REASONS FOR INCREASING ABUSE OF TRAMADOL AMONG THE YOUTH OF

JAPEKROM

CHAPTER ONE

1.0 INTRODUCTION

1.1 Background Information

The World Health Organization (WHO) defines Substance abuse as the harmful or hazardous use
of psychoactive substances, including alcohol and illicit drugs (WHO, 2014).

In recent times, Tramadol abuse has been on the increase in many parts of the world.

The World Health Organization’s Expert Committee on Drug Dependence (ECDD,2017) referred
to Tramadol as “a centrally acting analgesic with a multimode of action which acts on serotonergic
and noradrenergic nociception, while its metabolite O-desmethylTramadol acts as a mu agonist
on the opioid receptor. Its analgesic potency is claimed to be about one tenth that of morphine”.
Tramadol is used to treat both acute and chronic pain of moderate to severe intensity.
Tramadol monotherapy does not usually provide adequate analgesia and is considered
to be a relatively safe.

The ECDD has reviewed Tramadol five times: in 1992, 2000, 2002, 2006 and 2014. In November 2017,
the Committee recommended that Tramadol be subject to a critical review at a subsequent meeting citing
that there is growing evidence of abuse of Tramadol in some African and West Asian countries.
Following the critical review, the Committee will determine whether to recommend to the Commission
on Narcotic
Drugs that Tramadol be placed under international control.

According to a report by the United Nations Office on Drugs and Crime (8th July. 2014),
Tramadol is often prescribed after surgery and is not under international control. The report
states that the use of Tramadol has greatly increased, especially in the Sahel region. Although the
prescribed dosage usually does not exceed 50 mg, recent seizures in the West African sub-region
are generally in excessive dosages of 100, 120, 125, 200, 225, or 250 mg. From the report, over
157 shipments of unauthorized Tramadol from India’s ports and airports to West Africa took
place in 2012. The shipments increased to 882 in 2013 while between January and mid-April

1
2014, 232 shipments were reported. The main points of destination or transit of Tramadol in
West Africa appear to be Benin, followed by Nigeria, Ghana, Togo, Niger, Sierra Leone,
Cameroon and Côte d’Ivoire. The report mentioned that Approximately 900 shipments of
Tramadol were seized in these countries between January 2012 and mid-April 2014. Misuse of
Tramadol is becoming a public health problem in most West African countries including Ghana.

In Ghana, recent media reports show that the phenomenon of Tramadol abuse is gradually
becoming a national crisis and for that matter urgent attention is required to address it. For instance
in a press statement released by the Pharmaceutical Society of Ghana warning against Tramadol
abuse, the president of the society, Mr. Njamin J.Botwe indicated that there is proliferation and
abuse of Tramadol in the country.

The statement further mentioned that the most recent one was the high doses of Tramadol
(200mg/250mg) popularly called TRAMOL which was contrary to the strength of 50mg and
100mg oral capsules and 50mg/ml-2ml in injections approved for use in Ghana by the Foods and
Drugs Authority (FDA) for the management of pain (.myjoyonline 2017)

The Western Regional Office of the FDA confiscated over 6000 capsules of Tramadol from
licensed chemical stores across the length and breadth of the Region in April, 2018 as part of an
exercise to stop chemical sellers from fuelling the abuse of the drug (GNA, 2018). The influx of
the drug is said to be due to the porous borders of the country.

According to the Pre-Review Report of the Expert Committee on Drug Dependence (ECDD) of
the World Health Organization (W.H.O) 2012 ,symptoms of Tramadol intoxication are similar to
those of other opioid analgesics but may include serotonergic and noradrenergic components.
Symptoms include central nervous system (CNS) depression and coma, tachycardia,
cardiovascular collapse, seizures, and respiratory depression up to respiratory arrest. Fatal
intoxications are rare and appear to be associated with large overdoses of Tramadol and co-
ingestion of other drugs (including alcohol).

People have varying reasons why they abuse any drug but the following are some of the reasons
ascribed by the youth for abusing Tramadol: getting high (euphoria), sexual enhancement,
reduction of pain, release of stress, morale booster, physical strength, and for recreational purposes

2
(enjoyment). The youth are influenced to abuse Tramadol by factors such as peer pressure,
unemployment, loneliness, availability and affordability of the drug etc.

The youth of today , are noted for the abuse of Tramadol in recent times.

1.2 Problem Statement

The effects of Tramadol abuse extends beyond the individual to his/her family, friends, community
and the entire nation. Ahmed (2012) opines that the negative effects of substance abuse among the
youth include: medical problems, academic problems, conflicts, crime, financial problems,
psychological disorders and increase in occultism. The increasing numbers of youth engaging in
the abuse of Tramadol require an in-depth research to unravel the real motive behind the abuse in
areas such as Japekrom and to look for a lasting solution to the problem. the study is intended to
determine reasons of the increasing abuse of tramadol among the youth, especially in Japekrom,
a community in Jaman south municipality.

1.3 Main objectives

To detemine the reasons of increasing abuse of tramadol among the youth.

1.4 Specific Objectives

Specifically, the study seeks to:

 Understand the causes of the increase in the abuse of Tramadol among the youth of
Japekrom
 determine how easily the youth get access to tramadol.
 Identify the effect of tramadol abuse among the youth of Japekrom.
 Identify measures of reducing tramadol abuse among the youth of Japekrom.

1.7 Operational Definition of Terms

Substance - refers to any item utilized by an individual such as illicit drugs, hallucinogens,
inhalants, or other mind-altering material to change their mood.

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Abuse - means to use (substances such as Tramadol) for purposes other than that for which it
was manufactured or prescribed and this relate to both legal and illegal substances.

Youth - means persons between the ages of 15 and 30 years

CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction

In this chapter we review literature related to the study. Literature was reviewed based on the
concept of substance abuse with special emphasis on Tramadol.
2.2 Concept of Substance Abuse

According to the World Health Organization (WHO, 2014) substance abuse refers
to the harmful or hazardous use of psychoactive substances, including alcohol and
illicit drugs. The use of psychoactive substances can lead to dependence syndrome - a
cluster of behavioural, cognitive, and physiological phenomena that develop after
repeated substance use. And that typically include a strong desire to take the drug with
difficulties in controlling its use, persisting in its use despite harmful consequences, a
higher priority given to drug use than to other activities and obligations, increased
tolerance, and sometimes a physical withdrawal state (WHO, 2014).

Similarly, the 2014 World Drug Report indicates that the misuse of Tramadol was on the
increase in parts of Africa, the Middle East and Asia.

The International Narcotics Control Board (2012) reported that Tramadol abuse is in increasing
concern which has become a serious problem in a number of countries in Africa.

In Ghana, drug or substance abuse comes in various shades. A national survey conducted by the
Ministry of Health on the prevalence and social consequences of substance (drug) use among
Second Cycle and Out of School Youth in Ghana (2003) defined drug abuse as involving taking
too much of a drug at one time or small doses at shorter intervals, taking a drug at regular
intervals but far beyond the duration given or taking it for a wrong reason. The survey also

4
mentioned that a drug can be abused if it is taken in combinations with other drugs knowingly or
unknowingly.

Tramadol according to the Foods and Drugs Authority (Ghana, 2018) is a man-made (synthetic)
narcotic analgesic (pain reliever) which is prescribed to patients suffering from moderate to
severe pain which can quickly become harmful when it is not taken as prescribed.

2.3 Tramadol abuse among the Youth

The Ministry of Health of Ghana has indicated that it had received many reports of Tramadol
abuse by mostly the youth since early 2017. Following this, swoops were conducted by the
Foods and Drugs Authority (FDA) in some parts of the country leading to the discovery of
alarming quantities of unregistered and expired Tramadol. According to the ministry, the FDA
was collaborating with the Pharmacy Council to restrict Tramadol display on the shelves of
community pharmacies and ensure strict enforcement on distribution as a controlled drug.

The FDA further reported that an overdose of Tramadol could lead to increased blood pressure,
convulsion, memory loss, seizures, coma, or death (FDA, 2018).

The drug is given various names by those who abuse it such as ‘gbang gbang’, ‘tramol’, ‘now
now’, ‘red’ etc. While some take the drug alone, others combine it with alcohol or energy drink.

2.4 Causes or Factors that Lead to Tramadol Abuse among the Youth.

The reasons for the abuse of Tramadol by the youth differ from person to person.

People take it for extra energy for manual work, euphoria (Tramadol can produce euphoria
comparable to heroin even at a single dose of 75mg), staying alert for long hours, especially for
commercial vehicle drivers and their mate(s) & students, making them dazed and easily drift to
deep restful sleep (FDA,2018)
Curiosity is another factor that causes or influence some of the youth to indulge in Tramadol abuse.
Another reason why people abuse Tramadol is to enable them cope with stress and forget about
their daily problem (FDA,2018)

Ignorance or very little knowledge about the impact of substance abuse is one of the contributing
factors to this problem. The evidence to suggest that abusers have less knowledge about the

5
negative consequences of substance use compared to non- users ( Marlatt&Gordon,1980; Senn,
1983)

People are drawn into drug abuse because its attractive, especially advertisments alcoholic
beverages on radio and television, even though the realize it's harmful to health. Drug abuse is a
“silent killer" , but drug manufacturers chose to keep the public ignorant of this fact(Hellman,
2002).

2.5 Access and Affordability of Tramadol

Tramadol has been found to be affordable and this lead to its use among the youth. Five Ghana
Cedis (GH₵5.00) according to the youth spoken to can buy a significant quantity of the drug
which can last them for some days, (Anon., 2018)

2.6 Effects of Tramadol Abuse

Tramadol is a depressant, which slows down the function of the central nervous system.
According to the FDA, Tramadol slows the rate of lung and heart functions and may result in the
following when it is abused:
 Confusion
 Drowsiness
 Vomiting
 Bluish discolouring to lips and fingernails
 Shallow breathing
 Coma
 Seizures,(myjoyonline, 2018)
Insomnia has also been reported to be one of the effects of Tramadol abuse which can have
devastating consequences. Lack of sleep disrupts the natural hormonal balance, and increases the
risk for depression, cardiac events, diabetes, and cancer. Some people who abuse Tramadol may
eventually experience a life-threatening allergic reaction to the drug known as anaphylaxis which
may result in hives, swelling, rash, difficulty in breathing, and shock. Studies by Stantan et all
(1979)

Tramadol is quite often given to patients who might be in pain after major surgery or to people
who have long-term conditions such as arthritis. (myjoyonline, 2018)

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Along with all other opioids, dependence and addiction are among the more serious effects of
Tramadol abuse. Those who use high doses of Tramadol can become tolerant to the medication,
and require higher doses to achieve the drug’s effects. This can cause the body to become
physically dependent on Tramadol, which in turn, increases the risk for addiction. A person who
becomes dependent on Tramadol will experience a set of withdrawal symptoms when reducing
their doses, or when attempting to quit the drug(Duguid, 1987).

Those who stop using Tramadol abruptly or who lower their usual dosage amount will experience
a set of general opioid withdrawal symptoms within 12 hours of the last dose. These symptoms
according to the United States Drug Enforcement Administration (DEA) include: a runny nose,
tearing eyes, sweating, muscle and body aches, abdominal pain and cramping, diarrhea, nausea
and vomiting, hypertension, rapid heart rate, agitation, irritability, problems with memory and
concentration, anxiety, depression and drug cravings, tingling and numbness in limbs, confusion,
panic attacks, extreme paranoia and hallucinations (Duguid, 1987).

2.7 Measures of Controlling Tramadol Abuse among the Youth.

continuously educating and enlightening the youth on the dangers associated with Tramadol abuse
can lead to a reduction in the menace of Tramadol abuse ,(Ahmed, 2012).

Other measures that were reviewed include; provision of employment parental monitoring and
law enforcement.

2.7.1 Enlightenment and Education has a significant influence on substance abuse (Ahmed,
2012). Effective educational campaign by the relevant state agencies would obviously lead to a
reduction in the abuse of Tramadol since education has the capacity to influence the lifestyle and
behaviour of the youth who are at risk of Tramadol abuse. The Ministry of Health and FDA have
giving the indication that they would intensify nationwide public education at schools, market
places, beaches,
transport terminals etc. on the dangers and misuse of Tramadol. They also plan to organize
training workshops in the entire country for law enforcement agencies and other stakeholders in
drug control on the abuse and misuse of Tramadol.

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Effective media campaign is also another way by which education can be carried out. Mass
media involves the use of newspapers, radio, television, magazine and the internet(Nana Aba
Anamoah,2018)

There is currently an ongoing media sensitization campaign on Tramadol abuse in Ghana ,

according to Nana Aba Anamoah (2018). As part of the campaign, a team from the Television
Station go round the country to meet and interact with the youth who abuse the drug to find out
what motivates them into the habit and how they could be supported to get out of it. The impact
of this effort by the TV Station has received a lot of support from well-meaning Ghanaians and
the campaign under the hashtag “#END TRAMADOL WITH GH. ONE# has been trending on all
the social media platforms in Ghana and beyond. The influence of the media in the fight against
substance abuse can therefore not be underestimated .

2.7.2 Job provision, It is widely believed that a higher number of unemployed youth have a
history of substance abuse disorder, more than those in full-time employment. The high
unemployment rate in Ghana therefore is a contributory factor to the rise in the Tramadol abuse
in the country.
A study in Ghana, conducted using unstructured interview where twenty six (26) participants
were interviewed in Tudu, Accra,found that unemployment is one of the predisposing factors to
substance abuse among the youth (Affinnih, 2012).

2.7.3 Responsible parents are required to keep an eye on the activities of their children to be
abreast with what the children engage in, who they associate with, and where they go to ensure
that the children's behaviours are not harmful to their development and safety. Poor parenting is
said to have contributed to high levels of Tramadol abuse among young adults. A strong parent-
child relationship is also an important protective factor when it comes to prevention of Tramadol
abuse among the youth. A mutual attachment between mothers and their adolescent children is
likely to reduce the risk of Tramadol use by adolescents. Parents who abuse Tramadol or other
drugs themselves are more likely to have their children take after them

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2. 7.4 Law Enforcement , on December 11, 2017, the United Nation’s Office on Drugs and
Crime (UNODC) issued a warning to the international community on the implications of the
abuse /non-medical use of Tramadol and its broader linkages with the global fight against
terrorism and transnational organized crime.
The UNODC Regional Representative for West and Central Africa, Pierre Lapaque is reported as
saying “the rise of Tramadol consumption and trafficking in the region is serious, worrying, and
needs to be addressed as soon as possible. We cannot let the situation get any further out of
control,”

To find ways to address "The Crisis of Tramadol and other Prescription Medicines in West
Africa", UNODC organized a workshop in August, 2018 in Abuja, Nigeria.

The event brought together senior representatives of law enforcement and health-care services,
justice and law enforcement, as well as chiefs of the Inter-ministerial drug committees from Togo,
Nigeria, Niger, Ghana, Benin and Côte d'Ivoire. At the workshop, officials discussed topics such
as public health, law enforcement, prevention and supply chain management.

Tramadol is not yet under international control and is seen by recreational users as a way of
boosting energy and improving mood. However, Tramadol can produce physical dependence, with
studies from the World Health Organization (WHO) showing that this dependence may already
occur when used daily even after a few weeks.

According to the World Drug Report 2017, in countries of West Africa, North Africa and the Near
and Middle East, Tramadol is the main substance used by people reporting non-medical use of
pharmaceutical opioids.

The literature review has revealed that a lot of work has been done on substance abuse. However,
since the issue of Tramadol abuse is relatively new work on it should be intensified at all fronts.
To this end, this study is very important since it would be able to unravel the reasons for the
increase in Tramadol abuse in Japekrom in particular and to a larger extent, Ghana as a whole.

There has never been the shortage of laws to regulate substance abuse in Ghana just as other
African countries. The challenge however, is that of enforcement of laws, rules and regulation for
the control of drug supply. Institutions such as the Food and Drugs Authority (FDA), the Narcotics
Control Board (NACOB), the Ghana Police Service, the Pharmacy Council are but a few of the

9
institutions with the mandate to check the enforcement of the various laws on the use of drugs in
the country but laxity, under resource bribery and corruption have affected the potency of these
institutions to effectively fight the abuse of Tramadol.

There is the need to empower the law enforcement agencies and retool them to be able to
function effectively. Also, the conditions of staff of those institutions should be improved to keep
them focused and committed to their responsibilities and to reduce the incidence of bribery and
corruption among law enforcement agents. The FDA is currently collaborating with the police
and other law enforcement agencies to organize swoops to restrict influx and arrest drug peddlers
of unregistered products. It plans to Increase stakeholder Collaboration with the Media, National
Road Safety Commission, NCCE, DVLA, GES, PSGH, Ghana National Licensed Chemical
Sellers Association, NACOB, GMA etc.
Again, the FDA would strengthen surveillance at the points of entry to prevent influx of
unregistered drugs and strengthen follow-up inspections to monitor the distribution records of
importers and manufacturers of Tramadol.

As a rapid response measure to reported cases of Tramadol abuse in Ghana in 2016, the FDA
strategically conducted a series of raids in three target regions (Northern, Volta and Western) to
substantiate reported cases of Tramadol abuse in Ghana.
Alarming quantities of unregistered Tramadol strengths (e.g. 120mg, 225mg and 250mg) were
uncovered.
The findings necessitated the need for a regulatory intervention to restrict Tramadol as a
controlled substance.

Obviously, non-medical use and trafficking of Tramadol is becoming the main drug threat in West
Africa today. One sign of this is the rise in seizures of pharmaceutical opioids on the continent,
driven by the worldwide popularity of Tramadol that is widely trafficked in the region.

CHAPTER THREE

MATERIAL AND METHODS

3.1 Introduction

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In this chapter, we describe the materials and methods used for this study. This includes the
Study Area, Study Design, Data Collection Tools, Data Analysis, Ethical Consideration and
Limitations of the study.

3.2STUDY AREA.

The research was conducted in the town Japekrom in the Jaman south municipality in the Brong Ahafo
region of Ghana . Japekrom
The Researchers adopted the cross sectional descriptive study using quantitative method. The
design was considered to be appropriate for the study due to the fact that not much in terms of
extensive research has been done in Tramadol abuse and also in the geographical area for this
research.

The research was conducted in the town of Japekrom in the Jaman South Municipality in the Brong
Ahafo Region of Ghana.

The Japekrom Municipality is one of the Ten (10) villages in the Brong Ahafo Region. The
municipality had an estimated population of 34,107 according to the 2010 Population and Housing
Census (PHC) and accounts for about ten percent of the district total population. Males constitute
46.4 percent and females represent 53.6 percent of the population of the municipality. The
population of the municipality is youthful with about two-fifth (40.5%) of the population below
15 years. The municipality has a total land area of about 755.37290 square kilometers (km2) and
It is located between latitudes 7o 27` N and 7o58’N and longitudes 2o 32’ W and 2o 66’W. It shares
borders with the Jaman North District in the north, Berekum Municipal in the south-east, Dormaa
Municipal in the south-west and La Cote d’Ivoire in the west. (GSS, 2010 PHS Report).

Japekrom is a peri-urban community in the municipality with a population of about Nine Thousand
(9,000) with majority of its adult population engaged in agricultural activities.

3.3The study population

study targeted the youth of Japekrom who were into the unregulated/non-medical use of
Tramadol.
Participants were youth residing in Japekrom between the ages of 15-30 years . Who were into
Tramadol abuse were recruited for this study.
The researchers adopted the purposive and snowball sampling techniques to select the

11
respondents for the study. Participants were selected on the basis of the researchers’ personal
judgement as to which of them will more likely enable the researchers generate the required data
for the study. Identified participants helped the researchers to reach their counterparts who were
ordinarily difficult to reach. In other words, the first respondent helped the researchers to recruit
the rest.

3.4 Study Design

The study used a simple structured questionnaire to solicit responses from study participants.

The questionnaire was developed based on the study objectives and the literature reviewed. This
enabled the researchers to achieve the research objectives.
3. 5 Sampling technique and size

In all ten(10) youth between the ages of 15-30 years were sampled for this study.Descriptive cross-
sectional study was used to carry out the study in Japekrom municipality. The advantage of using
descriptive cross-sectional design are ,it's relatively inexpensive and less time constraints that resulted
from the need to balance academic work and relatively smaller sample size was used for the study
(Manion and Cohen 1990).

3.6 Data collection method and instruments.

The Researchers developed closed format questions which was administered personally by
researchers to respondents. Respondents were required to select from a set of given options
which was appropriate to their situation.

3.7Data Analysis Techniques

The Researchers used Content analysis to analyze the data which was gathered from respondents
through the administered questionnaires. The advantage of using content analysis in this study was
that it helped the Researchers to reduce the data collected into simplified form, which helped to
produce results using quantitative techniques that satisfies the accomplishment of the research
objectives.

Also, content analysis of the individual participants’ answers was used to achieve all the objectives
of the study. The Researchers scrutinized every data to ascertain its suitability within the themes
assigned by researchers and the themes were compared with
each other to help identify the commonalities and the relationships among the themes which were
12
used to arrive at the reasons why the abuse of Tramadol was on the increase among the youth of
Japekrom.

3.8 Ethical Considerations

The Researchers obtained Ethical clearance from the management of the Holy Family Nursing and
Midwifery Training College, Berekum before the study was commenced.

Participants were provided with clear information on the purpose of the study and their
consents were duly sought. The consent was explained to each participant
in the best understandable manner. Voluntary and confidential nature of the study was
emphasized. Participants were informed that they could opt out at will anytime they felt like
discontinuing the process. The Researchers ensured that participants had maximum privacy
during the process and confidentiality was fully guaranteed as the Researchers were the only
ones who had access to the information supplied by participants. Again, the questionnaires did
not bear the names of respondents and were administered at the convenience of participants.

3.8 Limitation of the Study

1. Time constraints that resulted from the need to balance academic and clinical duties and research
activities took great toll on the strength of the group members.

2. We had difficulties finding the research program, as we could not get any organization or
anyone to support us financially.

3The major limitation of this study is that the findings may not qualify for generalizability. This
is because the participants were purposely selected by the Researchers to achieve the objectives
of the study. Again, it is instructive to note that all participants were males even though there
there is the possibility that females within the study area may be abusing Tramadol. The
responses given by participants may reflect the views of participants and not necessarily that of
all the youth who abuse Tramadol in Japekrom. The above notwithstanding, participants were
selected from different suburbs of Japekrom as well as from diverse backgrounds to ensure
higher representativeness.

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 CHAPTER FOUR

DATA ANALYSIS AND RESULTS

4.0 Introduction

This Chapter is dedicated to the analysis of the data obtained from the study. The Researchers
used content analysis to analyse the data since that was the simplest way by which the outcome
of the findings could be analysed. This was done to identify the themes that run through the
responses by participants. Data was therefore reduced into graphical presentations.

4.1 Demographic Characteristics of Participants

The table below shows the demographic characteristics of the Ten Respondents of the study.
Participants were assigned code names ranging from P1-P10

NAME SEX AGE(YRS) EDUCATIONAL MARITAL EMPLOYMENT

BACKGROUND STATUS STATUS
P1 M 16 SHS Student Single Unemployed
P2 M 19 SHS Graduate Single Unemployed
P3 M 20 SHS Graduate Single Unemployed
P4 M 25 HND Graduate Married Driver
P5 M 17 JHS Graduate Single Unemployed
P6 M 20 JHS Graduate Single Driver
P7 M 19 SHS Graduate Single Unemployed
P8 M 26 Uneducated Married Mechanic
P9 M 18 SHS Graduate Single Unemployed
P10 M 21 SHS Graduate Single Chainsaw
Operator

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4.2 Participants Knowledge of Substance/Drug Abuse

The research revealed that ninety percent (90%) of respondents had knowledge of drug abuse.

PLEASE GRAPHS HERE!!

CHAPTER FIVE

DISCUSSION, CONCLUSIONS AND REOMMENDATIONS

5.0 Introduction

This chapter presents the discussion of findings of the study together with the conclusions and
recommendations. The aim of the study was to explore the reasons why there is an upsurge in
Tramadol abuse among the youth of Japekrom, a town in the Jaman South Municipality of the
Brong Ahafo Region. The Ten (10) participants selected for the study were administered with the
questionnaire which sought to obtain information on the reason why many more youth of Japekrom
are abusing Tramadol, the effects of Tramadol abuse and measures to control Tramadol abuse.

The study showed that participants had a reasonable understanding of the concept of Substance
abuse. The study found out that many of the participants had been abusing Tramadol for over two
years.
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5.2 Causes of Tramadol Abuse

The study discovered that Tramadol is increasingly being abused by the youth of Japekrom for
varying reasons including: energy booster, euphoria, sex enhancement and stress management.

The study further revealed that the youth are motivated to go into Tramadol abuse mainly through
peer pressure and curiosity. Researchers like Jibril et al. (2008) had earlier come out with similar
findings with regards to other substances such as marijuana. Peer pressure came out as a very
strong influence that lead the youth of Japekrom into Tramadol abuse. The research also revealed
that Tramadol could be purchased from the regular chemical shops with ease without any
prescription since none of the 80% of respondents who buy from chemical shops ever went with a
prescription from a medical Doctor. Government and the Pharmacy Council may have to see to
the proper regulation of the sale of the drug. Even more serious is the fact that 20% of respondents
indicated that they buy the drug from hawkers in the open.

5.3 Frequency of Abuse

The frequency at which respondents abuse Tramadol daily was very alarming. 80% of respondents
use the drug at least twice a day with the remaining 20% indicating that they abuse the drug once
every day. Furthermore, the study found that as much as 70% of respondents have been abusing
Tramadol for over two years where as the remaining 30% responded that they have abused the
drug for a year. The implication is that Tramadol abuse have been with us far longer than we
imagined and for that matter there is the possibility that a greater number of Ghanaian youth have
fallen victims to the menace.

5.3 Effects of Tramadol Abuse

In this study the researchers sought to understand the reasons for the increase in Tramadol abuse
among the youth of Japekrom and also look at the impact of the Tramadol on users. The study
found out that the main effects of Tramadol abuse on the youth of Japekrom were vomiting (60%),
dizziness (20%), drowsiness (10%) and shallow breath (10%). All these are health issues which
may lead to serious complications on the youth in their future life.

5.4 Measures of Controlling Tramadol Abuse among the youth

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Up to 60% of respondents believe that public education and sensitization is the on the dangers of
Tramadol abuse is the way to address the situation. This calls for a concerted effort from the
Government and other stakeholders to embark upon education and sensitization across the country
on the dangers of the phenomenon before it gets to a crisis situation. 30% and 10% see law
enforcement and parental control respectively as the means by which the situation can be
controlled.

The good news from the findings of the study however is that 80% of respondents expressed their
willingness to quit the behaviour if they get the needed support. As a country, we should find a
way of identifying these abusers and rehabilitate them. There was 20% of respondents who are
unwilling to quit the Tramadol probably because they have become highly addicted. Those ones
may require special treatment.

5.5 Implication of the study for policy direction

The study has shown that after all, the youth are not oblivious of what substance abuse is. It is
instructive to note that almost all the respondents knew something about substance abuse and were
aware that they were using Tramadol for the wrong purpose. It came out from the study that there
is the need to intensify education on the issue in order to bring the abuse under control. This can
be done by introducing the education right from the basic levels of the education system.

5.6 Implications for health workers

The research has revealed that the abuse of Tramadol among the youth is very real and the dangers
associated with it is enormous. Consequently, health professionals in the country should
necessarily include public education on the dangers of the phenomenon as part of their outreach
and other contacts with patients and the general public, especially the youth. The Public Health
department of the Ghana Health service should also design and implement educational
programmes on the control of the abuse of Tramadol and other related substances.

5.7 Implication for Further Research

This study has identified a number of issues regarding the abuse of Tramadol among the youth and
has accordingly proffered some reasonable measures to help in the control of the situation.
However, the researchers admit that more could be done if we want to completely address the

17
menace of Tramadol and other substance abuse in the society. Further research can therefore be
conducted into the area with a possible wider population and a more representative sample size for
a national discourse.

5.8 Conclusion

The study has brought out a number of interesting views from the perspective of the youth of
Japekrom who are engaged in the abuse of Tramadol with affordability, convenience and
availability being the major reasons why the choice of Tramadol. It is also clear that the situation
puts the future of the youth in jeopardy if no serious action is taken to bring the current situation
under control. Expanded research should be conducted to cover the entire country so that a lasting
solution can be sought to end the menace.

5.9 Recommendation

On the bases of the findings of this study, the researchers wish to make the following
recommendations for consideration by the Government, Civil Society Organizations, Law
Enforcement Agencies, Parents, Media and Researchers.

5.9.1. The Government

 The Government of Ghana should put in place the requisite policies and programmes to
provide job opportunities for the teeming unemployed youth. This would occupy their
attention for productive activities instead of engaging in drugs.
 The Government should invest in research into the abuse of Tramadol for a lasting solution
 The Government should organize a national debate/ dialogue on Tramadol abuse to solicit
the views of the general public towards ending the practice.
 The Government should review the laws on the importation of Tramadol and other related
drugs to ensure that that it is properly regulated.
 The Government should resource the law enforcement agencies to be able to combat the
menace

5.9.2 Parents
Parental responsibility and vigilance is key in the fight against Tramadol abuse. Therefore

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  Parents should be in constant monitoring of their teenage children to identify any change
in attitude in time and address it quickly.
 Parents should show love and affection to their children to keep them from joining bad
company that may lead them to Tramadol abuse
 Parents who abuse drugs themselves should not introduce their children to the practice

5.9.3 The Media

The media in Ghana is such a powerful tool which can make a great difference in the fight against
Tramadol abuse by:
 Dedicating airtime for the campaign against Tramadol abuse
 Joining Civil Society Organizations and the state institutions to educate the public on the abuse of
Tramadol
 Organizing special programmes on Tramadol abuse to inform the general public about Tramadol
abuse.

5.9.4 Researchers
Researchers should show interest in the area of Tramadol and other substance abuse and do further
extensive investigation into the menace to come out with workable solutions to the canker.

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