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Abstract

Background: Substance abuse is a rising public health concern in Egypt. Some reports estimate that over 10% of Egyptian adults use at least one substance of abuse which is double the percentage in the developed countries. Tramadol is one of the most common abused substances in Egypt. The highly addictive weak opioid is becoming increasingly popular among Egyptians as it is readily available, relatively cheap, causes euphoric sensation, and allegedly improves sexual performance. The working class seems to be particularly severed by the uprising tramadol epidemic which could end up in an economic and public health crisis. Objectives: We have conducted a systematic review and narrative analysis to answer an important question: what is the prevalence of tramadol abuse in Egypt? Methods: We have conducted a systematic search using four data sources: PubMed (including MEDLINE), Cumulative Index of Nursing and Allied Health Literature CINAHL, Scopus and Web of Science. Boolean expressions between keywords, created a complex search string that was used to capture the studies discussing the research question of interest. Results: Our analysis revealed that tramadol is probably the most abused substance in Egypt among the working class and a popular substance of abuse among adolescents and university students. Over 90% of construction workers use tramadol as their preferred substance of abuse, while 52%, 40%, and 25% of bus drivers, hospital cleaners, and textile workers respectively reported tramadol abuse. Among university students, pure tramadol use was reported by 1.8%, and tramadol use with other substances was reported by 10.8%. Tramadol is also becoming increasingly popular among adolescents and school students. Over 8% of adolescents reported using at least one substance of abuse. Of those, 83% are using tramadol alone while 17% are using tramadol with other substances. Another study reported that almost 2% of school students are abusing tramadol. In general, tramadol abuse is prevalent among 92% of mono and polysubstance abusers in Egypt. Conclusion: Egypt is witnessing a tramadol epidemic that is mainly threatening the working class. Unless appropriate responses from the authorities and the society are taken, the socioeconomic consequences will be grave.

Biography

Abdullah S. Eldaly, MD works in Division of plastic surgery, Mayo Clinic, Jacksonville, Florida.