The Trend of Tramadol Vending in Retail Pharmacies and Negative Impact of Abusing Drug on its Purchasers in Mosul City, Iraq
Keywords:tramadol, drug abuse, dependence, pharmacy, Mosul, Iraq
Since 1998 tramadol was introduced to the Iraqi markets as a nonscheduled centrally acting analgesic with low abuse potential. Many patients (or customers on their behalf) purchased the drug from retail pharmacies without medical prescription which may raise a strong need to investigate the suspicion of potential trmadol abuse among those customers who visited those pharmacies in Mosul which is one of the biggest cities in north Iraq.
Methodology: Under the supervision of the pharmacists in ten retail pharmacies (which were selected randomly from different areas in Mosul), a closed-ended questionnaire constructed by the researches and designed to detect the trends of purchasing tramadol from private pharmacies besides the International Neuropsychiatric Intervew version-5(module L), were filled out for every patient or (someone on their behalf) who purchased tramadol from those pharmacies during six months period (June 2012-December 2012). Sociodemographic characters of the purchasers were obtained in this study and subjected to descriptive statistics to make comparison with other studies.
Results: Of 163 patients or (someone purchased the drug on their behalf) who seek tramadol from the pharmacies, 84 (51.53%) purchasers did not have prescription. About 98(60.12%) patients reported abuse or addiction criterias on tramadol after interviewing them through M.I.N.I. international neuropsychiatric interview version- 5. Â Most of the purchasers were males and females below thirty (73.3%, 74.1% consecutively). Participants who were unemployed (83.9%), singles (92.6%) were aging below thirty. Approximately (60%) of the patients reported a history of addiction or drug abuse.Â Most of the patients with no prescription(46%) had abuse criteria on tramadol.
Conclusion: Patients who request tramadol from private pharmacies in Mosul seem to have a high potential for drug abuse, dependence, in particular those who do not have prescriptions. The high prevalence of people under 30 years of age seeking tramadol could be a worldwide trend. Construction of detoxification units is highly recommended in Mosul.
Angela N. Duke, George E. Bigelow, Ryan K. Lanier, and Eric C. Strain. Discriminative Stimulus Effects of Tramadol in Humans. J Pharmacol Exp Ther. 2011 July; 338(1): 255â€“262.
Minami K, Uezono Y, Ueta Y. Pharmacological aspects of the effects of tramadol on G-protein coupled receptors. J Pharmacol Sci. 2007;103(3):253â€“60.
Preston KL, Jasinski DR, Testa M. Abuse potential and pharmacological comparison of tramadol and morphine. Drug Alcohol Depend 1991;27:7-17
Adams EH, Breiner S, Cicero TJ, Geller A, Inciardi JA, Schnoll SH, et al. A comparison of the abuse liability of tramadol, NSAIDs, and hydrocodone in patients with chronic pain. J Pain Symptom Manage 2006;31:465-76.
Inciardi JA, Cicero TJ, Munoz A, Adams EH, Geller A, Senay EC, et al. The diversion of Ultram, Ultracet, and generic tramadol HCL. J Addict Dis 2006;25:53-8.
Sarkar S, Nebhinani N, Singh SM, Mattoo SK, Basu D. Tramadol dependence: A case series from India. Indian J Psychol Med 2012;34:283-5
. Preston KL, Jasinski DR, Testa M. Abuse potential and pharmacological comparison of tramadol and morphine. Drug Alcohol Depend. 1991;27(1):7â€“17.
Friderichs E, Felgenhauer F, Jongschaap P, Osterloh G. Pharmacological studies on analgesia, dependence on and tolerance of tramadol, a potent analgetic drug. Arzneimittelforschung.1978;28(1a):122â€“34. German.
. US Food and Drug Administration. 1998. Minutes of the FDA Drug Abuse Advisory Committee. FDA Administration. Access date: Aug 2012. www.fda.gov/ohrms/dockets/ac/98/transcpt/3411t2.rtf
Ehrenreich H, Poser W. Dependence on tramadol. Clin Investig 1993;72:76.
Freye E, Levy J. Acute abstinence syndrome following abrupt cessation of long-term use of tramadol (Ultram): A case study. Eur J Pain 2000;4:307-11.
Yates WR, Nguyen MH, Warnock JK. Tramadol dependence with no history of substance abuse. Am J Psychiatry 2001;158:964.
Senay EC, Adams EH, Geller A, Inciardi JA, Munoz A, Schnoll SH, et al. Physical dependence on Ultram (tramadol hydrochloride): Both opioid-like and atypical withdrawal symptoms occur. Drug Alcohol Depend 2003;69:233-41.
Barsotti CE, Mycyk MB, Reyes J. Withdrawal syndrome from tramadol hydrochloride. Am J Emerg Med 2003;21:87-8.
Stoehr JD, Essary AC, Ou C, Ashby R, Sucher M. The risk of tramadol abuse and dependence: Findings in two patients. JAAPA 2009;22:31-2, 34-5
Pollice R, Casacchia M, Bianchini V, Mazza M, Conti CM, Roncone R. Severe tramadol addiction in a 61 year-old woman without a history of substance abuse. Int J Immunopathol Pharmacol 2008;21:475-6
TjÃ¤derborn M, JÃ¶nsson AK, Ahlner J, HÃ¤gg S. Tramadol dependence: A survey of spontaneously reported cases in Sweden. Pharmacoepidemiol Drug Saf 2009;18:1192-8
Cicero TJ, Adams EH, Geller A, Inciardi JA, Munoz A, Schnoll SH, et al. A postmarketing surveillance program to monitor Ultram (tramadol hydrochloride) abuse in the United States. Drug Alcohol Depend 1999;57:7-22.
Jovanovic-Cupic V, Martinovic Z, NeÅ¡ic N. Seizures Associated with Intoxication and Abuse of Tramadol. Clin Toxicol 2006;44:143-6.
Skipper GE, Fletcher C, Rocha-Judd R, Brase D. Tramadol abuse and dependence among physicians. JAMA 2004;292:1818-9.
Ojha R, Bhatia SC. Tramadol Dependence in a Patient With No Previous Substance History. Prim Care Companion J Clin Psychiatry 2010;12: / PCC.09100779
Rashmi Ojha, MD and Subhash C. Bhatia, Tramadol Dependence in a Patient With No Previous Substance History. Prim Care Companion J ClinPsychiatry. 2010; 12(1): PCC.09100779.
Adams EH, Breiner B, Cicero TJ, et al. A comparison of the abuse liability of tramadol, NSAIDs, and hydrocodone in patients with chronic pain. J Pain Symptom Manage. 2006;31(5):465â€“76.
Savage S, Covington EC, Heit HA, Hunt J, Jorason DE, S chnoll SH. Definitions related to the use of opioids for the treatment of pain AP Society, A consensus statement from the American Academy of Pain Medicine, the American Pain Society and American Society of Addiction Medicine. Glenview IL, 2001.
Duke AN, Bigelow GE, Lanier RK, Strain EC. Discriminative stimulus effects of tramadol in humans. J Pharmacol Exp Ther 2011;338:255-62
Sheehan DV, Lecrubier Y, Sheehan KH, Janavs J, Baker R, Knapp E, Sheehan M. Weiller E, Hergueta T, Amorim P, Bonora LI, Lepine JP. The Mini international neuropsychiatric interview (M.I.N.I) : The development and validation of structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59 suppl 20:22-33 PMID 9881538.
Ghanim M. The Arabic version of the Mini International Neuropsychiatric Interview (M.I.N.I): Reliability, Validity, Egypt J of psychiatr. 2002; 21
Ebrahim Zabihi, Aateffeh Hoseinzaadeh, Maryam Emami, Mahdieh Mardani, Baradaran Mahmoud, andMoghadamnia Ali Akbar. Potential for Tramadol Abuse by Patients Visiting Pharmacies in Northern Iran. Subst Abuse. 2011; 5: 11â€“15.
Shania S, Soltaninejad K, Heydari K, Sasanian G, Abdollahi M. Tramadol intoxication: A review of 114 cases. Hum Exp Toxicol. 2008;27(3):201-5
Iravani FS, Akhgari M, Jokar F. Bahmanabadi L. Current trends in tramadol related fatalities, Tehran, Iran 2005-2008. Subst Use Misuse. 2010;45(13):2162-71.
Grella CE, Scott CK, Foss MA. Gender differences in long-term drug treatment outcomes in Chicago PETS. J Subst Abuse Treat. 2005;28:S3â€“S12.
Walitzer KS, Dearing RL. Gender differences in alcohol and substance use relapse. Clin Psychol Rev. 2006;26:128â€“148
Independent Drug Monitoring Unit. Heroin and Employment. Available from the URL: http://www.idmu.co.uk/hemployment.htm. accessed on Friday, 08 February 2013.
Hyun Ji Yim, Hyun Ah Park, Jae Heon Kang, Kyung-Woo Kim, Young Gyu Cho, Yang Im Hur, and O Jin Ee Choi. Marital Status and Health Behavior in Middle-aged Korean Adults. Korean J Fam Med. 2012 November; 33(6): 390â€“397
How to Cite
- Papers must be submitted on the understanding that they have not been published elsewhere (except in the form of an abstract or as part of a published lecture, review, or thesis) and are not currently under consideration by another journal published by any other publisher.
- It is also the authors responsibility to ensure that the articles emanating from a particular source are submitted with the necessary approval.
- The authors warrant that the paper is original and that he/she is the author of the paper, except for material that is clearly identified as to its original source, with permission notices from the copyright owners where required.
- The authors ensure that all the references carefully and they are accurate in the text as well as in the list of references (and vice versa).
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Attribution-NonCommercial 4.0 International that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
- The journal/publisher is not responsible for subsequent uses of the work. It is the author's responsibility to bring an infringement action if so desired by the author.