CHAPTER ONE: INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Africa with approximately one fifth of the world’s population is by far the continent with the least document in terms of data on substance abuse (Data for Africa, 2011).Nigeria the most populous country in Africa and the eight most populous in the world with an estimate population over 154 million, does not have current data on substance abuse treatment demand and treatment facilities. The drug treatment demand figures quoted in the 2011 world drug report by United Nation Office on Drug and Crime were sourced from 2004 data obtained from the government .UNODC (2011).
In 1998, because of the non existence of a national database of existing structures and services developed to tackle the menance of drug abuse in Nigeria, the United Nation International Drug Control Programme conducted a rapid situation assessment of drug abuse in Nigeria with one of the objective being to determine the availability, adequacy, nature and location of secondary, tertiary drug prevention services and personnel. UNIDCP (1998).The results reveals that substance abuse treatment facilities existed in the states but largely as part of psychiatry, general or university teaching hospital. UNIDCP (1998).
Tramadol is sold by hawkers, patent medicine stores and pharmacies in Maiduguri metropolis. In all the arrest made by The National Agency for Food and Drug Administration and Control NAFDAC on drug hawkers, all of them sell Tramadol. NAFDAC (2011).They claim to have bought the drug at patent medicine stores or pharmacies. Investigation by the Agency reveals it is very difficult to visibly see Tramadol in pms or pharmacies, most of them hide the substance in an unknown location and only present it on demand .NAFDAC (2011).Most of the hawkers in Maiduguri metropolitan consume Tramadol and they claim it is the backbone of their business. They do not expose the drug visibly while hawking .From 2004 to 2011 the agency imposed 761 sanctions on drugs and 30% were on drug hawkers. NAFDAC annual report (2004-2011).The menance of illegal sell and abuse of Tramadol is increasing in the metropolis because routine inspection visits and surveillances have been reduced by the regulatory agencies within the state due to the insecurity within the state. NAFDAC weekly report (2012).
Tramadol is a man-made (synthetic) analgesic (pain reliever). Its exact mechanism of action is unknown but it is similar to morphine. Like morphine, tramadol binds to receptors in the brain (opioid receptors) that are important for transmitting the sensation of pain from throughout the body. Tramadol, like other narcotics is used for the treatment of pain. Salem (2008). An increasingly alarming phenomenon of Tramadol (Tramal, Amadol, Tramax, Contramal, Trama SR, Ultradol, and Tramundin) abuse has been heavily demonstrated in the Nigerian communities in the last four years. NAFDAC (2012).
Though the issue of drug abuse is not new to Nigerian societies, tramadol is associated with a wide range of abuse and illegal transactions that made it easily accessible and readily provided at cheap cost despite being scheduled. Dasgupta (2010). The alleged usages of tramadol contributed greatly to its popularity and massive use especially among youth and middle-aged groups as a remedy for premature ejaculation and for extended orgasm and to increase sexual pleasure as promoted in many online drug stores and media. Jacny (2007).
It seemed also a problem in countries like Israeli and Egypt .Report shows that “some supplies of the drug are smuggled into Gaza from Egypt through tunnels, tramadol being the mostly used one. Their lower price and availability without prescription make them very popular. It relieves psychosomatic symptoms related to stress, like headaches and abdominal pain, as well as depression and nervousness”. Rough estimates suggested that there are 15,000 addicted males to tramadol in Gaza (30% of males between 14 and 30 years old). Iravani (2010). Tramadol is used to alleviate the stress of living in the besieged Palestinian territory. In the United Arab Emirates the phenomenon of selling Tramadol in an unlawful manner has been on the rise. Twenty-one cases of trafficking tramadol had been probed since January 2010. Iravani (2010).
Tramadol was approved for marketing as a safe analgesic in 1995 under the trade name of “Ultram®”. The manufacturer initially claimed that it produced only very weak narcotic effects. Recent data demonstrated that its opioid activity is the overriding contributor to its pharmacological activity. The inadequate product labelling and lacking of established abuse potential lead to the safety feeling of many physicians to prescribe it to recovering narcotic addicts and to known narcotic abusers. As a consequence, numerous reports of abuse and dependence have been received. Yakeshita et al. (2009).
Present results indicated that a clinically-prescribed dose of oral tramadol has abuse liability-related effects in recreational drug users. It suggested the need for further abuse liability testing of the oral formulation in opioid abusers. The observed co-presentations with tramadol abuse cases presented to emergency departments as well as tramadol-related deaths have been increasing in Iran. Biological samples obtained during autopsy of the studied cases were analyzed and tramadol was detected in 294 cases alone or together with other drugs. The majority of the cases were young male adults. Tramadol-related deaths in 2008 were 32.5 times more frequent than in 2005. These results suggested that tramadol-related fatalities are growing in Iran especially among substance abusers. Salem (2008).