan etal. (30) in their study observed that individuals who had friends who took tramadol and other substances had a greater risk of abusing drugs than those who did not have such friends. The study also agrees with a study in Egypt about the causes of addiction, it was reported that, 50% of the participants studied were addicted as a result of peer influence. Agani, in Saudi Arabia, it was reported that tramadol dependence began as a result of users acting under the influence of their friends (19).

Perceived Effects of Tramadol Use.

The findings of this study revealed that tramadol use does not result in Respiratory failures, with majority of participants strongly disagreeing that the intake of tramadol is a trigger of respiratory failure. This finding agrees to that of Shuai et al. (34) they asserted that tramadol does not cause respiratory depression in neonates when administered intramuscular, and would cause far less respiratory depression when the mode of administration is intravenous. Indeed, this conforms to a study conducted by Shuai et al. (34) they reported that tramadol did not produce clinically meaningful respiratory depression at recommended therapeutic dosages, according to their findings.

Perananthan & Buckley, (11) noticed that tramadol usage for extended periods of time and at high doses is owing to results of side effects as respiratory depression. Similarly, it was reported that respiratory failure are all possible adverse effects of tramadol usage (35).

The study also found that tramadol use does not result in anxiety, depression, aggressiveness, inattentiveness and seizures. It was shown in a study by Mehrpour et al. (35) that these symptoms only shows when a tramadol user tries to avoid the drug for some time. They reported that anxiety, despair, agony, extreme mood fluctuations, aggression, seizures as well as tremors and fatigue are just a few of the symptom’s participants are faced with during withdrawal.

The finding also agrees to numerous literature that debates the possibility of tramadol causing seizures. Gardner et al. (13) reported that, tramadol can only cause seizures in people when administered in high dosages in patients with epilepsy or in tandem with additional seizure-inducing medicines. Similarly, Gardner et al. (13) asserted that with the range of the occurrence of seizures among tramadol users, seizures has only <1% chance of occurrence.

This findings however disagreed with Nakhaee et al. (35) who refuted the allegation, that tramadol can cause seizures even when administered at the appropriate dosage and without any co-medications. The study also showed that tramadol use can result in the user’s dependence on the drug. This finding is supported by Zabihi et al. (16) in Northern Iran in 2007-2008. It was revealed in their study that roughly two-thirds of the 162 participants indicated dependency. Conclusions were drawn that there was a high potential of Tramadol dependency in the use of Tramadol. Zebala et al. (36) agreed with the dependency but on condition that an individual has taken in repeated doses. They argued that, even though tramadol appears to bear a low dependency when compared to more potent alternative analgesics such as heroin, it is clear that repeated dosages of tramadol can cause tramadol physical dependence similar to that of other opioids, and due care must be exercised when administering tramadol to someone at the risk of abusing substance.

Knowledge, Attitude and Practice Towards Tramadol Use.

The research showed that tramadol users had a fair general knowledge on tramadol. A high number of the participants indicated that tramadol is not an illicit drug. Again, when probed further, it was realized that some participants misconstrue all painkillers to be the same as tramadol. This finding agrees with a survey conducted by Anetor & Oyekan-Thomas, (37) where it became obvious that many people who abuse the drug cannot appropriately characterize tramadol drugs. He further suggested that many of the participants were not familiar with tramadol-classified drugs and were unable to distinguish between tramadol other abused substances.

It was observed that majority of the participants did not have adequate knowledge on the dangers associated with tramadol abuse. A study conducted by Bassiony et al. (22) on adolescence substance abuse supported limited knowledge of participants on the consequences of the tramadol abuse. Contrarily, (38) disagreed with the finding of the study showing majority of the participants sometimes become aware of the effects but have to continue.

This research also found that tramadol users, learned about tramadol via their acquaintances or peers. This finding is support that of Anzaku J. (39) who used tramadol as a case study to analyze the critical appraisal of knowledge, attitude, and prevalence of drug addiction among adults and teenagers in Lagos State, Nigeria. He realized that majority of the participants affirmed got information from their friends and peers (37).

Again, findings from the study showed majority participants take in tramadol by adding the powdered content into energy drinks. This is support the study conducted in Wassa Amenfi, Ghana, which indicates that participants said they mix tramadol with an energy drink and consume it (9;17).

The study found that tramadol users reported using powdered content of tramadol in its raw form. Perananthan & Buckley, (11) works supported this finding and equally reported that users of tramadol sometimes grind the pills into tiny pieces to lick ("snorting"). Furthermore, Barbosa et al. (19)agreed with this observation, and reported that licking was widespread due to the expected impact of doing so (noting the quick high, and feeling good). He found that nearly half (44%) of the participants "Always" stripped away foreign matter before licking, citing equal frequency either a desire for only the drug in the powder for a more immediate high (16%) or a dislike of the shell's properties, such as being sticky, irksome or scorching the nose, or experiencing dust in the nose (16%).

The study again found that participants take tramadol by injecting it into their bodies through the veins. Abd El-Azim, (40) agrees with this finding and thus observed that the intravenous route is acknowledged as one of the most prevalent tramadol administration patterns in Egypt. His study in Egypt discovered that the most prevalent methods of delivery were intravenous in 46.8% of cases and oral in 40.3% of instances.

A different observation about tramadol use. He opined that licking, snorting and injecting tramadol increases the perceived intensity of its effects. According to him, while tramadol pills are intended for oral use, it ought not be crushed and utilized for inhalation or injection. Inhaling and injecting it increases the perceived intensity of the effects, thereby resulting in high amounts of it entering the circulation, making it more effective for overdosing and potentially producing bad consequences including seizures (10).

Perceived Psychological State of Tricycle Drivers Regarding Tramadol Abuse.

The study found that when under the influence of tramadol, the user’s ability to remember events is not interrupted, also, tramadol does not reduce the user’s ability to perform task, it does not alter users’ perception and does not trigger blackouts.

This finding supports the findings of Saapiire et al. (15), who reported that participants stay in the practice for a variety of psychological and physical fulfillment, including attentiveness and high energy levels. Saapiire et al., (15) reported similar results on memory, concentration and attentiveness, as well as a sense of hope. He came to the conclusion that a few of the participants mentioned alertness and attentiveness as another reason for the constant tramadol use is that the drug causes the participants to become more focused, alert, and attentive to their daily activities. Again, this finding is supporting the findings of Barbosa et al. (19) demonstrated in a randomized control trial that tramadol has an impact on stimulus processing related to sustained attention.

This research has brought to light the reasons for the pervasive tramadol use among the tricycle drivers in the Tamale metropolis. Supporting with the findings from other countries, this study to revealed the need to identify peer pressure as one of compelling factors that often usher tricycle drivers into the practice of tramadol abuse.

Tricycle drivers who use tramadol had a fair knowledge about the drug, also, the higher the educational level of the participants the more informed and knowledgeable he is about tramadol. Averagely, the daily dosage (milligram) intake of tramadol among tricycle drivers in the tamale metropolis was in large quantities.

Nausea and road accident, sleepiness and dizziness are possible effects of tramadol use identified in this study. While, respiratory failures, anxiety, depression, aggressiveness, seizures and inattentiveness and the inability to focus are some of the effects of tramadol use.

The psychological effects associated with tramadol includes blare vision, hearing and coordination disorders couple with user’s ability to issue fair sense of judgement is impaired.

Finally, the availability of tramadol in the tamale metropolis should be strictly regulated, as its abuse among tricycle drivers is on the ascendancy. It is a real problem that must be addressed with a concerted effort because it is long overdue and the time to act is now.

Conflict of interest.

The authors show no conflict of interest with regards the publication of this paper.

Availability of funding.

There was no funding available for this study. The authors used their own resources to conduct the study.

Ethical consideration.

The authors sought ethical consideration from the Kwame Nkrumah University of Science and Technology Committee on Human Research, Publication and Ethics with the Reference number CHRPE/AP /196/22. The study was based on people’s opinion and no experiment was carried out but was approved by Kwame Nkrumah University of Science and Technology Committee on Human Research, Publication Ethics. All the participants were asked to signed informed concerned form before the interviews were conducted.

Data availability.

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

The data is available in the form of narrations from the participants.

Abiona TC, Aloba OO FF. Pattern of alcohol consumption among commercial road transport workers in a semi-urban community in South West Nigeria. East. East Afr Med J. 2006;83:494– 9.
Mohammed A. Programme based budget estimates for 2022 Tamale Metropolitant Assembly. 2022;(October 2021):9.
Waheed SA, Adesola RO, Abraham Y. Tramadol and its health implications. World News Nat Sci. 2022;42(April):123–38.
Mehrpour O, Sharifi M, Zamani N. Tramadol Poisoning. Toxicol Stud - Cells, Drugs Environ. 2015;(August).
Sweileh WM, Shraim NY, Zyoud SH, Al-Jabi SW. Worldwide research productivity on tramadol: a bibliometric analysis. Springerplus. 2016;5(1).
Grond S, Sablotzki A. Clinical pharmacology of tramadol. Vol. 43, Clinical Pharmacokinetics. 2004. 879–923 p.
Epstein DH, Preston KL, Jasinski DR. Abuse liability, behavioral pharmacology, and physical-dependence potential of opioids in humans and laboratory animals: Lessons from tramadol. Biol Psychol. 2006;73(1):90–9.
Balogun SK, Osuh JI, Onibokun OO. Effects of Separate and Combined Chronic Ingestion of Codeine and Tramadol on Feeding Behaviour of Female Albino Rats. J Med Res Heal Sci. 2020;6(7).
Ansari H, Kouti L. Drug Interaction and Serotonin Toxicity with Opioid Use: Another Reason to Avoid Opioids in Headache and Migraine Treatment. Curr Pain Headache Rep [Internet]. 2016;20(8):1–7. Available from: http://dx.doi.org/10.1007/s11916-016-0579-3
Zhang H, Liu Z. The investigation of tramadol dependence with no history of substance abuse: A cross-sectional survey of spontaneously reported cases in Guangzhou City, China. Biomed Res Int. 2013;2013:3–8.
Perananthan V, Buckley N. Opioids and antidepressants: Which combinations to avoid. Aust Prescr. 2021;44(2):41–4.
Terman G. Is Tramadol an Opioid or a Nonopioid Analgesic? Yes! Washingt Med Comm [Internet]. 2020;10. Available from: https://wmc.wa.gov/sites/default/files/public/Newsletter/IsTramadolanOpioid.pdf
Gardner JS, Blough D, Drinkard CR, Shatin D, Anderson G, Graham D, et al. Tramadol and seizures: A surveillance study in a managed care population. Pharmacotherapy. 2000;20(12):1423–31.
Bassiony MM, Salah El-Deen GM, Yousef U, Raya Y, Abdel-Ghani MM, El-Gohari H, et al. Adolescent tramadol use and abuse in Egypt. Am J Drug Alcohol Abuse. 2015;41(3):206–11.
Saapiire F, Namillah G, Tanye V, Abubakari A. 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. Psychiatry J. 2021;2021:1–10.
Zabihi E, Hoseinzaadeh A, Emami M, Mardani M, Mahmoud B, Akbar MA. Potential for tramadol abuse by patients visiting pharmacies in Northern Iran. Subst Abus Res Treat. 2011;5(1):11–5.
Kwasi Elliason E. Abuse and Misuse of Tramadol among the Youth in the Wassa Amenfi West Municipality in the Western Region of Ghana. Psychol Psychol Res Int J. 2018;3(7):1–18.
Häkkinen M. Abuse and Fatal Poisonings Involving Prescription Opiods - Revelations from postmortem toxicology. Unpublished. 2015.
Barbosa J, Leal S, Pereira FC, Dinis-Oliveira RJ, Faria J. Tramadol and Tapentadol Induce Conditioned Place Preference with a Differential Impact on Rewarding Memory and Incubation of Craving. Pharmaceuticals. 2023;16(1):1–12.
Almér Herrnsdorf E, Holmstedt A, Håkansson A. Tramadol misuse in treatment-seeking adolescents and young adults with problematic substance use – Prediction of treatment retention. Addict Behav Reports. 2022;16(July).
Sarfo G. Prevalence of Cigarette, Alcohol, Marijuana and Tramadol Use Among Senior High School Students in the Bekwai Municipality, Ghana. 2020;1–163.
Bassiony MM, Abdelghani M, Salah El-Deen GM, Hassan MS, El-Gohari H, Youssef UM. Opioid use disorders attributed to tramadol among egyptian university students. J Addict Med. 2018;12(2):150–5.
Ajzen I. The theory of planned behaviour: Reactions and reflections. Taylor Fr. 2011;26:1113–27.
Schifter DE, Ajzen I. Intention, Perceived Control, and Weight Loss. An Application of the Theory of Planned Behavior. J Pers Soc Psychol. 1985;49(3):843–51.
Ajzen I. Consumer attitudes and behavior : the theory of planned behavior applied to food consumption decisions. 2015;(February):121–38.
Braun V, Clarke V. APA thematic analysis pre-pub. Published as: Braun, V. & Clarke, V. (2012) Thematic analysis. In H. Cooper, P. M. Camic, D. L. Long, A. T. Panter, D. Rindskopf, & K. J. Sher (Eds), APA handbook of research methods in psychology, Vol. 2: Research designs: Quantitative, qualitative, neur. 2012. p. 57–71.
Kumekpor T. No Title. In: Research methods and techniques of social research. SonLife Publishers.; 2002.
Kolawole Balogun S, Iheukwumere Osuh J, Olatunde Olotu O. Effects of Separate and Combined Chronic Ingestion of Codeine and Tramadol on Exploratory Learning Behaviour Among Male Albino Rats. Am J Appl Psychol. 2020;9(4):99.
Fuseini AG, Afizu A, Yakubu YH, Nachinab G. Facilitators to the continuous abuse of tramadol among the youth: A qualitative study in Northern Ghana. Nurs Open. 2019;6(4):1388–98.
Alhassan JAK. “Here in Ghana hard work don’t deserve money”: The uncertainty and precarity of youth who use tramadol. SSM - Qual Res Heal [Internet]. 2022;2(August):100165. Available from: https://doi.org/10.1016/j.ssmqr.2022.100165
Peprah P, Agyemang-Duah W, Appiah-Brempong E, Akwasi AG, Morgan AK. “with tramadol, i ride like a Jaguar”: A qualitative study of motivations for non-medical purpose tramadol use among commercial vehicle operators in Kumasi, Ghana. Subst Abus Treat Prev Policy. 2020;15(1):1–15.
Uppal H, Jayatunga U. Decompression illness type II with stroke: Challenging situation in acute neurorehabilitation. Int Marit Health. 2020;71(2):105–8.
Elwy AE hamid M, Tabl G. Effects of Chronic Usage of Tramadol , Acetaminophen and Tramacet on Some Biochemical and Immunological Changes in Male Rats INTRODUCTION : 2014;35(1):63–71.
Shuai R, Bravo AJ, Anker JJ, Kushner MG, Hogarth L. The direct effect of drinking to cope on alcohol problems is not mediated by alcohol consumption: Invariance across gender and countries. Addict Behav Reports [Internet]. 2022;16(October):100469. Available from: https://doi.org/10.1016/j.abrep.2022.100469
Nakhaee S, Hoyte C, Dart RC, Askari M, Lamarine RJ, Mehrpour O. A review on tramadol toxicity: mechanism of action, clinical presentation, and treatment. Forensic Toxicol [Internet]. 2021;39(2):293–310. Available from: https://doi.org/10.1007/s11419-020-00569-0
Zebala JA, Searle SL, Webster LR, Johnson MS, Schuler AD, Maeda DY, et al. Desmetramadol Has the Safety and Analgesic Profile of Tramadol Without Its Metabolic Liabilities: Consecutive Randomized, Double-Blind, Placebo- and Active Comparator-Controlled Trials. J Pain. 2019;20(10):1218–35.
Anetor GO, Oyekan-Thomas MF. Knowledge and attitude of youths to substance abuse in Alimosho Local Government area of Lagos State. Int J Biol Chem Sci. 2018;12(2):822.
Soremekun RO, Folorunso BO, Adeyemi OC. Prevalence and perception of drug use amongst secondary school students in two local government areas of lagos state, nigeria. South African J Psychiatry. 2020;26:1–6.
J. AP. The critical assessment of knowledge, attitude and prevalence of drug abuse among adults and teenagers in Surulere local government area (L.G.A), Lagos state, Nigeria; a case study of tramadol, Tecana American University Education. 2019;
Abd El-Azim K. Psychosocial correlates of substance abuse: A study in an Egyptian sample. MD thesis supervised by Prof Farouk Lotaief Prof Naglaa El Mahalawy Prof Aida Seif El Dawla Prof Tarek Assad. Fac Med Shams Univ. 2001;

No competing interests reported.

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Tramadol Abuse Among Yeloyelo Drivers in the Tamale Metropolis

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