Mental Health Authority must fight Tramadol plague

Like pregnancy, the non-medical use of the drug, Tramadol, a widely prescribed painkiller, which, as a synthetic opioid that offers a valuable substitute for morphine, and its derivatives in African countries, has gone beyond the stage where our hands can cover it.

It has protruded and has become a plague that must be fought to save the youth.

 Fortunately, the Mental Health Authority (MHA) is putting together plans to go to battle in Ghana.

About six years ago, the then Director General of the Ghana Health Services (GHS), Anthony Nsiah-Asare, warned in Sunyani that the country would experience a mental health crisis if the abuse of Tramadol was not checked.

Across Africa, the surge in the misuse of the drug on the continent has become worrying that researchers of a recent study say there is the need for a more nuanced and targeted interventions to address the unique challenges and factors contributing to the growing phenomenon all over the continent.

The researchers of the study, “Prevalence and health consequences of non-medical use of Tramadol in Africa: A systematic scoping review,” published by PLOS Global Public Health on January 18, 2024, said the non-medical use of Tramadol is a multidimensional issue with far-reaching economic, societal and safety implications.

They also said, “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.”

A co-author of the study, Olumuyiwa Omonaiye of the Institute of Health Transformation of the Deakin University in Australia, said “Tramadol is a pain-relieving medication created by the Grünenthal laboratory in 1962 and works in the brain to lessen how we perceive pain.

The World Health Organisation (WHO) has, however, categorised it as a Level 2 weak opioid”.

Omonaiye said in 2017, the United Nations Office on drug and Crime (UNODC) issued a cautionary statement concerning the detrimental effects of non-medical use and trafficking of tramadol on the economies and security of the Sahel and Niger Delta region, highlighting its significant social consequences.

Drug report

A 2023 Word Drug Report by UNODC said, Africa “accounts for half of the quantities of pharmaceutical opioids, especially tramadol, seized globally between 2017-2021; these opioids are primarily consumed in the region.” (https://www.unodc.org/westandcentralafrica/en/westandcentralafrica/press/world_drug_report_2023.html)

In Ghana, Tramadol misuse has become very prevalent and recent reports from Tamale show that there is a growing number of young people who have become addicted to the drug. Some of these addicts are seen standing in very awkward positions as if they are robots.

 Some remove their cloths and move about aimlessly.

Others just sit looking into the skies as if they are waiting for something to drop.

Commenting on the situation, a consultant psychiatrist at the Ho Teaching Hospital,Eugene Dordoye  said, “the misuse of Tramadol has been with us for a while and two or three years ago, the minister of health issued a directive that everybody should comply with the rules of its prescription to end its misuse.”

It is important to note that as far back as 2017, the Pharmaceutical Society of Ghana (PSG) cautioned the general public in a statement on the proliferation of the drug and said although the drug was approved for the management of pain, the rapid increase in its use by the youth is worrying.

The PSG said, “the strengths approved for use in Ghana by the Food and Drugs Authority (FDA) are the 50 milligrammes(mg) and 100mg oral capsules,” not 200mg/250mg that has been found to be circulating in markets in the country.

Given what is happening, it is important that we heed the old warning by Nsiah-Asare that the MHA had estimated that more than four million Ghanaians were mentally ill, while mental health institutions had been complaining about the lack of resources to cater for patients.

 This is the main reason why we should be fighting tramadol.

Researchers

????The researchers of the study on tramadol misuse said they used 83 studies on non-medical use of the drug’s prevalence or health consequences were selected from 532 titles/abstracts screened, including 60 cross-sectional and six qualitative studies from 10 African countries.????

Their study began in 2022 and is scheduled for conclusion in 2026.

However, this initial phase of the study, which comprised a systematic scoping review involving the scholarly synthesis of evidence from peer-reviewed articles and grey literature, commenced in 2022 and concluded in 2023 with researchers from the University of Ottawa, Canada and the Deakin University, Australia.

They found that five distinct groups significantly affected by the non-medical use of tramadol, include young adults/active populations with varying degrees of prevalence ranging from 1.9 per cent to 77.04 per cent, professionals, where drivers exhibit a relatively high prevalence of tramadol non-medical use, ranging from 7.2 per cent to 35.1per cent and commercial motorcyclists, with a prevalence of 76 per cent.

In addition, they also found patients, who have a high rate of tramadol non-medical use, with prevalence rates ranging from 77.1 per cent to 92 per cent, academics, with a considerable rate of tramadol misuse among substance-using undergraduates (74.2 per cent) and substance-using high school students (83.3 per cent), and other individuals impacted in various ways.

Consequences

The health consequences, they classified into four distinct types: intoxication, dependence syndrome, withdrawal syndrome and other symptoms.

Omonaiye said their study was part of a three studies project, “aimed at demonstrating the social and economic consequences of non-medical substance usage in African countries grappling with what is frequently termed the African opioid crisis.”

“In recent years, authorities have observed a notable surge in the illicit use of tramadol among younger populations in African countries, evident from the substantial quantities of this substance confiscate, he said.

Omonaiye said the non-medical use of tramadol poses even greater risks as the illicit doses sold in street markets are typically two to five times higher than the standard doses (ranging from 100 to 250 mg compared to the usual 50 mg), consequently heightening its addictive potential, adding that, “Tramadol's affordability, accessibility and ease of concealment contribute to its popularity among young Africans.”

He said the issue of non-medical use of Tramadol was a public health concern issue and, therefore, it was imperative to launch extensive awareness campaigns regarding the hazards associated with its use, with a particular focus on high-risk demographics such as students and drivers.

“Implementing systematic monitoring mechanisms can provide valuable insights into emerging trends and aid in the efficient allocation of resources for prevention and treatment in vulnerable communities,” he added.

Omonaiye called for stricter control measures, enhanced border checks and alignment of sub-regional and continental pharmaceutical regulations as essential to combat illicit trafficking. Additionally, directing research funding towards comprehending the long-term ramifications of tramadol NMU and developing effective interventions is crucial.

Renewed fight

Thankfully, the MHA wants to fight the misuse of the drug with renewed education and awareness creation of the dangers of its use.

“We must understand why it's being abused and then tailor our education and awareness creation appropriately,” the authority said.

In Tamale for example, they suggested the use of educational programmes in schools (primary, secondary and tertiary) to raise awareness of substance abuse, including tramadol.