1. Introduction
Commercial tricycle operations have taken over taxi operations in many cities in Ghana in recent years
| [38] | 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. |
[38]
. However, these operators use illegal substances, which put the passengers and other road users in danger. The Psychoactive substance use constitutes 59.5% of road traffic accidents among commercial tricycle operators
| [1] | Abiona TC, Aloba OO FF. Pattern of alcohol consumption among commercial road transport workers in a semi-urban community in South West Nigeria. East. Afr Med J. 2006; 83: 494-9. |
[1]
This supports the reports from the national road safety commission that the introduction and use of tricycles in the Tamale has contributed to an increase in traffic accidents in the Northern region
| [23] | Mohammed A. Programme-based budget estimates for 2022 Tamale Metropolitant Assembly. 2022; (October 2021): 9. |
[23]
.
A study conducted in Port-Harcout, Nigeria, found a high link between the usage of psychoactive drugs, particularly Tramadol, and accidents among commercial tricycle drivers
| [27] | Perananthan V, Buckley N. Opioids and antidepressants: Which combinations to avoid. Aust Prescr. 2021; 44(2): 41-4. |
[27]
. It has been stated that psychotropic substances, especially, are frequently prescribed to new entrants into commercial trike operation as cures for stress. Mehrpour et al.,
In the late 1970s, the German pharmaceutical firm Grünenthal introduced and promoted tramadol under the brand name "Tramal"
| [34] | Sweileh WM, Shraim NY, Zyoud SH, Al-Jabi SW. Worldwide research productivity on tramadol: a bibliometric analysis. Springerplus. 2016; 5(1). |
[34]
. Since then, it has been distributed in over 100 countries in various forms such as drops, sustained and oral formulations, rectal suppositories, and injectables
| [17] | Grond S, Sablotzki A. Clinical pharmacology of tramadol. Vol. 43, Clinical Pharmacokinetics. 2004. p. 879-923. |
[17]
. Since the 1980s, it has been permitted in various countries and has become the most often prescribed opioid on the world Mehrpour et al.,
| [24] | Mehrpour O, Sharifi M, Zamani N. Tramadol poisoning. Toxicol Stud - Cells, Drugs Environ. 2015; (August). |
[24]
.
Different authorities have defined tramadol in various ways. Tramadol, for example, is a pain medicine that is widely used to treat mild to severe pain
| [13] | 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. |
[13]
. Furthermore, Grond and Sablotzki
| [17] | Grond S, Sablotzki A. Clinical pharmacology of tramadol. Vol. 43, Clinical Pharmacokinetics. 2004. p. 879-923. |
[17]
stated that tramadol is a pain reliever that is both effective and well tolerated in the treatment of labor pain, trauma, renal or biliary colic, as well as persistent discomfort from viral or non-infectious sources, particularly neurological discomfort. Similarly, tramadol, like many other prescription pain relievers, stimulates brain receptors and interacts with the serotonin and neurotransmitter systems in ways similar to opioids (Balogun, 2020). Tramadol, commonly known as Ult-ram, is an orally administered pain reliever that can aid with mild to severe discomfort
| [13] | 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. |
[13]
.
Tramadol is classified as an opioid analgesic and is typically prescribed by a doctor to help with pain management after surgery
| [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]. |
[7]
. It has been proposed that tramadol is an opioid agonist medication with a potency estimated to be 10% that of morphine. To summarize, tramadol is a distinct form of prescription pain medication used to treat mild to moderately severe and severe pain
| [38] | 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. |
[38]
.
Compared to other opiates that serve the same purpose, tramadol was formerly regarded to be the cheapest and safest medicine with a little risk of addiction.
However, in many cases, persons who require medical treatment and have been prescribed tramadol by a physician start using it in excess of the appropriate medical dose, leading in tramadol misuse. This is because people who take tramadol may develop a tolerance to it over time, which means they need more tramadol to achieve the same results
| [38] | 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. |
[38]
. Tramadol has significant medical benefits when used properly; however, it can have serious health consequences when used without medical supervision, in higher doses than recommended, or in combination with illegal substances, alcoholic beverages, and various prescribed or over-the-counter (OTC) drugs
| [35] | Tam, C. L., & Foo, Y. C. (2012). Contributory factors of drug abuse and the accessibility of drugs. International Journal of Collaborative Research on Internal Medicine & Public Health, 4(9), 1621. |
[35]
. According to medical experts, the overuse of Tramadol functions similarly to heroin and can cause mental disorders can also impair several essential organs in humans
| [38] | 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. |
[38]
.
The primary explanation given for tramadol abuse is because it causes a tremendous surge of exhilaration, which is why most users abuse the prescription on occasion
| [16] | 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. |
[16]
.
Tramadol is occasionally used in conjunction with other drugs, a practice known as poly-drug misuse
| [11] | 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. |
[11]
. A study of 204 high school students found that 18 (8.8%) were using tramadol, as demonstrated by a urine test. 15 (83.3%) of those who used tramadol took it alone, while 3 (16.7%) used it in conjunction with another substance (marijuana, alcohol, and tramadol)
| [10] | 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. |
[10]
.
It has been noted that users frequently combine tramadol with other drugs to increase their euphoria or to self-medicate
| [10] | 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. |
[10]
. Tramadol is commonly combined with sedatives, alcohol, and other painkillers such as sleeping tablets and benzodiazepines, as well as cold treatments
| [39] | 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. |
[39]
. Kwasi Elliason
| [22] | 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. |
[22]
performed a survey of young people in Wassa Amenfi, Ghana, and discovered that 62.3% of respondents took tramadol with an alcoholic beverage, while 29% mixed tramadol with an energy drink and consumed it. Only 8.7% of respondents reported swallowing tramadol with water. Interestingly, tramadol and several other opioids may have pharmacokinetic and pharmacodynamic interactions that increase their toxicity and lead to death (18). Tramadol a moderate opioid with a pharmacological action similar to codeine, and its use may lead to tramadol addiction
| [8] | 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). |
[8]
. As a result, it exhibits severe side effects such as psychotic convulsions and fatal overdoses
| [12] | 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. |
[12]
.
Tramadol abuse has been connected to risky behavior and other addiction disorders, according to UK statistics
| [4] | 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). |
[4]
. Almér Herrnsdorf et al., investigated the unlawful use of buprenorphine and methadone among adolescents and young adults in Sweden and discovered that benzodiazepines and tramadol were far more commonly used by teens, implying that tramadol misuse has increased in recent years.
Tramadol is the second most regularly confiscated prescription substance in Sweden, according to police data
| [29] | Sarfo G. Prevalence of Cigarette, Alcohol, Marijuana and Tramadol Use Among Senior High School Students in the Bekwai Municipality, Ghana. 2020; 1-163. |
[29]
. Since 2008, tramadol use in Egypt has surged, leading in an increase in drug treatment center admissions
| [10] | 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. |
[10]
. Despite the fact that drug addiction is not a new issue in Egyptian society, tramadol usage has been a significant public health concern in Egypt over the last four years
| [10] | 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. |
[10]
.
In Ghana, there is a scarcity of data on tramadol abuse. However, data from the Food and Drugs Authority suggest that tramadol addiction is common in Ghana, as evidenced by the Food and Drugs Authority's conclusions on the drug's widespread use
| [28] | 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. |
[28]
, and several media publications on society's challenges associated the use of illicit drugs.
Despite evidence of a high rate of tramadol usage among young people, no scientifically rigorous investigation has been done to evaluate the extent of the problem in the Northern region. As a result, there is an increasing public impression of tramadol usage and irresponsible driving in Tamale, resulting in a high rate of accidents among tricycle drivers. Thus, the purpose of this article is to investigate the factors that contribute to tramadol usage by trike drivers.
The purpose is to determine tricycle drivers' knowledge and attitudes concerning tramadol use, as well as to examine their perceptions of tramadol's effects. Anto and Danso
| [43] | Danso, M., & Anto, F. (2021). Factors Associated with Tramadol Abuse: A Cross-Sectional Study Among Commercial Drivers and Assistants in the Accra Metropolitan Area of Ghana. Drugs-Real World Outcomes, 1-11. |
[43]
observed that people who drink alcohol are more likely to abuse tramadol than people who do not.
The usage of illegal substances in Ghana is now one of the primary causes of our health-care system's excessive congestion. According to research conducted in Ghana's Brong Ahafo Region, tramadol abuse and addiction result in an overburdened criminal system, a stressed health-care system, a loss of production, and environmental degradation
| [28] | 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. |
[28]
. It is critical to rehabilitate and treat problematic drug users; unfortunately, most African countries lack the infrastructure and services to enable such healing and therapeutic treatments
| [34] | Sweileh WM, Shraim NY, Zyoud SH, Al-Jabi SW. Worldwide research productivity on tramadol: a bibliometric analysis. Springerplus. 2016; 5(1). |
[34]
.
In Northern Ghana, a qualitative examination into the factors influencing tramadol misuse among youths indicated that tramadol has lately gained appeal among the youth in the Tamale metropolitan region and the most active individuals, particularly among the youth and certain senior populations
| [5] | 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 |
[5]
. This epidemic has become a national health concern, with community members concerned about tramadol addiction and its impact on metropolitan health
| [15] | 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. |
[15]
. The Food and Drugs Authority of Ghana (FDA) discovered that certain adolescents, students, market women, and commercial drivers used tramadol in considerable quantities. This was shown in a 2016-2018 analysis of Ghana's administrative areas (World Drug Report).
The purpose of this research is to look at tramadol use among tricycle drivers in the Tamale city. The study's purpose is to determine the effects of tramadol abuse among tricycle drivers in the Tamale Metropolis.
5. Methodology
The study was done in Ghana's Northern Region, specifically in the Tamale Metropolitan Area. Tamale is the administrative capital of the Northern Region. The Metropolis is bounded to the north by Savelugu Municipal, to the south by the Central Gonja District, to the east by Yendi Municipal, and to the west by the Kumbungu District.
According to the Ghana Statistical Service
| [41] | Ghana Statistical Service (2010). 2010 Population Census of Ghana, Demographic and Economic Characteristics, Northern Region. Tamale: GSS. |
[41]
, the population of the Tamale Metropolitan Area is 293,881, with 146,979 males and 146,902 females.
Tamale is a multicultural community, however the Dagomba make up the majority of the population. There are a variety of religious faiths, with Islam being the most common. Farming is the primary source of income for the community. Commercial activities are among the most common occupations the population. As a result, "Yam Yam" driving is seen as a profitable venture in the city, and the majority of the youth are involved in this business.
Figure 1. Map of Tamale Metropolis.
5.1. Study Setting
The study was conducted in the Tamale Metropolitan area. Tamale was granted metropolitan status in 2005 by legislative instrument 1453 and is administered by the Local Government Law, Act 462
| [44] | Ghana Statistical Service (2014). Ghana Living Standards Survey, Report of the Fifth Round (GLSS 5). Accra: GSS. |
[44]
.
Tamale metropolitan area is located in the Northern Region Ghana. It is the capital and the administrative center of the region. It is located between 9.16°- and 9.34°-degrees north latitude, and 00.36°- and 00.57°-degrees west longitude
| [41] | Ghana Statistical Service (2010). 2010 Population Census of Ghana, Demographic and Economic Characteristics, Northern Region. Tamale: GSS. |
[41]
. It has a vast land area of 731km
2 and is around 180 meters above sea level (GSS)
| [41] | Ghana Statistical Service (2010). 2010 Population Census of Ghana, Demographic and Economic Characteristics, Northern Region. Tamale: GSS. |
[41]
. The Savelugu-Nanton District borders the metropolis to the north, the Central and East Gonja to the south, the Yendi municipal to the east, and Tolon-Kumbungu District to the West. Tamale Metropolitan Assembly (TMA) is further subdivided into three sub-metros which includes the Tamale north, center, and south sub-metros.
The Tamale metro area has a human population of 293,881 people, with 146,979 males and 146,902 females, according to statistics from the Ghana Statistical Service
| [41] | Ghana Statistical Service (2010). 2010 Population Census of Ghana, Demographic and Economic Characteristics, Northern Region. Tamale: GSS. |
[41]
. In 2012 and 2013, the Metropolis' population was estimated to be 383,205 and 404,609 people, respectively (Ghana Statistical Service)
| [44] | Ghana Statistical Service (2014). Ghana Living Standards Survey, Report of the Fifth Round (GLSS 5). Accra: GSS. |
[44]
.
Despite the fact that native Dagomba make up the bulk of the population, there is ethnic variety. In the city, almost all of Ghana's ethnic groupings are represented. There is also a wide range of religious beliefs, with Islam being the most prevalent
| [44] | Ghana Statistical Service (2014). Ghana Living Standards Survey, Report of the Fifth Round (GLSS 5). Accra: GSS. |
[44]
.
5.2. Research Design
The study used a qualitative research methodology using an ethnographic approach and was conducted in Ghana's Northern Region from May to September 2022. Ethnography is the study and understanding of people and cultures to make better products, services, solutions, systems and future that are intuitive, embedded in context and useful
| [21] | Kumekpor, T. K. B.(2002) Research methods and techniques of social research. SonLife Publishers. |
[21]
. In other words, ethnographic research design involves a researcher studying a particular social group in its natural environment to gain an in-depth, insider perspective on their behaviours, beliefs and interactions
| [21] | Kumekpor, T. K. B.(2002) Research methods and techniques of social research. SonLife Publishers. |
[21]
. In applying this design to this study the researchers stayed in the communities to observe the activities of tricycles drivers and even border some of the vehicles to have first hand impression.
5.3. Sampling Technique
A total of 30 tricycle drivers and 60 passengers were recruited from six terminal stations in Tamale and its surroundings using purposive and snowball sampling strategies. In-depth interviews were conducted with the recruited tricycle drivers to determine their role in tramadol consumption. Observation was also used to identify and elicit group patterns of behavior among tricycle drivers in the Metropolis. In addition, 60 people who use tricycle transportation were chosen for focus group talks to learn about their perspectives on substance abuse among tricycle drivers and the impact it plays in their daily performance.
5.4. Study Participants
The study's participants were tricycle drivers and tricycle key informants (station masters).
In other to participate in this study, a driver must have worked in a terminal for at least three years and be a current driver at a specific terminal or station. Passengers have to have used tricycle services for at least two years and be familiar with the trike drivers' operations and demeanor.
The research was carried out in the most widely spoken language (Dagbani), which was then transcribed and translated into English.
5.5. Data Collection Tools
The investigation was conducted using qualitative data gathering methodologies. Data gathering methods included an interview guide, focus group discussions (FGDs), and key informant approaches. These technologies were used to acquire both primary and secondary data.
The researchers utilized a tape recorder to record the Focus Group Discussions. The parties gave permission for the talk to be audio-taped. Instead of their original names, all conversation participants received a unique participation number. Each participant began their contribution by mentioning their tag numbers to guarantee that data were associated with participants. The conversations were transcribed and analyzed. The transcription was completed in an orderly manner, with a verbatim replication of every phrase, including stutters, pauses, mannerisms, and other movements./nonverbal cues were all equally recorded.
The researchers also observed attitude and demeanor, body language, and emotions during the data collection process. This gave the researchers information on whether the participants' facial expressions matched the uttered words.
5.6. Data Analysis
The data was coded and examined using thematic content analysis. Thematic content analysis was carried out using both deductive and inductive analysis. The taped interviews were carefully listened to three times before being transcribed by two independent researchers and juxtaposed to ensure accuracy and control for inconsistencies. Before analysis, the transcripts were read several times to gain a more full understanding.
This study's materials included interview guides, in-depth interviews, and focus group discussion guides. Data collection and transcription training was provided to research assistants. Following transcription, the data was coded, and teams formed from the data were used to study it. The data was analyzed and then interpreted by the researchers for easy understanding.
5.7. Rigor
The study was guided by Guba and Lincoln’s evaluative practice
| [9] | 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. |
[9]
, to ascertain data reliability and accuracy, including dependability, credibility, transferability, and conformity.
In other to ensure data reliability, authorities in the relevant authorities were contacted for the preparation of the focus group discussion guide, interview guide, and in-depth interview guide for data analysis to ensure reliability.
To establish credibility, interviews were conducted within an appropriate time frame.
To ascertain transferability, the snowball and purposive sampling techniques were used for data collection from diverse participants with much diversity taking in to consideration
| [9] | 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. |
[9]
.
After the interviews, participants were promised of a debriefing on the transcripts for member verification following data transcription.
It has been stated that social science research frequently encounters ethical issues
| [21] | Kumekpor, T. K. B.(2002) Research methods and techniques of social research. SonLife Publishers. |
[21]
. One such debate, the author claims, was whether doing a secret research was a good idea. The author claimed that clandestine research on societal issues, such as prostitution, drug dealing, and drug peddling, deserves extensive consideration. As a result, participants were given the option of participating or not participating, and their secrecy was guaranteed.
6. Results
6.1. Factors Perceived to Contribute to the Usage of Tramadol
In this study, tramadol misuse was defined as the use of tramadol without a doctor's clearance. Tramadol dosage limitations 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; however, any intake beyond these amounts is considered abuse.
The findings of this study revealed that the majority of participants used tramadol on a daily basis. The narrations of the tricycle drivers at the various stations yielded the following results.
A tricycle driver from the Aboabo terminal explains that:
I take tramadol to stay awake while transporting people from Aboabo to Nyohini and Lamashegu from buses who arrive at 2 a.m. I make a lot of money at night. A destination that would ordinarily cost 2 cedis in the daytime will cost 15 cedis at night. Because tricycle drivers are not available during certain hours, travelers would have few options.
(Number 10, FGD, Aboabo tricycle terminal).
It was revealed that psychoactive medicines, particularly tramadol, are frequently prescribed to novice trike operators as a way to relieve tension and weariness. During a focus group discussion, a participant stated that tramadol provides them energy and helps them hustle.
I hustle on the street to make a living. Tramadol motivates me to work more."
(Number 1, FGD, CBG terminal).
It was also discovered that several tricycle drivers abuse tramadol based on their own experiences. A participant offered the following observation regarding why he takes tramadol without a doctor's prescription:
''I had an accident with my trike and was in excruciating pain. I couldn't sleep, so my doctor recommended tramadol for me. And when I took it, it relieved my agony. I had no idea such a medicine could alleviate pain so effectively. So if I feel some minor discomfort in any part of my body, I just go to the pharmacy and obtain some tramadol to buy."
(Number 3, FGD, CBG terminal).
A passenger also made the following observation in an in-death interview Thus:
We were four passengers and the driver making five. Three were at the back and one in front with the driver. All of a sudden we heard the passenger front shouting our man is sleeping by the time we realize we were in a gutter and this driver was still sleeping while people are struggling to bring us out. We were told later that he took tramadol.
Another passenger narrates her experience from hospital road as:
We took the tricycle from hospital to taxi station in town. By the time we got to Gulkpe Naa Palace we hear wooooo kpayi our tricycle has collided with other vehicle and our driver was still sleeping in that process. Later revelations indicated that the tricycle driver was under the influence of tramadol.
6.2. Knowledge, Attitude and Practice of Tramadol
The majority of participants in the study learned about tramadol via their peers. The researchers conducted in-depth interviews to determine where tricycle drivers learn about tramadol.
The findings revealed that tricycle drivers in the Tamale Metropolis had generally fair understanding of Tramadol. Many of the participants stated that Tramadol is not an unlawful drug, although few were unsure.
This finding is confirmed by a key informant at the Motor Traffic and Transport Unit in Tamale, who said that the increased incidence of accidents in the Tamale Metropolis is a result of high illiteracy among tricycle riders, most of whom he stated are into drugs and lack understanding of the repercussions of such drugs especially tramadol. He observed thus:
"Tramadol has a wide range of consequences on our health. The young lads here simply take it to give them energy to work, and they soon find themselves in troubles and they could have situations they cannot avoided if they had known the outcome of this medication. Many traffic accidents are caused by tricycle drivers using tramadol. Arresting them today may result in threats from their leaders and politicians, but we are not concerned. We shall continue to perform our legitimate duties."
(KI, MTTU, Ghana police service).
Furthermore, some individuals wrongly associate all painkillers with tramadol. This was validated during a focus group discussion when a participant was asked the quantity of tramadol he takes after responding yes to using tramadol, he observed the following:
I was told tramadol the only painkiller by a drug store owner. So any time I feel pains I go to the store to buy tramadol and it solves my problem of bodily pains.
(Number 10, FGD, ADB)
In the same FGD, a participant asserted the following:
''When I take it with the capsule, it makes me melancholy, inattentive, and itching in my cheeks. People will scratch their cheeks because the capsule causes itching.
(Number 1, FGD, Access Bank)
At the GCB terminal, a participant reported thus:
Mixing cream cracker with tramadol powder and stirring with hot water until it became starchy before consuming. It is the most effective approach to improve sexual performance.
(Number 1, FGD, CBG terminal).
It was also discovered that particular types of ingestion have different jargon names associated with them. Mixing tramadol with marijuana was identified as ''Tar'', and disconnecting the capsule and eating the powdered substance after throwing the coats is named ''Leaning'', as confirmed by the following participants:
I take tramadol by 'leaning' it. Because it is the most effective and convenient option. You merely need to unplug the capsule, place the powdered contents in your palm, and lick them. And you're good to go.
(Number 9, FGD, ADB terminal).
6.3. Sources of Tramadol
The data revealed that the majority of individuals obtained the substance from the Tamale Forest. Out of fear of getting imprisoned, the majority of participants choose to obtain tramadol in the forest. One tricycle driver reported going to the forest daily to get tramadol due to fear of being harassed or arrested if he went to the pharmacy without a prescription. He narrated his first time experience as follows:
The first time I went to the pharmacy to buy tramadol, everyone looked at me strangely. They inquired about the prescription, including who would take it and what the user intended to use it for. I was so embarrassed that I had to lie. I resolved never to return to the drugstore to purchase the medicine again. So, whenever I need it, I drive my tricycle to the Gumani forest and obtain some."
(Number 2, FGD, Aboabo terminal).
Also, when asked how they are able to obtain the drug from the pharmacy without a prescription, one participant stated that pharmacists may have a restrictive attitude if they suspect you of being a spy.
A participant stated,
"As a result of Anas' exposure, everyone is on guard." They are concerned that you are surreptitiously taping the entire episode, so if you are not a regular client or are not well-known, they will most likely treat you unfairly. But if they know you, you have no reason to fear at all."
(Number 5, FGD, CBG terminal).
Another person added that:
''You don't even need to tell them you need tramadol; just say the amount and they'll understand. For instance, I'd want to buy 250 or 150. They understand you're talking about Tramadol and will get it for you"
(Number 8, FGD, CBG terminal).
6.4. Dosages Taken by Users
The desire for an initial sensation or pleasure is what causes tramadol users to settle comfortably on higher dosages of 250 and 500 mg. According to a Key Informant, taking tramadol for the first time causes a distinct sensation. The more you use tramadol, the less likely you are to feel that way again. This causes users to transition to a greater dosage or milligram than before, totally rejuvenated in their belief that they would get the original feeling they got previously." (Number 1, KII, CBG terminal)
The above usage supports the findings of Kolawole, etal.,
| [19] | Anzaku P. J., 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. |
[19]
in Lagos State, Nigeria where they studied the combined effects of ingestion of codeine and tramadol among Albino male rats.
6.5. Frequency of Using Tramadol
The fact that the majority of participants take Tramadol on a daily basis supports its dependence potential. According to
| [20] | 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. |
[20]
, indicators of psychological dependence on drugs include an increase in frequency of usage. The substance is used to get high, and the demand for the effect grows with frequency of use, and when you don't get it, you feel really uncomfortable. During a focus group discussion, one participant stated that not taking medication for a day causes them to quiver.
(Number 1, FGD, ADB terminal).
A participant observed that if tramadol is not used on a daily basis, it can cause stiffness and falls.
(Number, KII Aboaboo Terminal).
6.6. Perceived Effects of Tramadol
According to the findings of this study, those who use tramadol are not aggressive; even when justified aggression is present, they choose not to be hostile. In a focus group discussion, one participant remarked that:
“After taking tramadol, we would apologize and want to make amends, even if we were having a heated disagreement”.
(Number 12, FGD Participants, Aboabo).
According to reports, users' seizures are triggered by the situations they find themselves in and the way their systems react to those situations [18]. Participants in a focus group discussion attested to this. "Whenever I take Tramadol and don't eat afterward, I constantly have seizures," one of them said. (Number 5, FGD, Access Bank terminal)
Another participant said that:
Additionally, taking Tramadol and spending a lot of time in the sun might cause convulsions and finally death.
(Number 9, FGD, CBG terminal).
According to a key informant in a similar development, the impacts vary from person to person depending on the characteristics of their systems.
"The basic fact is that the effects apply to individuals differently depending on how their systems respond to the medications,"
The key informant clarified, that some people will take it and go to bed. Others will accept it and incur fees.
(Number 2, KII, CBG terminal).
According to the Tamale officer of the MTTU Directorate, tricycle drivers' usage of Tramadol is a contributing factor in eight out of ten incidents. Another challenge for the Metropolis police, according to the in-charge, was the regular obstruction of the police by relatives of accident victims when they were being taken to the mortuary for autopsy.
The officer observed:
We all know that this is a Muslim town, therefore if someone dies, they quickly go bury them. For this reason, I am unable to provide you with precise numbers of the number of fatal incidents caused by Tramadol. Eight out of ten accidents would be caused by the use of Tramadol, if we were permitted to transport the victims to the mortuary for an autopsy.
(KI, MTTU, Ghana Police Service).
6.7. Perceived Effects of Tramadol on the Mind
Investigations on the effects of tramadol use showed that the operators' vision was clouded. Tramadol hinders a rider's vision on the road, according to two tricycle accident victims who served as key informants at the accident ward of the Tamale Teaching Hospital. According to them, a rider with poor eyesight is more likely to be involved in an accident since having a good perspective of the road is essential for safe riding. This supports Donkor,
| [42] | Donkor, B. K. (2015). Drug use and its perceived effects on small scale mine labourers in Asutifi north district of the Brong Ahafo region of Ghana. university of cape coast. |
[42]
finding in Asutifi north district of Brong Ahafo region of Ghana where driver under the influence of tramadol are likely to put passengers lives at risk. The participants talked about how tramadol or other psychoactive medications can make it harder for riders to see road signs, pedestrians, or approaching cars.
One of the key informants opined that:
"You will have trouble seeing the road if you take tramadol right now and drive. You can't see the road well if your physique is weak. It is hard for me to notice the turns and curves of the road or other cars approaching me when I bike out on tramadol. My companions once collided with another car, and I once struck pedestrians.
(Number 2, KII, TTH, Accident Ward).
Riders who use tramadol have been found to have cognitive and motor impairments. Key sources claim that riding a tricycle is a delicate activity that requires a great deal of focus. They asserted that the rider had to constantly plan their actions to prevent getting into an accident. When using psychoactive substances, a rider's ability to reason and plan their movements is compromised. Participants thought that when using psychoactive substances impairs one's capacity to calculate and navigate, the likelihood of getting into a traffic accident increased. One participant said:
"Tramadol affects your head and thinking, so when you take it while riding, you won't be able to think and analyze things very effectively." On the road, you could make poor decisions that result in an accident. Tramadol will impair your ability to bike, thus you cannot take it while riding. We refer to it as a medication for this reason. Everyone is impacted.
(Number 1, KII, TTH, Accident ward).
7. Discussion
Before discussing the perceived consequences of tramadol use among tricycle drivers, the study looks at the elements that contribute to their use in the city. After discussing tricycle drivers' attitudes and knowledge about tramadol usage, it looked at how they felt about their psychological well-being in relation to tramadol abuse.
7.1. Tricycle Drivers' Use of Tramadol Is Caused by Certain Factors
The results showed that the majority of participants employ tramadol while discussing their motivations. Tramadol is taken by some individuals in order to be physically active. When drivers were asked to enumerate the reasons they used tramadol, this became apparent. This is in line with the findings of Fuseini et al., who also found that most tramadol users find that the medicine gives them the energy they need to carry out their daily tasks without feeling exhausted or to relieve stress following a demanding workday in keeping with this claim. Tramadol enhances task performance, according to a randomized controlled trial by
| [5] | 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 |
[5]
.
However, the results are in stark contrast to those of Waheed et al.,
| [37] | Waheed SA, Adesola RO, Abraham Y. Tramadol and its health implications. World News Nat Sci. 2022; 42(April): 123-38. |
[37]
who found in their study that tramadol significantly increases drowsiness and dizziness while lowering the risk of chronic depression. Similar to this, Balogun et al.,
| [8] | 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). |
[8]
noted that tramadol might cause fatigue and vertigo instead of vigor, especially when taken in large quantities.
The results also showed that most of the individuals used medications, including painkillers, to treat their pain. This is in line with Terman's
| [35] | Tam, C. L., & Foo, Y. C. (2012). Contributory factors of drug abuse and the accessibility of drugs. International Journal of Collaborative Research on Internal Medicine & Public Health, 4(9), 1621. |
[35]
recommendation that tramadol be taken to treat both acute and chronic pain. According to him, doctors use tramadol as a potent treatment for both acute (such as pain following surgery or trauma) and chronic (such as pain from cancer) conditions. Furthermore, after describing two instances in which participants experienced a significant change in their mood after taking tramadol, a systematic investigation validated the undeniable effect that the drug has on reducing pain
| [26] | 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. |
[26]
. Similarly, Uppal & Jayatunga,
| [36] | Uppal H, Jayatunga U. Decompression illness type II with stroke: Challenging situation in acute neurorehabilitation. Int Marit Health. 2020; 71(2): 105-8. |
[36]
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 of tramadol simply because their friends or peers are into the tramadol-taking business. In agreement with this finding, a qualitative study conducted by Elwy & Tabl,
| [14] | 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. |
[14]
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 their behavior. Furthermore, in their study, Alhassan et al.,
| [5] | 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 |
[5]
found that people who had friends who used tramadol and other drugs were more likely to abuse drugs than people without such connections. The findings also supports a study on the causes of addiction conducted in Egypt, which found that peer pressure was the primary cause of addiction for 50% of the participants. According to reports, tramadol dependence in Saudi Arabia started when users acted under the influence of their buddies
| [12] | 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. |
[12]
.
7.2. The Use of Tramadol and Its Perceived Effects
According to the study's findings, most participants strongly disagreed that taking tramadol causes respiratory failure, indicating that the drug does not cause respiratory failures. This result is consistent with that of Shuai et al.,
| [32] | 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 |
[32]
, who claimed that intramuscular tramadol injection did not result in respiratory depression in neonates and that intravenous administration would result in significantly reduced respiratory depression. This is in fact consistent with a research by Shuai et al.,
| [32] | 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 |
[32]
, who found that tramadol did not result in clinically significant respiratory depression at the approved therapeutic dosages.
Perananthan and Buckley
| [27] | Perananthan V, Buckley N. Opioids and antidepressants: Which combinations to avoid. Aust Prescr. 2021; 44(2): 41-4. |
[27]
observed that the use of tramadol at high dosages and over prolonged periods of time results in adverse effects such as respiratory depression. Similarly, it was noted that using tramadol may result in respiratory failure
| [25] | 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 |
[25]
.
Additionally, the study discovered that using tramadol did not cause seizures, anxiety, sadness, aggression, or inattention. According to a study by Mehrpour et al.,
| [24] | Mehrpour O, Sharifi M, Zamani N. Tramadol poisoning. Toxicol Stud - Cells, Drugs Environ. 2015; (August). |
[24]
, these symptoms only appear when a tramadol user attempts to stop using the medication for a while. They stated that among the symptoms that people experience during withdrawal include anxiety, despair, anguish, severe mood swings, hostility, convulsions, tremors, and exhaustion.
The results also concur with a large body of research that questions whether tramadol can cause seizures. According to Gardner et al.,
| [16] | 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. |
[16]
, tramadol only induces seizures in humans when given in large quantities to epileptic individuals or in combination with other medications that cause seizures. In a similar vein, Gardner et al.,
| [16] | 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. |
[16]
claimed that seizures have a mere <1% risk of occurring among tramadol users.
This result, however, was in contrast to that of Nakhaee et al.,
| [25] | 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 |
[25]
, who denied the claim that tramadol can induce seizures even when taken as prescribed and without the presence of any other drugs. The study also demonstrated that using tramadol can lead to drug dependence.
Zabihi et al.,
| [39] | 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. |
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in Northern Iran in 2007-2008 corroborate this finding. About two-thirds of the 162 people in their study reported having a dependency. The usage of tramadol was found to have a substantial potential for dependency. Zebala et al.,
| [40] | 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. |
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acknowledged the dependence, but only if the person had taken the medication repeatedly. Although tramadol seems to have a low dependency rate when compared to more powerful alternative analgesics like heroin, they contended that it is evident that repeated tramadol dosages can result in tramadol physical dependence that is comparable to that of other opioids, and that caution must be taken when giving tramadol to a person who is at risk of substance abuse.
7.3. Tramadol Use: Knowledge, Attitude, and Practice
According to the study, users of tramadol knew a reasonable amount about the drug in general. A significant portion of the participants said that tramadol is not illegal. Further investigation revealed that several participants mistakenly believed that all painkillers were equivalent to tramadol. This result is supports a survey by Anetor & Oyekan-Thomas
| [6] | Anetor GO, Oyekan-Thomas MF. Knowledge and attitude of youths towards substance abuse in Alimosho Local Government area of Lagos State. Int J Biol Chem Sci. 2018; 12(2): 822. |
[6]
, which showed that many drug abusers are unable to accurately describe tramadol medications. They also implied that a large number of participants were unfamiliar with medicines that were classed as tramadol and could not tell tramadol from other opioids that were misused.
It was noted that most participants lacked sufficient understanding of the risks connected to tramadol usage.
According to a study on teen substance abuse by Bassiony et al.,
| [10] | 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. |
[10]
, participants had little awareness of the negative effects of tramadol misuse. On the other hand, Soremekun
| [33] | Soremekun RO, Folorunso BO, Adeyemi OC. Prevalence and perception of drug use among secondary school students in two local government areas of Lagos state, Nigeria. South African J Psychiatry. 2020; 26: 1-6. |
[33]
disagreed with the study's findings, which indicated that most participants occasionally become aware of the impacts yet must continue.
Additionally, this study revealed that tramadol users were introduced to the drug by their classmates or acquaintances. This result confirms that of Ansari H.
| [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]. |
[7]
, who examined the critical evaluation of knowledge, attitude, and prevalence of drug addiction among adults and adolescents in Lagos State, Nigeria, using tramadol as a case study. He discovered that most participants acknowledged that they obtained information from peers and friends. This supports findings of Soremeku etai.,
| [31] | Sher (Eds), APA handbook of research methods in psychology, Vol. 2: Research designs: Quantitative, qualitative, neur. 2012. p. 57-71. |
[31]
on prevalence and perception of drug use among secondary school students in Lagos State, Nigeria where majority of the student population were engaged I tromadol abuse.
Once more, the study's results demonstrated that most individuals consume tramadol by mixing the powdered medication into energy beverages. The study carried out in Wassa Amenfi, Ghana, supports this, showing that participants reported consuming tramadol mixed with an energy drink (9;17).
According to the survey, users of tramadol reported taking the drug's powdered form. This discovery was corroborated by Perananthan & Buckley's
| [27] | Perananthan V, Buckley N. Opioids and antidepressants: Which combinations to avoid. Aust Prescr. 2021; 44(2): 41-4. |
[27]
research, which also revealed that tramadol users occasionally ground the pills into tiny bits for licking (a practice known as "snorting"). Additionally, Barbosa et al.,
| [12] | 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. |
[12]
concurred with this finding and noted that licking was common because of the anticipated benefits (noting the instant high and feeling good).
Nearly half (44%) of the participants "Always" removed foreign objects before licking, with an equal percentage stating that they preferred the drug in the powder alone for a more instantaneous high (16%) or that they didn't like the shell's characteristics, such as being sticky, annoying, or burning their nose, or that they got dust in their nose (16%).
Once again, the study discovered that participants administer tramadol intravenously. This conclusion is supported by Abd El-Azim
| [2] | Abd El-Azim, K. (2001). 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. Faculty of medicine–Ain Shams University. |
[2]
, who said that the intravenous route is recognized as one of the most common ways to provide tramadol in Egypt. In Egypt, his research found that the most common delivery modalities were oral in 46.8% of cases and intravenous in 40.3% of cases.
An further observation regarding tramadol use. He believed that tramadol's effects are regarded as being more intense when it is licked, snorted, and injected. He said that although tramadol pills are meant to be used orally, they shouldn't be broken up and used for injection or inhalation. Tramadol is more effective at overdosing and may have negative side effects, such as seizures, when it is inhaled or injected because it intensifies the effects reported by the user, allowing large amounts to enter the bloodstream
| [38] | 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. |
[38]
.
Tricycle drivers' perceptions of their mental health in relation to tramadol abuse.
The results of the study showed that tramadol does not impair a person's memory of events or their capacity to carry out tasks; rather, it change users' perceptions without causing blackouts.
This result confirms the findings of Saapiire et al.,
| [28] | 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. |
[28]
, who found that participants remain in the practice for a range of physical and psychological benefits, such as increased energy and attentiveness. Similar findings regarding memory, focus, and attentiveness, as well as a feeling of hope, were reported by Saapiire et al., in
| [28] | 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. |
[28]
. Some individuals cited alertness and attentiveness as additional explanation for their continuous tramadol use, leading them to conclude that the medicine makes them more focused, alert, and aware of their everyday activities. Once more, this result confirms the findings of Barbosa et al.,
| [12] | 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. |
[12]
, who showed in a randomized control study that tramadol affects persistent attention-related stimuli processing.
7.4. Conclusion
The causes of the prevalent tramadol use among Tamale's tricycle drivers have been clarified by this study. This study demonstrated the necessity of identifying peer pressure as one of the strong elements that frequently lead tricycle drivers to engage in tramadol usage, which is consistent with data from other nations.
Tramadol-using tricycle drivers had a reasonable understanding of the drug, and the more educated the participants, the more aware and knowledgeable they were about the drug. The average daily dosage (milligram) of tramadol consumed by tricycle drivers in the city of Tamale was high.
This study found that probable side effects of tramadol use include nausea, dizziness, tiredness, and car accidents. Other side effects of tramadol use include respiratory problems, anxiety, depression, aggression, seizures, inattention, and difficulty focusing.
Tramadol can cause psychological side effects such as clouded vision, hearing, and coordination issues, as well as a diminished capacity for exercising sound judgment.
Finally, because tramadol misuse among tricycle drivers is on the rise, its availability in the Tamale city should be rigorously regulated. The moment to take action is now, and this is a serious issue that requires a coordinated effort to solve.
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