Prevalence Of Tramadol Abuse Among Patients Admitted In Federal Neuropsychiatric Hospital Calabar

Prevalence Of Tramadol Abuse Among Patients Admitted In Federal Neuropsychiatric Hospital Calabar
Abstract
Tramadol is a psychoactive substance used to treat a variety of mental and behavioural disorders. It has been reported that tramadol has a detrimental and addictive effect in Nigeria. The present study seeks to determine the prevalence and factors responsible for tramadamol abuse among patients admitted in Federal Neuropsychiatric Hospital, Calabar, from 2013-2017. The study was carried out using a structured instrument, which was used to elicit data from the medical records regarding patients that have been admitted from 2013 to 2017 to have abused tramadomol. The data were analysed using table, percentages and bar chart. The results showed that there was a high prevalence rate of the condition within the specified period of study. The major factors or reasons why patients abuse the condition were to enhance sexual performance 97.3%, peer group influence 94.4%, to increase physical performance during worker’s labour 83.3% and to relieve pain 72%. There was no significant difference in the percentages between the groups in terms of gender, age, and sex. There were no significant differences in the socio-demographic characteristics of the patients admitted to the hospital. The findings of this study will be significant to practicing psychiatrists, psychiatrists, other health professionals and Hospital management, because it will identify the current rates and trends in the pattern of drug abuse, its causative factors and help them develop appropriate therapeutic modalities to alleviate the disorder.
Chapter One
Introduction
1.1 Background of the Study
The 21st century Nigeria has witnessed changing trends in the pattern of psychoactive substance use with tramadol HCL emerging as a candidate drug in various parts and regions of the country (Borofka and Olatawura, 2016).
In Nigeria, the use and abuse of tramadol has become a problem of National mental health and psychiatric significance, this is because, the use and abuse of Tramadol have been associated with psychosocial, economic and medical complications (Burke, 2016).
Calabar, Cross River State, like other parts of the country has its own share of the National drug abuse epidemic, and has exhibited changing trends over time with tramadol usage trends and patterns increasing with time (Ibrahim, Aliyu, Adeleke and Omoniyi 2017). Based on Anecdotal clinical records and experience, the emergence of the opiod-based analgesic; tramadol among drug abusers admitted in Neuropsychiatric Hospital with the last ten (10) years presents a major concern in mental Health care and in the society, as the number of patients admitted in Neuropsychiatric facilities have seen an increase (Lanier, Lofwall and Mintzer 2010).
Tramadol is a centrally acting analgesic with strong opiod agonist properties as well as inhibitory effects on the reuptake of noradrenaline and serotonin. It was initially thought to have minimal addictive potentials when compared to other opiod analgesics, but the unfolding scenarios are contrary (Boostani and Derakhashan, 2012).
Though not included in the essential drug list of the country, it is often prescribed for acute and moderate pains that are not responsive to other non-narcotic analgesics by clinicians. It is often used off-label for other purposes such as premature ejaculation and for its euphoric effects, and muscular enhancement (Chiang and Goldfrank, 2009). Literature also abound that and have documented the detrimental effects of tramadol which include, induction of seizures and Parkinson-like symptoms, development of classical opiod withdrawal syndrome and psychiatric symptoms such as aggressiveness, hostility, mania, mental and behavioural disorders (Aliyu, Adeleke, Omoniyi, and Ibrahim, 2016).
Tramadol is associated with increased tendency of being addictive and it is more accessible and cheap to buy than heroin and other opiods or psychoactive drugs. Its availability without prescription makes it easy to obtain and some people consider it a treatment for sexual dysfunctions such as weak erections and delay orgasms.
The National Drug Law Enforcement Agency (2015), reports that, 3.2 million people over the age of 18 in Nigeria, used tramadol for non-medical reasons in their life time. The prevalence of Tramadol Abuse is 54% and over 65% of tramadol users were within 18-37 years of age, while the average age of onset of use was 24 years (Liu, Lianz and Ren 2014).
The major mode of initiation into tramadol use was peer influence and 63% used over 200mg per day. The primary reasons for tramadol abuse was reported as relief of tiredness, stress and pain 48%, prolonging of sexual enhancement and intercourse 40% and compulsive urge was 12% (Bashirian, 2014).
Socio-demographic characteristics reveals that males constituted over 83% of tramadol users, and the reasons for the male predominance was attributed to socio-cultural influences, but recently, females have also been reported to abuse tramadol.
The detrimental and addictive effects of tramadol abuse have been revealed by the influx of patients presenting in emergency centres of psychiatric and mental Health facilities with cases of suicide attempts, acute schizophrenia, mental and behavioural disorders secondary to its compulsive addiction.
It is in context of this background information, that this study seeks to determine the prevalence and factors responsible for Tramadol abuse among patients admitted in the Federal Neuropsychiatric Hospital, Calabar from 2013 – 2017.
1.2 Statement of Problem
Tramadol Abuse is becoming prevalent and a current trend with an increase in proliferation of youths and young adults indulging in the abuse. Despite the awareness on the detrimental effects and psychiatric comorbidities elicited by tramadol abuse, people do not in any way desist and refrain from the abnormal usage of tramadol which can be described as an unhealthy habit (Burke, 2016).
The rise in the incidence of criminal activities, violence and conflicts, as well as antisocial behaviours among youths in our society, tertiary institutions and secondary schools has been correlated or attributed to substance abuse such as tramadol which they use to get high and over energetic (Ibrahim et al, 2017).
Parents, law enforcement agencies, social and mental health institutions have regularly organized sensitizations and educational programmes to counsel and enlighten the youths and young adults on the consequences of drug abuse, especially tramadol abuse and the need to abstain from its use without proper recommendation or prescription by a Health expert, but this has not proved to yield a positive turn around because the number of youths arrested by Law Enforcement Agencies acting under the influence of Tramadol and most alarming, the number of patients admitted to the Neuropsychiatric hospital with emergency psychiatric manifestations due to tramadol abuse have shown a geometric increase over the past few years (Okoye, 2013).
Furthermore, tramadol is easily accessible by these youths who can buy large amounts from vendors or chemists who are not current with medical guidelines, thus the easy access to procure the drug at large quantity and at affordable price has also fueled the prevalence and increase its abuse (Aliyu et al, 2016).
It is therefore based on this premise that the researcher seeks to determine the prevalence and factors responsible for tramadol abuse among patients admitted in Federal Neuropsychiatric Hospital Calabar, from 2013-2017.
1.3 Objectives of the Study
The objectives of this study are;
- To determine the prevalence of tramadol abuse among patients admitted in Federal Neuropsychiatric Hospital Calabar, from 2013-2017.
- To ascertain the socio-demographic characteristics of the patients with tramadol abuse admitted in Federal Neuropsychiatric Hospital, Calabar from 2013-2017.
- To find out the factors responsible for tramadol abuse among patients admitted in Federal Neuropsychiatric Hospital from 2013-2017.
1.4 Significance of the Study
The present study seeks to determine the prevalence and factors responsible for tramadol abuse among patients admitted in Federal Neuropsychiatric Hospital, Calabar from 2013-2017.
The study will be of paramount significance to the researcher and other scholars investigating in trends of substance abuse in Nigeria, as valuable informations and data acquired from this study concerning prevalence and factors responsible for tramadol abuse will be of relevant contributions to literatures on the subject matter.
The study will also be significant to practicing psychiatrist, psychiatric nurses, other health professionals and Hospital management, because it will identify the current rates and trends in tramadol abuse, its causative factors and help them develop appropriate therapeutic modalities to alleviate the disorder.
It will also be of valuable information to relevant law enforcement agencies and government via the Ministry of Health to formulate and modify policies and steps to curb the situation.
1.5 Research Questions
- What is the prevalence of tramadol abuse among patients admitted in Federal Neuropsychiatric Hospital Calabar from 2013-2017?
- What are the socio-demographic characteristics of tramadol abuse among patients admitted in Federal Neuropsychiatric Hospital Calabar from 2013 – 2017?
- What are the factors responsible for tramadol abuse among patients admitted in Federal Neuropsychiatric Hospital Calabar from 2013-2017?
1.6 Scope of the Study / Limitation of the Study
The study seeks to investigate the prevalence and factors responsible for Tramadol Abuse among patients in Federal Neuropsychiatric Hospital, Calabar. The study is restricted to patients and information obtained from their case files in the medical records unit in Federal
Neuropsychiatric Hospital, Calabar and the scope does not extend beyond this locus of study.
However, limitations and challenges that could possibly be envisaged or encountered in this study may include, unavailability of sufficient data and time constraints.
1.7 Operational Definitions of Terms
Prevalence:
This is the rate and pattern of usage and abuse of tramadol among patients admitted in Federal Neuropsychiatric Hospital Calabar, from 2013-2017.
Factors:
This means reasons for the abuse of tramadol among patients admitted in Federal Neuropsychiatric Hospital Calabar, from 2013-2017.
Tramadol Abuse:
The abnormal and non-prescriptional use of the narcotic-opiod analgesic drug tramadol causing psychoactive disturbances among patients admitted in Federal Neuropsychiatric Hospital Calabar.
Patients:
These are persons admitted in Federal Neuropsychiatric Hospital, Calabar presenting with psychological, mental and behavioural disorders and receiving treatment for tramadol abuse and addiction.
Chapter Five
Discussion of Findings, Summary, Conclusion and Recommendation
5.1 Discussion of Findings
This chapter deals with the discussion of findings gathered from the research study in relation to reviewed literature and research questions, implications for nursing, summary, conclusion, recommendations and suggestions for further studies.
Research Question I
“What are the prevalence of tramadol abuse among patients in Federal Neuropsychiatric Hospital, Calabar from 2013 – 2017”?
Based on the findings, it was clearly reviewed that, the highest prevalence occurred in 2017 (n=72, 27.6%) and the lowest percentage (n=30, 11.5%) in 2013. This indicates that, the rest of the percentages representing other years under the period of study fall between the percentages above. These percentages put together make the total percentage of prevalence of tramadol abuse patients admitted in the hospital during the period of study.
Research Question 2
The research question seeks to know the sex in the “socio demographic characteristics” of patients with tramadol abuse from 2013 – 2017. Following the findings, it was revealed that tramadol abuse has the greatest tool or percentage amongst male. The analysis shows that out of the total percentage under study, males had in 2013 100%, while female had nil %, in 2014 males had 100%, while females had nil %, in 2015 males had 96.6% while female had 3.3%, in 2016 males had 96.3% while the female had 3.6% and in 2017 males had 94.4% while the female had 5.5%.
In the analysis of age bracket that the prevalence was higher, it was observed that; age 31-34years had the highest percentage (n=10, 33.3%) in 2013, while age 40 and above had the lowest percentage (n=1, 3.4%).
2014 highest prevalence 31-34 years (n=12, 27.9%) and lowest percentage 41 and above (n=2, 4.6%), 2015 highest percentage 20-30 years (n=20, 33.3%) and lowest percentage 40 and above with (n=5, 8.3%), 2016 highest percentage 25-30years (n=15, 27.3%) and lowest percentage to be 45 and above with (n=5, 9.1%) and 2017 highest percentage 31-34years (n=20, 27.8%) lowest being (n=6, 8.3%) for 40 years and above respectively.
Following the analysis above, it is clear that the prevalence of tramadol abuse is highest in the age group of 31-40years. This is based on the total number of percentages for the five years for each age group.
Research Question 3
“What are factors responsible for tramadol abuse among patients in Federal Neuropsychiatric Hospital, Calabar from 2013- 2017”?
Findings from this study clearly shows that the major factors or reasons why patients abuse tramadol were to enhance sexual performance 97.3% (n=70), peer group influence 94.4% (n=68), to increase physical performance during worker’s labour 83.3% (n=60) and to relieve pain 72% (n=52). Other factors identified in this study includes feelings of euphoria and relieve of stress, 69.3% (n=50) and 58% (n=42) respectively. also 27.7% (n=20), 13.8% (n=10) and 16.7% (n=12) revealed that the enhance sleep, relieve frustration, and boost appetite were factors responsible for tramadol abuse. Lastly, 20.8% (n=15) also indicated parental influence as factors responsible for tramadol abuse among patients admitted in Federal Neuropsychiatric Hospital, Calabar between 2013-2017.
5.2 Relationship with Other Studies / Literature Review
In research question one “the prevalence of tramadol abuse among patients in Federal Neuropsychiatric Hospital, Calabar from 2013-2017”. This question has been answered by the statistical records of such condition within the specified period in the chosen hospital, to be of high rate. These findings collaborate with the work done by Bashirian (2014), Burke (2016) and Aliyu (2016), who reported high prevalence of tramadol abuse with 54.4%, 77.5% and 50.7% respectively as stated in the literature review.
In research question two, which asked the “socio-demographic characteristics of patients with tramadol abuse”. It was revealed that, the prevalence was high in males than females as revealed by the hospital records within the time frame of study. This also conform with the study carried out by Marwa (2009) in PCC-Asu Hospital in Egypt. He reported that, males had the highest prevalence of tramadol abuse with 77.2% with female 67.9%. Research question three asked “factors responsible for tramadol abuse from 2013-2017”. It was analyzed as obtained from records and patients that, certain factors as seen in the discussion in the research analysis contribute to tramadol abuse which confirm the work of Haladu (2009). He pointed that, peer pressure plays a major role in influencing many adolescents into tramadol abuse.
Also, Mahmoud (2011) reported that, the factors responsible for tramadol abuse can be linked to the fact that, it creates feelings of euphoria, feeling good, calm and relaxed.
Other factors such as to relieve stress, relieve pains, to enhance physical and sexual performance, relieve frustration are factors which conform to a similar research study carried out by Isanedighi (2010) and Ibrahim (2016) in a clinic in North-Eastern Nigeria.
5.3 Implication for Nursing
The prevalence of tramadol abuse is a trend that is common among our youths, and hence poses a great risk, for nurses. It is therefore imperative and incumbent on nurses to educate patients properly with valuable information concerning drug abuse in other to curb the situation; with the increase in the rate of tramadol abuse in Federal Neuropsychiatric Hospital, Calabar, it will result in overcrowding in the various wards thereby leading to overworking off the staff.
Youths indulging in drug abuse will be become less productive resulting in increased joblessness, crimes and social vices in the society. Tramadol abuse in women leads to conflict in the home, where she cannot live up to her responsibilities at home resulting to poor parenting and infertility, thereby posing a great challenge to mental health nursing. The mental Health nurse has to advocate, educate and sensitize the general public on all these issues in other to prevent and ameliorate any further problem arising from tramadol and other drugs of abuse.
5.4 Summary
The study focus on the prevalence and factors responsible for tramadol abuse among patients in Federal Neuropsychiatric Hospital, Calabar from 2013-2017. The researcher was motivated into studying this case, when she noticed increase cases of tramadol abuse compared with few years back.
Related literature on the condition was reviewed, method adopted was statistical method, were data were collected from the hospital records and analysed using table, percentages and bar chart.
From the study, it was discovered that, there was a high rate of prevalence of tramadol abuse in 2017. Furthermore, it was also discovered that the age group mostly affected are people within the ages of 25-30 and 31-34 years. It was also discovered that, the male patients are prone to the condition and the possible reasons clearly stated. Several factors were pointed out as reasons responsible for tramadol abuse, such factors as to relieve pains, to feel good/euphoria, to increase physical and sexual performance, peer group influence, enhance sleep etc.
5.5 Conclusion
Based on the research study carried out, the prevalence and facors responsible for tramadol abuse among patients in Federal Neuropsychiatric Hospital, Calabar from 2013-2017, was reviewed that, there was a high prevalence rate of the condition within the specified period of study. Men were discovered to have the highest rate of tramadol abuse than women. This was concluded following the analysis of data gotten from the hospital records of such treated case.
5.6 Recommendations
For the prevention and possible reduction of tramadol abuse among patients, the following recommendations are made;
- The patient and family should adequately benefit from group counseling on the need to comply to medication, and to keep to appointment during trial leave after discharge.
- The family should maintain a positive and therapeutic family relationship.
- Patient should be taught good coping skill strategies to withstand stressful life situations.
- Patient should learn to set advisable life goals/objectives which helps for adequate planning, proper implementation, re-planning and evaluation when need arises.
- The government and other non-governmental organization and communities should encourage and support community mental health services.
- The government should provide adequate mental health facilities to enhance prevention and care of mental illness.
- Nurses should develop good attitude towards the mentally ill they are caring for.
- Campaign against stigmatization by the public on the mentally ill and against substance use by the public.
5.7 Suggestions for Further Studies
There are as follows:
- Study should be carried out to identify why people in the ages of 25-30 and 31-34 years have the high prevalence in tramadol abuse.
- Study should be carried out to identify why men have higher prevalence in tramadol abuse than females.
- Studies should be carried out to identify ways of preventing/reducing the high prevalence of tramadol abuse among patients in Federal Neuropsychiatric Hospital, Calabar.


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