Over the past few months, the Food and Drugs Authority, the Narcotics Control Board and the Pharmaceutical Society of Ghana have unanimously raised grave concerns about the excessive non- medical use of Tramadol (commonly called Trams) among the youth. Tramadol misuse has been endemic among some young people in certain parts of the country, but until recently, we had hugely underestimated the public health impact of this problem.
Tramadol is a painkiller medication that is a synthetic analogue of codeine. In comparison with other opiates, tramadol is a commonly prescribed analgesic because of its relatively lower risk of addiction and better safety profile.
As a practising Pharmacists, we had a rare opportunity to engage in a very revealing tête-à-tête with a 27-year-old guy who has been a victim of tramadol abuse for over five years. Even though he did admit that tramadol is legally indicated for the management of moderate to moderately severe pain, he expressly and firmly denied any knowledge of Trams being a prescription only medicine.
How is Tramadol Abused?
Any non-medical use of tramadol can be considered as abuse. Tramadol is apparently abused for its euphoric effect and its potential ability to lengthen the ejaculatory latency period.
Even though the registered single dose unit available in Ghana is the 50mg and 100 mg tablets or capsules, some preparations on the open market claim to contain 200 or even 320 mg of the tramadol. Chronic Abusers often take higher doses because the smaller doses do not work for them any longer.
Premature ejaculation (PE) is a common male sexual disorder. Perceived or real premature ejaculation is associated with sexual anxiety and altered sensitivity to serotonin (a chemical present in the brain that sends signals between nerve cells in the brain).
Serotonin plays an important role in regulating mood, and low levels of serotonin in the brain have been associated with depression and many sexual dysfunctions including Premature Ejaculation. Since tramadol is believed to increase brain levels of serotonin, it makes pharmacological sense that young men are misusing it as a sexual enhancer to delay ejaculation.
On the issue of euphoria, it appears that trams abusers are very knowledgeable in Pharmacology. For various reasons, tramadol is often consumed in high doses and concomitantly and/or preceding the consumption of alcohol, codeine, chlorimipramine (Anafranil), diphenhydramine and dextromethorphan. These medicines (except Anafranil) are available in many over-the-counter cough preparations. Apart from Trams delaying ejaculation, the feeling of euphoria enhances physical performances because the sensation of fatigue and pain is essentially blunted.
Codeine is another opiate given by mouth in the form of linctuses for the relief of a cough and it’s also present in some other cough preparations. It is readily available and commonly abused concomitantly with Trams for enhanced Euphoria.
Trams abusers are also aware of ‘hangover’ symptoms from abuse as well as its antidote. They resort to cough preparations containing diphenhydramine. Diphenhydramine is a sedating antihistamine for managing allergic reactions. Additionally, it helps with insomnia associated with extreme euphoria. Dextromethorphan is also present in many cough mixtures as well. It has been clinically proven to be effective in reducing alcohol and opioid withdrawal symptoms. Apparently, Trams abusers are aware of these, at least from what my resource person told me.
Are abusers justified then?
Even though there is some evidence to support the use of Tramadol in the short-term management of premature ejaculation, this should not be encouraged because the risk involved is higher and there are better and safer alternatives. Besides, abusers rarely follow any medical advice in using tramadol.
Repeated use of opioids is associated with the development of psychological and physical dependence. Although this is less of a problem with legitimate therapeutic use, dependence may develop rapidly when opioids are regularly abused.
Drug dependence of the opioid type is characterized by an overwhelming need to keep taking the drug (or one with similar properties), by a physical requirement for the drug in order to avoid withdrawal symptoms, and by a tendency to increase the dose owing to the development of tolerance.
In our case, abusers who withdraw often suffer from a heightened form of premature ejaculation. Abusers are then forced to resort to it, this time at higher doses. According to scientific studies, however, opioids misuse can lower the levels of the male sex hormone (testosterone), suppress sexual function in men and cause erectile dysfunction (impotence) later in life. They can also contribute to low libido and difficulty with orgasm in both men and women.
Tramadol-related deaths have occurred in patients with previous histories of emotional disturbances or suicidal ideation or attempts as well as histories of misuse of tranquillizers and alcohol,
If you have a genuine need to treat Premature Ejaculation, kindly speak to your trusted health professional for a proper assessment and appropriate treatment. If you are already on Trams and withdrawal is becoming challenging, kindly seek professional help from the nearest hospital or contact PHARMA RESEARCH Ghana via
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