الفهرس 
AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Abuse of tramadol is a serious problem in a number of African countries, including Egypt, Libya and Mauritius. In 2011 and 2012, Egypt witnessed an upsurge in trafficking in Tramadol. While in 2011, total seizures inducing Tramadol preparations amounted to 120 million tablets, about 320 million tramadol tablets were seized in the sea ports of Alexandria, Damietta and Port Said in the first quarter of 2012. The preparations are smuggled to Egypt mainly from China and India.
Prescribing data from the NHS Business Services Authority (NHSBSA) indicate an increase in Tramadol prescription, with the number of Daily Defined Doses increasing from approximately 5.9 million in September 2005 to 11.1 million in September 2012.
The 2009 Drug-related deaths in the UK report published by the np-SAD mentions that the proportion of deaths involving tramadol rose from 2.2% in 2004 to 3.6% in 2006 and has since remained stable.
An increasingly alarming phenomenon of Tramadol abuse has been heavily demonstrated in the recent years. Although the issue of drug abuse is not a newly introduced issue to Egyptian society but the wide range of usage and illegal transactions associated with tramadol abuse making it the most easily accessible and readily provided drug at cheap cost.
The aim of the present work was:
1- To estimate the prevalence of tramadol abuse in an Egyptian sample of those attending Al Maamourah Addiction treatment clinics.
2- To study its epidemiological correlates such as sociodemographic variables, clinical symptoms, physical complications and co-morbidities (psychological) in comparison to other substance abusers.
The study was conducted on 516 subjects attending al-mamoura outpatient addiction treatment clinics from the first of November 2013 to the first of March 2014, fulfilling the criteria of substance abuse according to DSM-IV, and aging between 18 & 65 years old, both male and female genders were included. In this study, tramadol abusers will be divided into three groups:
1) Pure tramadol abusers: those who only abused tramadol and never anything else.
2) Predominantly tramadol abusers: those who predominantly abuse tramadol, and if abusing anything else, is of occasional, temporary use and never heavy abusers.
3) Poly substance abusers: those who are using tramadol among many other substances, all of which have been abused significantly.
Results of this study revealed that:
Tramadol abuse prevalence was found to be 82.6% of studied cases; it was as follow, pure tramadol abusers (10.46%) of studied cases, predominantly tramadol abusers (13.95%) of studied cases, Poly substance abusers including tramadol (58.13%) of studied cases.
The range of age in group I (pure and predominantly tramadol abusers) was 18 – 42 years which was less than that in group II (non-tramadol abusers) with a statistical significant difference between the two groups. No female gender present in both group I & group II.
according to educational level, illiteracy was found to be the most common educational level (42.85%) in group I, also read and write level represents 28.57% of group I, while in group II technical education was the most common one (46.67%) and read and write level represents 20% of group II, which is statistically significant difference. As regard socioeconomic level, low level was most common in group I (53.97%), while medium level was most common in group II (43.33%), high levels also differ statistically in group I (8.73%) than in group II (25.26%), very low levels also show statistically significant difference (2=30.205 p<0.001) between group I (14.29%) and group II (7.78%). As regard marital status married cases were found to be more in
group II (53.34%) comparing to (23.8%) of group I, while single cases represent 76.19% of group I & 40% of group II this difference is statistically significant. according to residency urban cases were more in group II (73.34%) than in group I (56.14%), while rural ones were more common in group I (42.85%) than group II (26.66%) with p at 0.015.
As regard intoxication, legal problems and financial problems no statistical significant difference found between two groups.
Physical complication differ statistically between the two groups, CNS complications mainly seizures were found to be more in group I (42.85%) than group II (13.3%), while Infectious diseases (HCV, HBV, TB & HIV) are more common in group II (40.0%) than in group I (7.93%), Injuries are more in group I (38.09%) than group II (21.1%), CVS complication also statistically differ (2=17.173 p <0.001) between group I (6.34%) and group II (26.67%).
As regard causes of substance intake, friends (peer pressure) still the most common cause of substance abuse in both groups, while 39.68% of group I experienced sexual cause of abuse comparing to 15.56% of group II which is a statistical significant difference, also fatigue was more common cause of intake in group I (18.25%) than in group II (5.56%) with p=
0.006, While loneliness was more common cause of intake in group II (16.67%) than in group I (7.14%) with p= 0.028.
According to withdrawal symptoms no statistical significant differences found between both groups, insomnia was the most frequent one followed by pain in both groups.
As regard co morbid Axis-I disorders along SCID-I scale no statistical significant differences found between both groups, Mood disorders were present in 39.68% of group I cases as current diagnosis and in 22.2% of cases as past diagnosis, comparing to 38.9% of group II cases as current diagnosis and in 23.3% of cases as past diagnosis, Psychotic disorders were found in 9.52% of group I cases as current diagnosis and 14.28% as past diagnosis comparing to 11.1% of group II cases as current diagnosis and 13.3% as past diagnosis, Anxiety disorders were found in 23.8% of group I cases as current diagnosis and 34.12% as past diagnosis, comparing to 23.3% of group II cases as current diagnosis and 36.7% as past diagnosis.
As regard co morbid Axis-II disorders along SCID-II scale no statistical significant differences found between both groups, the most prevalent personality disorder among group I (31.74%) and group II (33.3%) was found to be antisocial personality disorder, also borderline personality disorder was found in 17.46% of group I and 20% of group II.
from the previous data we concluded that tramadol dependence is so common and so we have to increase awareness of all stuff of mental health care providers and also an efficient screening and assessment process is critical to recognize and understand the extent of substance use disorder in order to create an effective treatment plan