The adverse effects that emerged from the interviews and analysis were categorised into three: physical, psychological and social effects. Almost all the participants were aware of possible physical side effects of tramadol and recalled at least one adverse physical experience as a result of misusing the drug.
Most reported and experienced adverse physical effects among the participants included, seizures, excessive vomiting, anorexia, loss of appetite, hallucination, severe nausea, agitation and confusion, drowsiness, dry mouth, headache, loss of strength, muscle aches, joint pains, severe redness, swelling, itching of the skin, sweating, swelling of the hands, ankles, feet, or lower legs, trembling and shaking of the hands or feet and weak or absent pulses in the legs.
It was emerged that most of these effects were pronounced in the early stages of tramadol use among the participants.
However, few of the participants explained that they continue to experience some of the highlighted adverse effects each time they use the drug. One of the participants noted:. Yes, I am aware that tramadol has some effects that can affect me physically. Some of my friends who misuse it have been reporting of several experiences such as vomiting, unnecessary confusion and agitation and body pains and weakness.
I believe the drug has some adverse effects that can be harmful. For instance, I feel very weak and sleepy whenever I take it. I remember last two weeks I nearly collapsed as a result of the drug because I took three tablets without eating 29 years old, male, driver.
For me, everyone who takes tramadol including myself is aware of the possible side effects of the drug. In fact, we experience the effects regularly such as seizures, skin itching, loss of appetite, dry mouth, among others. I aware of the side effects of tramadol because I listen to the radio, watch television and they talk about the harmful effects of tramadol misuse. Using myself for example, I always feel very weak, dizzy and confused each time I take the drug. I nearly had a seizure one time as a result of tramadol.
Again, I do not really when I am on tramadol, whereas my mouth becomes dry 42 years old, male, driver. Some of the study participants also highlighted myriad of perceived psychological problems as additional adverse effects of tramadol. The participants repeatedly mentioned irritability, anger, overactive reflexes, loss of consciousness, discouragement, general feeling of discomfort and sad and loss of interest or pleasure.
The participants recounted experiencing either one or a combination of these psychological problems associated with tramadol misuse. I think I become too temperamental and do not feel like talking to anyone when I take tramadol. Sometimes, I feel discouraged to the extent that I get irritated and angry easily 27 years old, male, driver. For me, I think the drug makes me unconscious most of the time.
I sometimes act unreasonably, and I think it is that drug that influences me 26 years old, male, assistant. Tramadol makes me think about strange things and frequently gets discouraged. Mostly I get angry and irritated over petty issues 31 years old, female, assistant. Social stigma and lack of respect were reported by all the participants as social effects of tramadol misuse.
All the study participants verbalised that most community members disapprove tramadol misuse and as a result stigmatise them for their indulgence. They specifically mentioned that members of the society do not accord them the needed respect as a result of their tramadol misuse and this act constitute an adverse social effect of tramadol misuse.
Some people do not respect me for misusing tramadol, and even do not want to associate with me. In fact, some even regard me as worthy of disgrace to my family 31 years old, female, assistant.
My community members regard me as a useless being worthy of great disgrace. I remember on one occasion a certain girl that I am far older than her told me I have no respect and admiration because I take tramadol 24 years old, male, driver. People talk to me anyhow because of the tramadol. At times they point hands on me as a useless person and even tell others not to be like me. They regard people who use tramadol as non-humans and crazy people 28 years old, male, driver.
Interestingly, almost all the participants said a word of praises to those who initiated them into tramadol use. It was observed that these praises were linked to the perceived benefits associated with the use of the drug such as perceived improved physical and sexual activity performances. In all, these participants thanked their initiators for introducing them into tramadol use.
One of these participants noted with appreciation:. In fact, I owe my master a lot of thanks and appreciations. I remember when he was introducing the drug to me, I was not really in support of it I now know he was doing me a lot of good.
Oh, I am very grateful to him 27 years old, male, driver. In fact, the drug has helped me improved significantly in my daily activity performance. I must say huge thanks to my friend who introduced it to me 26 years old, male, assistant.
You know this job is mostly for males as it is very hard. Big thanks to my friend who first gave me the drug 31 years old, female, assistant. Interestingly, almost the participants exhibited no sign of stopping the use of tramadol for non-medical purposes. In their own evaluations and assessments, the drug is effective for the purposes that they are using it for and as a result, do not have any reason for quitting it.
Personally, I do not have any plans for stopping tramadol use for now. The drug is very effective, nice and feels great whenever I take. Maybe, when I am too old, I can consider stopping but now no intention to quit 28 years old, male, driver.
It was observed that few of the participants who were willing to stop using tramadol for non-medical purposes were looking for alternatives or substitutes for the drug. Some of the participants mentioned that until they find alternative drugs that work as tramadol, they are not going to stop its usage.
For me, I will stop using tramadol when I find a different drug that works like it. Till then, I have no plans of stopping 30 years old, female, assistant. I am looking forward to finding another drug with the same effectiveness as tramadol before I stop using tramadol 26 years old, male, driver. Though participants indicated no sign of stopping non-medical use of tramadol, they rather expressed strong support for the ongoing fake tramadol seizures and prosecution of illegal tramadol peddlers.
They further expressed their willingness to collaborate with health officials and security agencies in finding fake and illegal tramadol peddlers. They claimed of knowing some of the illegal and fake tramadol peddlers and they could serve as whistle-blowers to health officials and security officers involved in the fight against tramadol proliferation in Ghana.
For their interest, helping officials to eradicate fake tramadol and illegal sellers would help them acquire safe, quality and standard tramadol from certified sellers. I think the officials are doing well by seizing fake tramadol and prosecuting illegal sellers. I and most of the people who use tramadol know can support the police in this regard because we know most of the illegal sellers in this city. We can give them information … … 35 years old, male, driver.
I heard the police are seizing fake tramadol and punishing the illegal sellers. I know some of those sellers and can help the police. If those fake sellers are punished, we can good tramadol and not fake ones 33 years old, male, assistant. For the sake of getting quality and standard tramadol from licensed shops, I am willing to support the police to arrest fake sellers. I know some of them and can help the police to arrest them 30 years old, male, driver.
This study offers a useful understanding of varied reasons for using tramadol for non-medical purposes among commercial vehicle drivers and assistants in Kumasi, Ghana. The study is novel in that it provides an in-depth description of the opinions of people who use tramadol, the ways in which they use and what they see as their key motivations.
These opinions are useful in informing strategies for curbing tramadol misuse in Ghana. The study found a range of motivations for using tramadol for non-medical purposes, and in many cases, these motivations were explicitly linked to their performed daily activities whilst at other times participants spoke of motivations in the broader social context.
The motivations fell into four main inter-linking identified categories: 1 sexual; 2 psychological; 3 physical; and 4 economic motivations. It must be emphasised that there was a great deal of overlap between the categories and a very strong theme to emerge was perceived improved sexual performance and satisfaction associated with the use of tramadol. Further, the identified motivations appear to be related to how long participants had been using the drug for non-medical purposes, to the intensity of their dependence and how they were introduced to the drug.
Many developing countries in the last decade have witnessed increasing trends in the misuse of psychoactive substances with tramadol becoming the major drug in these countries including Ghana [ 6 , 16 ]. Tramadol manifests some effect characteristic close to that of opioid agonists, and its misuse seems to be a problem for Ghana as several reports on the side effects of the drug, especially when taken in higher doses including nausea and vomiting, constipation, sweating, dizziness, seizures and postural hypotension, among others continue to build-up [ 5 , 6 , 16 , 38 , 39 , 40 ].
Our study contributes to the existing literature in various ways. To the best of our knowledge, this is the first study to explore motivations for non-medical purposes tramadol use in Ghana. In relation to empirical literature [ 2 , 7 , 25 ] participants got introduced to tramadol use by two main factors including pressure from friends, relatives and members of the community they live, and curiosity.
These pressures as narrated by the participants were in the forms of threats, coercion, and allurement by friends and workmates and superiors. For most of the participants, their inability to resist the pressure and fear of being sacked from work by their superiors led them into non-medical purpose tramadol use. It is also interesting to note that the constant public campaigns and education on radios and televisions by health officials and private individuals against tramadol misuse have in a way raised the curiosity levels of those who use the drug as reported by some of the study participants.
In the quest to satisfy their curiosity concerning the functions that the drug could perform as widely reported by the public, friends and colleagues, participants got into the use of the drug for non-medical purposes. Wasify et al. Throughout history, sexual health and function have been important components of life [ 42 , 43 ] and our study found three main sexual factors serving as motivations for non-medical purposes tramadol use among the participants.
These include prolonging time of sexual intercourse, treatment for premature ejaculation and ejaculation-related personal distress. These sexual reasons for the continuous use of tramadol have been reported previously [ 2 , 7 , 16 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ]. A perceived decline in sexual function and the quest to satisfy partners by meeting their sexual needs and standards cause the affected individuals to search for solutions including patronising sex enhancing products such as tramadol.
Our study participants continuously explore various ways to boost and maintain their sexual ability or stimulate sexual desire and this has resulted in their continuous misuse of tramadol.
It is also in line with Manortey et al. Having females buying tramadol for their partners for sexual purposes as a sign of spousal support or endorsement for tramadol use in this study is an indication that sex is a complex activity that is not only meant for procreation but also for enjoyment and natural relaxation. However, the mechanism through which tramadol improves sexual performance and cures premature ejaculation and ejaculation related issues were not known to the participants though empirical studies demonstrate that the relationship between tramadol and sexual function appears to be controversial [ 16 , 50 ].
However, the use of tramadol for managing premature ejaculation and ejaculation related distress has been cautioned [ 56 , 57 ].
This suggests that additional rigorous well-designed studies are warranted to further investigate the potential long-term effects and risks of tramadol on sexual functions, especially in the Ghanaian context. Aside from the sexual gratifications for non-medical purposes, tramadol use, participants verbalized some psychological factors as other motivations that drive them to use the drug including euphoria, alertness and attentiveness and sense of hope and belonging.
Particularly, participants associated extreme excitement and happiness with tramadol use and therefore continue to use the drug especially in bad occasions.
The drug to the participants makes them focused, alert and attentive on their daily activities. Under the influence of the drug, those who use it care less about what others say or think about them.
The use of the tramadol also makes them hopeful of a better future in worrying situations and make them feel belonged. This finding mirrors previous evidence on the antidepressant effect of the drug [ 2 , 6 , 25 , 58 , 59 ]. For instance, [ 52 ] a randomised control trial demonstrated that tramadol has an impact on stimulus processing related to sustained attention.
In addition, this study provides evidence to suggest that certain physical effects including perceived invigorating and analgesic effects of tramadol also served as motivations for non-medical purposes tramadol use among the study participants.
In consonance with other existing evidence, [ 2 , 7 , 24 ] participants believed the drug energizes them to carry out their daily activities with no or limited fatigue. They mentioned that under the influence of the drug, they can work tirelessly to give their maximum output which makes them make money for a living. Again, participants were motivated to use tramadol because of its perceived stress or fatigue relieve effect. To de-stress themselves and relieve their fatigue, participants used relied on tramadol and this finding reflects previous evidence on the analgesic effect of the drug [ 2 , 6 , 24 ].
Significantly, the study observed some factors which are largely economic in nature that also motivate the study participants to use tramadol. The main economic motivating factors for non-medical purposes tramadol use were affordability and availability of the drug. The study found that tramadol is readily available, accessible and affordable compared to other similar drugs. In Ghana, tramadol is not on the list of controlled substances regulated by the Food and Drugs Authority, because it is believed to have a low misuse potential compared with the prototypic opioids such as morphine.
This in a way has made the drug readily available in pharmacies, chemical shops and the black market and can be acquired without a prescription [ 7 ]. With this, participants did not incur much cost in acquiring the drug which motivates them to use it.
Most of the participants had experienced or continue to experience some unpleasant side effects of tramadol misuse such as vomiting, seizures, loss of appetite, agitation, irritability, stigma, headache, hallucinations, among others.
These findings are in line with previous findings [ 7 , 22 ] on the common adverse effects of tramadol. It also mirrors trend on the common effects of tramadol where majority of the respondents responded to know the side effects of aphrodisiac products particularly tramadol [47]. Whilst the mechanism s through which tramadol causes these adverse effects is largely difficult to explain in this study, the side effect of a headache could possibly be an indication that usage of these substances increases blood pressure which may result in cardiovascular disorders with prolonged use.
Second, participants of the study offered some praise to those who introduced them into tramadol use. This finding in a way appears surprising as one may think that the misuse of the drug has harmful side effects on the health and wellbeing of those who use it and therefore the users will rather blame their initiators for introducing them to tramadol use. Third, knowing the effects of tramadol misuse, participants showed no willingness of stopping using tramadol for non-medical purposes which suggests the dependence and addictive potentials of the drug [ 1 ].
Participants valued the perceived benefits they derive from the drug over stopping using the drug. Interestingly, few of the participants who expressed a desire to quit tramadol misuse were looking for alternative drugs that work as tramadol.
These findings contradict previous results of Fuseini et al. These two findings of the study are indications of how complex and complicated the tramadol misuse fight in Ghana is. Fourth, one good revelation from this study is that many of the participants expressed willingness and desire to support the ongoing efforts of health officials and security agencies to curb tramadol misuse. Most of the participants claimed knowing most of the unlicensed chemical shops and people selling what they see as fake tramadol.
With this, they were willing to collaborate with officials to help seize and eradicate fake tramadol and sellers. The authors see this as a useful ground where health officials and other stakeholders can utilise to form partnerships and alliances to influence those who use it to quit tramadol use.
This study has provided knowledge and evidence regarding motivations for non-medical tramadol use in Ghana from the perspective of those who use the drug. Thus, this study offers a depth of understanding to support the ongoing effort toward addressing tramadol misuse in Ghana.
However, two important caveats must be acknowledged here: Our findings cannot be regarded as representative to other groups of people who use tramadol and different settings as the study is purely qualitative with aim of identifying contextual themes that cannot be independent of the individuals and context involved. To this, a larger quantitative study would be required. This study has ramifications for both policy and practice.
The findings are relevant to the social policy directions particularly towards the effort to influence policy formulation and implementation by government and other stakeholders involved in policy making for curbing the menace of tramadol misuse in Ghana. Our findings indicate that those who use tramadol for non-medical purposes are motivated by diverse factors and aware, having knowledge and experiencing some adverse effects from their misuse.
With this, the way forward in curbing their misuse and subsequent effects is to introduce measures, interventions and policies that provide opportunity for active involvement, engagement and participation by those who misuse tramadol to help influence their decisions to quit using the drug.
The study findings also necessitate the need for a stricter regulatory intervention to restrict tramadol as a controlled substance where access of the drug can be obtained through authorisation, utilisation and distribution records vetting and official inspections by the Food and Drugs Authority.
Furthermore, the study findings also indicate that there is the need for intensified psychoeducational and awareness creation programmes for those who use tramadol due to the dependence and addictive potentials of tramadol revealed in the study. The willingness of those who use tramadol for non-medical purposes to collaborate with officials in dealing with fake tramadol sellers also offers a useful ground where health officials can form partnerships and alliances to influence those who use it to quit using through psychological support, professional counselling, guidance, rehabilitation as well as other psychoeducational programmes.
Moreover, the easy accessibility of tramadol and the reluctance to discontinue the use of the drug by the participants underscore the need for clinically-driven and tailored medication-assisted treatments and programmes that use cognitive behavioural approaches by the Ghana Health Service and other stakeholders.
The combination of behavioural therapies and medications would enhance motivation toward behavioural changes and provide a whole-patient approach to the prevention of tramadol misuse and treatment of its associated disorders. This study provides a qualitative evidence that, due to a range of sexual, psychological, physical and economic factors, commercial vehicle drivers and assistants in Kumasi are motivated to use tramadol and that stopping the drug use appeared to be no option for the participants.
It is, therefore, imperative for stakeholders to take into consideration the findings of the study in order to guide the design and implementation of policies toward curbing tramadol misuse. Whilst further evidence is required to document the extent of these motivations in other settings and groups and how they might be best addressed, it makes sense for health officials and security agencies to involve those misusing tramadol in the fight against non-medical purpose usage of the drug as such opportunity for involvement, participation and partnership exist per the findings of the study.
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CAS Google Scholar. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. PubMed Google Scholar. Salm-Reifferscheidt L. Tramadol: Africa's opioid crisis. Lancet London, England. World Health Organisation. Tramadol: Pre-review report agenda item 5. Facilitators to the continuous abuse of tramadol among the youth: a qualitative study in northern Ghana. Nursing Open. Tramadol abuse and sexual function.
Sex Med Rev. Prescription opioid abuse in the UK. Br J Clin Pharmacol. Nonmedical use of prescription drugs in the European Union. BMC Psychiatry. National survey on drug use and health. J Addict. Tramadol dependence: a survey of spontaneously reported cases in Sweden. It is not uncommon for addicts to feel ambushed or react defensively to an intervention. The help of a professional interventionist can prepare you and your loved ones for this and other possible reactions.
When staging an intervention for Tramadol addiction, timing and location are very important. Making the addict feel as comfortable as possible is key. Those who are physically dependent on Tramadol will experience withdrawal symptoms if they reduce their dose too quickly or stop taking the drug altogether.
Common Tramadol withdrawal symptoms include sweating, nausea, anxiety, depression, restlessness, hyperactivity, and diarrhea. These symptoms generally last for days. Typically, those who have taken higher doses of Tramadol and for longer periods of time have more severe withdrawal symptoms. An inpatient, medically-supervised detox is recommended to wean individuals off Tramadol in order to reduce withdrawal symptoms.
Weaning off the drug in this way can help to reduce withdrawal symptoms associated with Tramadol addiction.
The process of ridding the body of the drug, called detox, is often the first step in many Tramadol treatment programs. Medically-supervised detox, and inpatient and outpatient rehabs provide professional, quality care, giving those battling Tramadol addiction a chance at recovery.
For help finding a detox or treatment program for Tramadol addiction, contact a treatment provider today. After graduation, he decided to pursue his passion of writing and editing. All of the information on this page has been reviewed and verified by a certified addiction professional. Theresa is also a Certified Professional Life Coach and volunteers at a local mental health facility helping individuals who struggle with homelessness and addiction.
Theresa is a well-rounded clinician with experience working as a Primary Addiction Counselor, Case Manager and Director of Utilization Review in various treatment centers for addiction and mental health in Florida, Minnesota, and Colorado.
She also has experience with admissions, marketing, and outreach. As a proud recovering addict herself, Theresa understands first-hand the struggles of addiction. There is no limit to what Theresa is willing to do to make a difference in the field of Addiction!
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Chats will be received and answered by one of treatment providers listed below, each of which is a paid advertiser:. Tramadol is also combined with acetaminophen in the drug Ultracet. Tramadol acts on two compounds associated with the sensation of pain: serotonin and norepinephrine. Tramadol helps relieve pain by decreasing the amount of these two compounds in brain cells. Liver enzymes break down tramadol into another compound called O-desmethyltramadol, which binds to the opioid receptor.
It belongs to the same schedule as Xanax, Soma, and Valium. Doctors should choose the lowest effective dosage for the shortest period and educate people on the possible risks of taking tramadol.
Tramadol can cause side effects in some people. They occur more often when people first start taking tramadol and can wear off over time.
The most common side effects of tramadol affect the abdominal tract and the brain. Respiratory depression is a serious side effect that may occur in people taking tramadol. If a person has difficulty breathing while taking tramadol, they must seek emergency medical attention.
People can experience respiratory depression with usual dosages of tramadol. Respiratory depression usually occurs when the person starts taking tramadol or when they increase their dosage. People who overdose on tramadol are at an even greater risk of respiratory depression. Combining certain drugs with tramadol can also increase the risk of respiratory depression. Some people are more at risk than others.
This can result in higher levels of this compound in the bloodstream and lead to respiratory depression. Adolescents aged 12—18 years may have additional risk factors for respiratory depression:. Some adolescents may be taking other medicines that put them at greater risk of respiratory depression.
In these situations, tramadol can cause life threatening respiratory depression. Serotonin syndrome develops when there is too much serotonin accumulating in the body.
This can cause mild to fatal symptoms. In rare cases, people can experience serotonin syndrome when taking tramadol alone or with other drugs. The symptoms of serotonin syndrome may include:.
QT prolongation is a serious condition affecting the heart rhythm. On an electrocardiogram of the heart, the QT interval represents a portion of the electrical activity during the heartbeat. Some drugs, such as tramadol, can cause QT prolongation. When a person has a prolonged QT interval, they may experience serious heart problems.
They may have an irregular heartbeat, which can become life threatening. In most cases of QT prolongation related to tramadol, a person has taken tramadol with other drugs that prolong the interval.
Although the combination of QT-prolonging drugs can be dangerous, some people are born with long QT syndrome. These people should let their doctor know about their condition before taking tramadol.
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