Prevalence of Tramadol Abuse and Associated Factors among Hawassa University Students

Prevalence of Tramadol Abuse and Associated Factors among Hawassa University Students | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of Tramadol Abuse and Associated Factors among Hawassa University Students Adanech Shiferaw¹, Wudinesh Tamiru¹, Fetiya Mohammed¹, Getu Ataro, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4044566/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Tramadol abuse is a current public health concern in Ethiopia. Drug abuse including that of tramadol is a significant public health issue that causes health, economic, and social problems to individual drug users, their families, the community, and the entire nation. Therefore this study delivers information regarding current tramadol abuse among students of an Ethiopian University. Objective: The aim of this study is to assess the prevalence of tramadol abuse and associated factors among Hawassa university students, February to June 2023. Methods and materials : A cross-sectional study was performed among 402 randomly selected Hawassa university students. Data was collected from participant through self-administered researcher made questionnaire using kobo toolbox software applications. Data from kobo toolbox were directly exported to and analyzed by using SPSS version 26 software. Binary logistic regression was applied to identify the factors associated with tramadol abuse. In the final model, Adjusted Odds Ratio, and 95% CI was used to measure the strength of association and P-value less than 0.05 considered statistically significant. Result: A total of 402 students were enrolled in this study of which 46 students (11.4%) had history of tramadol abuse once in their lifetime with 23.9% of them were active tramadol abuser with some dependence behaviors. The result of multivariate analysis shows that having a friend who use drugs (p=0.041, OR=1.691), knowing about tramadol (p=0.001, OR=13.766) and having the history of taking tramadol with physicians prescription in their life time (P<0.001, OR=12.951) were the significant predictors of tramadol abuse. Conclusion: The life time prevalence of tramadol abuse among university students is high and it demands attention of government and the general public. tramadol abuse misuse non-medical use drug abuse drug misuse Opioid abuse 1. INTRODUCTION Tramadol abuse is the major current public health concern in Ethiopia. Ethiopian ministry of health and Ethiopian Food and Drug Authority (EFDA) recently reported that there are problems regarding the right prescription, distribution, and usage of tramadol in medical facilities and pharmacies (1). Tramadol was over-the-counter medicine in Ethiopia till November 2022. Tramadol is a weak opioid analgesics that used to treat moderate to severe pain such as dental pain, labor pain, chronic pain, cancer pain and acute pain (2, 3). It has good analgesic activity through its Mu opioid receptor agonist activity by inhibiting the serotonin and noradrenaline reuptake and it augment the central dopamine activation (2). However it has been shown to cause physical dependence may be when it is used consistently for more than a few weeks (4). The term "drug abuse" describes non-medical use of a substance with the explicit goal of inducing a desired change in mental state or physical performance; like euphoria in the case of opioids, anesthetics, and sedatives (5). Whereas, Tramadol abuse is using tramadol without a prescription as well as using it more frequently, longer, or in higher quantities than recommended (1). Almost 271 million people, or 5.5% of the world's population between the ages of 15 and 64, took drugs, and 35.6 million of them struggled with drug use problems as reported in 2017 (6). Global public health are under significant threat from the amount of non-medical usage of prescription medications(3, 7). World drug report in 2018 stated that tramadol trafficking and non-medical usage are the primary drug threats in several parts of Africa medications (3). In Egypt and other African countries the prevalence of tramadol usage has dramatically increased over time, necessitating a high level of attention from various authorities(8). In Egypt the prevalence of tramadol abuse ranged from 1.9% to 18.9% among university students, 8.8% among high school students and 49% among addiction patients (9, 10, 11) . Furthermore, the prevalence of tramadol use ranging from 24.9% to 36.2% among Ghanaian adolescents and drivers have been reported (7, 12, 13). Where as in Nigeria it had been reported that the prevalence of tramadol abuse was ranged from 3.8% to 54.4% (14). The socio-environmental characteristics such as conflict in family, peer pressure, having drug abuser friend or family member, having history of smoking or other abuse, higher education, being male and recreational purpose were the commonly reported reasons for tramadol abuse (9, 14-16). Drug abuse including that of tramadol is a significant public health issue that causes health, economic, and social problems to individual drug users, their families, the community, and the entire nation. Drug misuse contributes to a number of serious social issues, including drunk driving, aggression, stress, and child abuse. It can also result in homelessness, criminality and missed work (17). It might also increases the risk of unemployment, physical health issues, dysfunctional social interactions, suicidal tendencies, mental illness, and even a shorter life expectancy (18). Study revealed that tramadol use was frequently accompanied by a number of serious side effects, such as severe vomiting, appetite loss, seizures, irritability, and social isolation(15). A rise in non-medical use or abuse of tramadol was reported by Ethiopian ministry of health and EFDA announced the strict control of tramadol distribution and consumption on November 2022 after hearing some reports regarding tramadol abuse among youth. EFDA stated that tramadol should only be ordered by health professional using opioid prescription, since it is one of basic pain medication (1). However, the extent and prevalence of this drug abuse in our country have not yet been properly determined and there was no published study on this issue as far as our search covers. Therefore, this study is well-timed (timely) and vital to deliver information regarding current tramadol abuse and associated factors among Hawassa university students in Ethiopia. Since University students can be well representative of the adult population in the country, the study on this population will give some insights regarding tramadol status in the country. Hence, any drug abuse among young generation should be better evaluated and enormous attention should be given to protect the future of these young drug users/abusers, their families and nation at large. The result of this study will help to provide current tramadol use status data for Ethiopian ministry of Education, Ethiopian ministry of health and health policy makers. The result of this study will also provide an input for future researchers regarding the magnitude of tramadol abuse among university students. The objectives of this study is to assess the prevalence of tramadol abuse and associated factors among Hawassa university students, 2022/23. 2. MATERIALS AND METHODS 2.1. Study area: The study was conducted in selected campuses of Hawassa University, which is located a 275 kilometers south to Addis Ababa city (19). 2.2. Study subject Study subject of this study is each and every Individual student of Hawassa University that were agreed to be involved in the study 2.3. Study design and period: The cross-sectional study was performed during time period from February to June 2023 2.4. Study methodology Sample size was calculated by using single population proportion formula, by taking confidence interval of 95% and margin of error of 0.05 and by taking prevalence 36.2% from study done in Ghana(19). The sample size was 383; after adding 5% non-response rate the final sample size was 402. Study participants were selected from selected four campuses of Hawassa University undergraduate, graduates and postgraduate students using simple random sampling. The ethical clearance was received from institutional review board of Hawassa University College of medicine and health science before starting the study. A data was collected by investigator made self-administered questionnaire using kobo collect. The questionnaire were created after studying the literature and consulting experts. After creating account the prepared questionnaire were generated into kobo toolbox server form. Finally the final form of the data collection tool generated into kobo toolbox were deployed to the devices of the data collectors. Oral informed consent (which is already included in kobo collect for) was received from each participants. Participants who were willing to participate were proceeded to fill the self-administered questionnaire completed by the participants through smart phone and Tablet based kobo collect app. Pretest was done on 10% of the sample size that were excluded from the study. The questionnaires that had clarity problem were all edited and then the validated and reliable questions were included as part of the questionnaire. 2.5. Data Management and Analysis Data in kobo toolbox were directly exported to SPSS version 26 software packages, checked, cleared, and analyzed by using SPSS. The normality for continuous variables was tested by using Shapiro–Wilk test, since the qualitative data in this study were found to be normal distribution and was described in terms of mean and standard deviation. Binary logistic regression was applied to identify the factors associated with tramadol abuse. Bivariable logistic regression was used to identify the candidate variables in the multivariable logistic regression. Variables with p-value less than 0.25 were inserted in to the multivariable logistic regression. Variable Inflation Factor test was used to check multicollinearity. Before fitted in to the final model, model fitness was checked Hosmer Lemeshow goodness of fit test. Multivariable logistic regression was applied to identify the factors independently associated with tramadol abuse. In the final model, Adjusted Odds Ratio, and 95% CI was used to measure the strength of association and P-value less than 0.05 considered statistically significant. 3. RESULT 1. Socio-demographic characteristics of study participants A total of 402 students were enrolled in this study, of these almost two third were males (65.7%). The participants were aged 18 to 35 and the mean age was 22 (22±2.882). The majority of these students were single (90%) and most of the respondents were living in campus dormitory (89.3%). [table 1] Table 1 Socio-demographic characteristics of the study participants Variable Mean ( x ±s) N(%) Variables N (%) Age 22 ±2.882 Residence In dormitory in campus 359 (89.3) Gender Female 138 (34.3) outside campus rental house 27 (6.7 ) Male 264 (65.7) living with family out of campus 16 (4.0) Marital status Married 19 (4.7) Level of study Undergraduate 358 (89.1) Single 362 (90.0) Graduate 25 (6.2) Breakup 21 (5.2 ) Post graduate 19 (4.7) Discipline/ campus : Main 225 (56%) Medicine and health 79 (19.7%) Family residence Urban 291(72.4) Awada campus 56 (13.9%) Rural 111 (27.6) Wondogenet campus 42 (10.9%) Substances you take in the last 30days? Alcohol beverages 48 (11.9%) Do you know tramadol? Yes 170 (42.3) Tobacco products 4(1.0%) No 232 (57.7) Khat 6(1.5%) Have you a friend who use drugs? Yes 91 (22.6) Hashish 1 (0.2%) No 311 (77.4) Poly substance 13 (3.2%) Have you a family member who use drug? Yes 56 (13.9) Tramadol 20 (5.0%) No 346 (86.1) Cocaine 6(1.5%) Have you ever used substances like Khat, Drug, Alcohol,Cigarette, Hashish,shisha or other in your life? Yes 71 (17.7%) Benzodiazepine 2(0.5%) No 331(82.3%) Pethidine 1(0.2%) 2. The Prevalence of tramadol use and abuse among the study participants The result shows that out of 402 students enrolled in this study 46 (11.4%) students used tramadol without doctor’s prescription once in their lifetime; whereas 16.2% of the participant used tramadol with doctors’ prescription. (Table.2). From those who reported tramadol use without doctors’ prescription 23.9% of them were currently active tramadol abuser with some dependence behaviors. [Table 3] The majority of those who reported tramadol abuse used the tablet preparation form of tramadol (8.2%) whereas the rest of them reported using IV form of tramadol (2.0%). Table 2. The characteristics related with prevalence of tramadol use and abuse among the study participants Variable N (%) During your life, have you ever taken tramadol with doctor’s prescription? Yes 65 (16.2) No 337 (83.8) If you ever take tramadol with doctors’ prescription for how long? For one day 19 (4.7) For 15 days 6 (1.5) I dont remember 19 (4.7) During your life, have you ever used any form of tramadol without doctor’s prescription? Yes 46 (11.4) No 356 (88.6) How much tramadol you use per day? (dose) 300mg 6 (1.5) Route of medication Oral/Tablet form 36 (9.0) Injection 10 (2.5) 3. Reasons for tramadol abuse among participants who reported tramadol abuse The major reason that the participants who abuse tramadol reported they used tramadol without physician prescription for the first time was for pain relief (69.9%), followed by peer pressure which accounts for 10.9% of tramadol users. The reported reasons for currently abusing tramadol among active abusers include for recreational purpose which accounts for 10.9% of tramadol abusers, followed by tramadol Addiction or craving (8.7%), to relieve stress/ frustration (and to increase physical performance. [table 3] Also those active tramadol abusers report some behavioral changes that enforce them to keep using tramadol like strong desire(sense of compulsion) to take tramadol/opioid (63.6%) followed by difficulties in controlling opioid use behavior (18.2%) and physiologic withdrawal state when drug has reduce (18.2%) among the active users. [table 3] Table 3. Reasons for tramadol abuse among participants who report history of tramadol use without doctor’s prescription Variables Total (%) Frequency among abusers For what reason did you started using tramadol Pain relief 32 (8.0%) 32 (69.6%) peer pressure 7 (1.7%) (15.2%) Joy seeking or recreational purpose 3 (.7%) 3 (6.5%) difficulty of sleeping 3 (.7%) 3 (6.5%) low self confidence 1 (.2 %) 1 (2.2%) Are you currently use tramadol as a habit actively? Yes 11 (2.7%) 11 (23.9%) No 391 (97.3) 35 (76.1%) For what reason you currently keep using tramadol Tramadol Addiction or craving 4 (1.0%) 4(8.7%) for recreational purpose 5 (1.2%) 5(10.9%) To relieve stress/ frustration 1 (.2%) 1 (2.2%) to increase physical performance 1 (.2%) 1 (2.2%) Behavioral reasons for keep using tramadol strong desire(sense of compulsion) to take tramadol 7 (1.7%) 7 (63.6%) Difficulties in controlling opioid use behavior 2 (.5%) 2 (18.2%) physiologic withdrawal state when drug has reduced 2 (.5%) 2 (18.2%) 4. Factors associated with tramadol abuse The result of Bivariate analysis shows that having a friend who abuse drugs, having a family member who abuse drugs, knowing about tramadol and having history of taking tramadol under physician prescription had significant association with tramadol abuse. [table 4]. History of tramadol abuse had no significant association with gender, marital status, level of study, residential status, discipline, using other psychoactive substance and satisfactions [table 4]. Table 4. Factors associated with tramadol abuse Variable Tramadol abuse history COR[95% CI] P value Yes No Know about tramadol Yes 44 (10.9%) 135 (33.6%) 40.159[9.576-168.417] <0.0001 No 2 (0.5%) 230 (57.2%) Ref Having a friend who use drugs Yes 16 (4%) 75 (28.7%) 0.5[0.259-0.966] 0.039 No 30 (7.5%) 281 (69.9%) Ref Having family member who use drug Yes 11 (2.7%) 45 (11.2%) 0.460[0.218-0.971] 0.042 No 35 (8.7%) 311 (77.4%) Ref History of taking tramadol by Dr’s prescription Yes 32 (8%) 33 (8.2%) <0.0001 No 14 (3.5%) 323 (80.3%) 22.372[10.857-46.10] Satisfaction with City of study Very high 18 (4.5%) 145 (36.1%) Ref 0.180 High 8 (2.0%) 127 (31.6%) 1.97[0.829-4.686] 0.125 Moderate 11 (2.7%) 36 (9.0%) 0.406[0.176-0.936] 0.334 Low 2 (0.5%) 19 (4.7%) 1.179[0.254-5.485] 0.833 Very low 7 (1.7% 29(7.2%) 0.514[0.197-1.343] 0.174 Satisfaction with University Very high 14 (3.5%) 109(27.1%) Ref 0.045 High 9 (2.2%) 132 (32.8%) 1.884[0.785-4.519] 0.156 Moderate 7 (1.7%) 54 (13.4%) 0.991[0.378-2.598] 0.985 Low 7 (1.7%) 29 (7.2%) 0.523[0.197-1.440] 0.214 Very low 9 (2.2%) 32 (8.0%) 0.457[0.181-1.152] 0.097 Satisfaction with Department Very high 19 (4.7% 135(33.6% Ref 0.184 High 7(1.7% 105(26.1% 2.111[0.855-5.210] 0.105 Moderate 8(2.0% 53(13.2% 0.932[0.385-2.259] 0.877 Low 3(0.7% 27(6.7% 1.267[0.350-4.582] 0.719 Very low 9(2.2% 36(9.0% 0.563[0.235-1.349] 0.198 COR-Crude odds ratio, CI-confidence interval, Ref-reference The result of multivariate analysis shows that having a friend who use drugs (p=0.041, OR=1.691), knowing about tramadol (p=0.001, OR=13.766) and having the history of taking tramadol with physicians prescription in their life time (P<0.001, OR=12.951) were the significant predictors of tramadol abuse. The other factor having a family member who use drugs and satisfaction with university, city and department were not significantly associated with tramadol abuse. [table 5] Table 5. Predictors of tramadol abuse Variables COR (95% CI) P value AOR(95% CI) P Value Knowing about tramadol YES NO 40.159 (9.576-168.417) <0.0001 13.766(3.003-63.113) 0.001 Ref 1 Having history of taking tramadol with prescription? YES No 22.372 (10.857-46.101) <.0001 7.960(3.603-17.587) <0.0001 Ref 1 Have you a friend who use drugs? YES No 1.998 (1.035-3.859) 0.039 1.691(0.718-3.980) 0.041 Ref 1 AOR- Adjusted odds ratio 4. DISCUSSION The result of this study shows that from the recruited 402 study participants 11.4% [95% CI 8.5-14.7] of the study participants had history of the tramadol abuse at least once in their life time, of whom 23.9% were active users. Whereas 16.2% of the respondents used tramadol under physician prescription. The prevalence of tramadol abuse found in present study is in line with findings of study by Bashirian et al. who reported 12.5% prevalence of tramadol abuse among college students in Iran (20). The finding by Bassiony et al. 2015 in Egypt is also in line with our finding that they reported the prevalence of tramadol abuse was 8.8% among school students (10). Whereas, The prevalence of tramadol abuse in current study is higher than the prevalence of 1.8% and 1.9% reported on the studies done in Egypt among Sohag University and Zagazig University students respectively (21,22 ). It is also higher than the prevalence of history of tramadol abuse in school children reported by Pourmohammadi et al. 2019 in Iran which was 4.71% (23). Khafagy et al. 2021 found 18.9% prevalence of life time tramadol abuse among Mansoura University students in Egypt (24).which is very higher than current study. The likely explanation for those difference on prevalence of tramadol abuse among these studies might be the variability regarding access to the drug among these countries, since tramadol is not yet under international control. Study by Lord et al. in 2008 reported the life time opioids abuse among pharmacy students were 8% which was lower than the finding of this present study (25). The possible explanation regarding the reason for such lower prevalence among pharmacy students may be the contribution of the pharmacological knowledge gained from their study as protective shield against drug abuse. Since our study sample incorporate students from four different campus dispersed among different disciplines and departments. In our findings 42.3% of the participants know about tramadol abuse. However compared to the above study by Lord et al. 2018 what they know about tramadol might not be with detailed risks and benefits based pharmacological scientific background. This finding agrees with finding by Abdulfetah et al. 2019 done in Egypt who reported more than one third of university students had good knowledge toward tramadol abuse(14). On the other hand tramadol abuse is significantly associated with knowledge about tramadol use in this present study. Those who had knowledge about tramadol use had almost thirteen times risk of developing tramadol abuse compared to those who had no information about tramadol (P-0.001, OR=13.766[3.003-63.113]. This might be due to half of the respondents’ with history of tramadol abuse were from college of medicine and health science and hence majority of health science students know about tramadol use. Khafagy et al. 2021 also reported tramadol as the most commonly used drug among medical students with prevalence of 1.8% (24). The prevalence of tramadol abuse is significantly associated with having a history of tramadol intake under physician prescription drug (P<0.0001, AOR= 7.960[3.603-17.587]). The possible explanation according to WHO studies report is tramadol may cause physical dependence if it is used daily for couple of weeks (3). Having a friend who practice non-medical drug use is one of the significant associated factors of tramadol abuse in this current study. This result agrees with the finding of the study reported by pourmohammadi et al. 2019 (23). Danso et al. 2021 also reported having a friend who abused drugs significantly associated with tramadol abuse which agrees with the finding of our current study (12). Peer pressure plays major role in every area of people’s life including that of drug abuse. Normally tramadol is opioid analgesics that used to treat acute and chronic pain. However there are a misconception as it is perceived by recreational users as a means of improving mood and boosting energy (3). In this study the reasons that the participants with history of tramadol abuse started using tramadol was majorly for pain relief constituting the 69.6% of the abusers, but also peer pressure (15.2%), joy seeking or recreational purpose (6.5%), difficulty of sleeping (6.5%) and low self-confidence(2.2%) were the reasons some of them started using tramadol. The predominant reasons active tramadol abuser were currently keep taking this drug was the strong desire (sense of compulsive urge or craving) to take tramadol followed by recreational purpose. This is consistent with finding by Ibrahim et al. 2017 in Nigeria that reported compulsive urge or craving for the drug as third reason to continual abuse of tramadol (14). Another Study done in Egypt by Mohamed et al. 2022 reported that the most common reason for tramadol abuse was for the pleasure effect to have good time which the similar with the second common reason in this current study (10). Almost 36 (9.0%) participants or more than two third of the participants with history of tramadol abuse used the oral or tablet form of tramadol. The study by Ibrahim et al. 2017 reported 96.1% of participants used tablet form of tramadol which is higher than our finding (14). The likely reasons for this difference may be tramadol (all formulation) was over-the-counter medicine in Ethiopia till the time of announcement by EFDA in November 2022 (1). This study is not without limitations. This study is done only in one University it is better if it incorporate different universities in Ethiopia just to generalize the prevalence of tramadol among Ethiopian university students at national level. The other limitations of this study is its cross-sectional nature. Even though this study has so many limitations it has its own qualities and strengths. From these good qualities the data collection process was done by using software application called Kobo Tool box, which is simple, easy and amazing technology that reassure the participants to give the right information without any fear of privacy. 4.1 Conclusion The life time prevalence of tramadol abuse among university students is high and it demands attention of government and general public. The outcome of this study shows that the prevalence of life time tramadol abuse was 11.4%, of whom 23.9% of them were active users. Tramadol abuse was significantly associated having a friend who use drugs, knowing about tramadol and having the history of taking tramadol under physician’s prescription in their life time. 4.2 Recommendation We recommend the future researcher to do large nationwide multicenter study. We recommend the higher education administrates to give health education on tramadol abuse risks and consequences for university students. We also recommend health professional to be cautious and responsible regarding rational prescription of tramadol. DECLARATION Ethics approval and consent to participate The ethical clearance with reference number IRB/189/15 was received from institutional review board of Hawassa University College of medicine and health science. Oral informed consent was also taken from all participants. Publication consent: Not applicable Availability of data and materials : data are available by correspondence author on reasonable request. Competing interest: No Funding source : Hawassa University funded this research and covered all the expenses of data collection and analysis process and payment for data collectors, supervisors and investigators. The funding institution had no role in decision to publish or preparation of the manuscript. Author’s contributions: The corresponding author contributes in the study by conceptualization, study design, supervision, data analysis, and drafting the manuscript. Wudinesh Tamiru, Fetiya Mohammed and Zewengel Bisrat have made a significant contribution in conceptualization and supervision of data collection process. Getu Ataro has made a significant contribution in conceptualization, study design and editing the final draft. All Authors read and approved the final manuscript. Acknowledgments: We would like to express our gratitude to Hawassa University for giving us grant for this work. We would also appreciate the willingness of data collectors, supervisors and study participants to participate in and play major role in this study. REFERENCES Dawit. Tramadol is listed and under strict control of narcotic drugs - Ethiopian Food and Drug Authority. https://wwwmohgovet/site/node/414. 2022. Subedi M, Bajaj S, Kumar MS, Mayur Y. 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Hawassa University; https://www.hu.edu.et/index.php/hu/overview/background Bashirian S, Barati M, Fathi Y. Prevalence and factors associated with tramadol abuse among college students in west of Iran: An application of the theory of planned behavior. Avicenna Journal of Neuro Psycho Physiology. 2014 Aug 10;1(1):26-30. Amin DM, Elnagdi SA, Amer SA. Drug abuse in Zagazig University students, Egypt: Cross sectional study. Occupational Diseases and Environmental Medicine. 2019;7(02):37. Meray MS, Ahmed FH, Rania AR. Study of drug abuse among university students in Sohag, Egypt. Journal of Forensic, Toxicology and Medicolegal Analysis. 2016 Oct;1(2):19-23. Pourmohammadi B, Jalilvand MA. Tramadol abuse and its related factors among higher education students in the city of Damghan, Semnan Province, Iran. Quarterly Journal of Iranian Chemical Communication. 2019;7(4. pp. 352-471, Serial No. 25):415-23. Khafagy M, Gomaa Z, Elwasify M. Substance use patterns among university students in Egypt. Middle East Current Psychiatry. 2021;28(1):1-9. Lord S, Downs G, Furtaw P, Chaudhuri A, Silverstein A, Gammaitoni A, Budman S. Nonmedical use of prescription opioids and stimulants among student pharmacists. Journal of the American Pharmacists Association. 2009 Jul 1;49(4):519-28. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4044566","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":387264570,"identity":"0b75038a-ef08-4a8e-9aa0-bf5684f9c55d","order_by":0,"name":"Adanech Shiferaw¹","email":"data:image/png;base64,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","orcid":"","institution":"Hawassa University","correspondingAuthor":true,"prefix":"","firstName":"Adanech","middleName":"","lastName":"Shiferaw¹","suffix":""},{"id":387264571,"identity":"575a9183-4c7e-405c-9b35-aa325a84f138","order_by":1,"name":"Wudinesh Tamiru¹","email":"","orcid":"","institution":"Hawassa University","correspondingAuthor":false,"prefix":"","firstName":"Wudinesh","middleName":"","lastName":"Tamiru¹","suffix":""},{"id":387264572,"identity":"e73ede4f-f2d5-41ca-8f72-573eb5812b4e","order_by":2,"name":"Fetiya Mohammed¹","email":"","orcid":"","institution":"Hawassa University","correspondingAuthor":false,"prefix":"","firstName":"Fetiya","middleName":"","lastName":"Mohammed¹","suffix":""},{"id":387264573,"identity":"2802d207-1623-47f1-996a-0efbb50cb126","order_by":3,"name":"Getu Ataro","email":"","orcid":"","institution":"Hawassa University","correspondingAuthor":false,"prefix":"","firstName":"Getu","middleName":"","lastName":"Ataro","suffix":""},{"id":387264574,"identity":"ddbe6f8f-26e8-44de-8502-cd9339b1a2a8","order_by":4,"name":"Zewengel Bisrat","email":"","orcid":"","institution":"Hawassa University","correspondingAuthor":false,"prefix":"","firstName":"Zewengel","middleName":"","lastName":"Bisrat","suffix":""}],"badges":[],"createdAt":"2024-03-08 13:33:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4044566/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4044566/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":70891099,"identity":"b5fcf298-afdd-4156-a772-d7581e6fb681","added_by":"auto","created_at":"2024-12-09 03:37:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":708344,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4044566/v1/da61df7a-b6b4-4e17-923e-a80a5e497dfd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of Tramadol Abuse and Associated Factors among Hawassa University Students","fulltext":[{"header":"1.\tINTRODUCTION","content":"\u003cp\u003eTramadol abuse is the major current public health concern in Ethiopia. Ethiopian ministry of health and Ethiopian Food and Drug Authority (EFDA) recently reported that there are problems regarding the right prescription, distribution, and usage of tramadol in medical facilities and pharmacies (1). \u0026nbsp;Tramadol was over-the-counter medicine in Ethiopia till November 2022.\u003c/p\u003e\n\u003cp\u003eTramadol is a weak opioid analgesics that used to treat moderate to severe pain such as dental pain, labor pain, chronic pain, cancer pain and acute pain (2, 3). It has good analgesic activity through its Mu opioid receptor agonist activity by inhibiting the serotonin and noradrenaline reuptake and it augment the central dopamine activation (2). However it has been shown to cause physical dependence may be when it is used consistently for more than a few weeks (4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe term \u0026quot;drug abuse\u0026quot; describes non-medical use of a substance with the explicit goal of inducing a desired change in mental state or physical performance; like euphoria in the case of opioids, anesthetics, and sedatives (5). Whereas, Tramadol abuse is using tramadol without a prescription as well as using it more frequently, longer, or in higher quantities than recommended (1). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlmost 271 million people, or 5.5% of the world\u0026apos;s population between the ages of 15 and 64, took drugs, and 35.6 million of them struggled with drug use problems as reported in 2017 (6). \u0026nbsp;Global public health are under significant threat from the amount of non-medical usage of prescription medications(3, 7). World drug report \u0026nbsp;in 2018 stated that tramadol trafficking and non-medical usage are the primary drug threats in several parts of Africa medications (3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn Egypt and other African countries the prevalence of tramadol usage has dramatically increased over time, necessitating a high level of attention from various authorities(8). In Egypt the prevalence of tramadol abuse ranged from 1.9% to 18.9% among university students, 8.8% among high school students and 49% among addiction patients (9, 10, 11) . Furthermore, the prevalence of tramadol use ranging from 24.9% to 36.2% among Ghanaian adolescents and drivers have been reported (7, 12, 13). Where as in Nigeria it had been reported that the prevalence of tramadol abuse was ranged from 3.8% to 54.4% (14). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe socio-environmental characteristics such as conflict in family, peer pressure, having drug abuser friend or family member, having history of smoking or other abuse, higher education, being male and recreational purpose were the commonly reported reasons for tramadol abuse (9, 14-16).\u003c/p\u003e\n\u003cp\u003eDrug abuse including that of tramadol is a significant public health issue that causes health, economic, and social problems to individual drug users, their families, the community, and the entire nation. \u0026nbsp; Drug misuse contributes to a number of serious social issues, including drunk driving, aggression, stress, and child abuse. It can also result in homelessness, criminality and \u0026nbsp;missed work (17). \u0026nbsp;It might also increases the risk of unemployment, physical health issues, dysfunctional social interactions, suicidal tendencies, mental illness, and even a shorter life expectancy (18). Study revealed that tramadol use was frequently accompanied by a number of serious side effects, such as severe vomiting, appetite loss, seizures, irritability, and social isolation(15). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA rise in non-medical use or abuse of tramadol was reported by Ethiopian ministry of health and EFDA announced the strict control of tramadol distribution and consumption on November 2022 after hearing some reports regarding tramadol abuse among youth. EFDA stated that tramadol should only be ordered by health professional using opioid prescription, since it is one of basic pain medication (1).\u003c/p\u003e\n\u003cp\u003eHowever, the extent and prevalence of this drug abuse in our country have not yet been properly determined and there was no published study on this issue as far as our search covers. \u0026nbsp;Therefore, this study is well-timed (timely) and vital to deliver information regarding current tramadol abuse and associated factors among Hawassa university students in Ethiopia. Since University students can be well representative of the adult population in the country, the study on this population will give some insights regarding tramadol status in the country.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHence, any drug abuse among young generation should be better evaluated and enormous attention should be given to protect the future of these young drug users/abusers, their families and nation at large. The result of this study will help to provide current tramadol use status data for Ethiopian ministry of Education, Ethiopian ministry of health and health policy makers. \u0026nbsp;The result of this study will also provide an input for future researchers regarding the magnitude of tramadol abuse among university students.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe objectives of this study is to assess the prevalence of tramadol abuse and associated factors among Hawassa university students, 2022/23.\u003c/p\u003e"},{"header":"2. MATERIALS AND METHODS ","content":"\u003cp\u003e\u003cstrong\u003e2.1. Study area:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in selected campuses of Hawassa University, which is located a 275 kilometers south to Addis Ababa city (19).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eStudy subject\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy subject of this study is each and every Individual student of Hawassa University that were agreed to be involved in the study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. Study design and period:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe cross-sectional study was performed during time period from February to June 2023\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4. Study methodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSample size was calculated by using single population proportion formula, by taking confidence interval of 95% and margin of error of 0.05 and by taking prevalence 36.2% from study done in Ghana(19). The sample size was 383; after adding 5% non-response rate the final sample size was 402. Study participants were selected from selected four campuses of Hawassa University undergraduate, graduates and postgraduate students using simple random sampling.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe ethical clearance was received from institutional review board of Hawassa University College of medicine and health science before starting the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA data was collected by investigator made self-administered questionnaire using kobo collect. The questionnaire were created after studying the literature and consulting experts. After creating account the prepared questionnaire were generated into kobo toolbox server form. Finally the final form of the data collection tool generated into kobo toolbox were deployed to the devices of the data collectors. Oral informed consent (which is already included in kobo collect for) was received from each participants. Participants who were willing to participate were proceeded to fill the self-administered questionnaire completed by the participants through smart phone and Tablet based kobo collect app.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePretest was done on 10% of the sample size that were excluded from the study. The questionnaires that had clarity problem were all edited and then the validated and reliable questions were included as part of the questionnaire.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5. Data Management and Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData in kobo toolbox were directly exported to SPSS version 26 software packages, checked, cleared, and analyzed by using SPSS. The normality for continuous variables was tested by using Shapiro–Wilk test, since the qualitative data in this study were found to be normal distribution and was described in terms of mean and standard deviation. Binary logistic regression was applied to identify the factors associated with tramadol abuse. Bivariable logistic regression was used to identify the candidate variables in the multivariable logistic regression. Variables with p-value less than 0.25 were inserted in to the multivariable logistic regression. Variable Inflation Factor test was used to check multicollinearity. Before fitted in to the final model, model fitness was checked Hosmer Lemeshow goodness of fit test.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMultivariable logistic regression was applied to identify the factors independently associated with tramadol abuse. In the final model, Adjusted Odds Ratio, and 95% CI was used to measure the strength of association and P-value less than 0.05 considered statistically significant.\u003c/p\u003e"},{"header":"3.\tRESULT","content":"\u003cp\u003e\u003cstrong\u003e1.\u0026nbsp; \u0026nbsp;Socio-demographic characteristics of study participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;A total of 402 students were enrolled in this study, of these almost two third were males (65.7%). The participants were aged 18 to 35 and the mean age was 22 (22\u0026plusmn;2.882). The majority of these students were single (90%) and most of the respondents were living in campus dormitory (89.3%). [table 1]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;1 Socio-demographic characteristics of the study participants\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"588\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eMean ( x \u0026plusmn;s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eN(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eVariables\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e22 \u0026plusmn;2.882\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eIn dormitory in campus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e359 (89.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e138 (34.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eoutside campus rental house\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e27 (6.7 )\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e264 (65.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eliving with \u0026nbsp;family out of campus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e16 (4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of study\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e358 (89.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e362 (90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eGraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e25 (6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eBreakup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e21 (5.2 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003ePost graduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e19 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiscipline/ campus\u003c/strong\u003e: Main\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e225 (56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMedicine and health\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e79 (19.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily residence\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e291(72.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eAwada campus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e56 (13.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e111 (27.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eWondogenet campus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e42 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubstances you take in the last 30days?\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAlcohol beverages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e48 (11.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you know tramadol?\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e170 (42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eTobacco products\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e4(1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e232 (57.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eKhat\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e6(1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you a friend who use drugs?\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e91 (22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eHashish\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e1 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e311 (77.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003ePoly substance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e13 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you a family member who use drug?\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e56 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eTramadol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e20 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e346 (86.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eCocaine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e6(1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eHave you ever used substances like Khat, Drug, Alcohol,Cigarette, Hashish,shisha or other in your life?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e71 (17.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBenzodiazepine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e2(0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e331(82.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003ePethidine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e1(0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e2. \u0026nbsp; The Prevalence of tramadol use and abuse among the study participants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe result shows that out of 402 students enrolled in this study 46 (11.4%) students used tramadol without doctor\u0026rsquo;s prescription once in their lifetime; whereas 16.2% of the participant used tramadol with doctors\u0026rsquo; prescription. (Table.2). From those who reported tramadol use without doctors\u0026rsquo; prescription 23.9% of them were currently active tramadol abuser with some dependence behaviors. [Table 3] The majority of those who reported tramadol abuse used the tablet preparation form of tramadol (8.2%) whereas the rest of them reported using IV form of tramadol (2.0%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;2. The characteristics related with prevalence of tramadol use and abuse among the study participants\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"618\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 492px;\"\u003e\n \u003cp\u003eVariable\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eDuring your life, have you ever taken tramadol with doctor\u0026rsquo;s prescription?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e65 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e337 (83.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eIf you ever take tramadol with doctors\u0026rsquo; prescription for how long?\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eFor one day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e19 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eFor \u0026lt;=15 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e21 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eFor \u0026gt;15 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e6 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eI dont remember\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e19 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eDuring your life, have you ever used any form of tramadol without doctor\u0026rsquo;s prescription?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e46 (11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e356 (88.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eHow much tramadol you use per day? (dose)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026lt;100mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e3 (.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e100-300mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e3 (.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026gt;300mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e6 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eRoute of medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eOral/Tablet form\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e36 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eInjection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e10 (2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.\u0026nbsp; \u0026nbsp;Reasons for tramadol abuse among participants who reported tramadol abuse\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe major reason that the participants who abuse tramadol reported they used tramadol without physician prescription for the first time was for pain relief (69.9%), followed by peer pressure which accounts for 10.9% of tramadol users. The reported reasons for currently abusing tramadol among active abusers include for recreational purpose which accounts for 10.9% of tramadol abusers, followed by tramadol Addiction or craving (8.7%), to relieve stress/ frustration (and to increase physical performance. [table 3]\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Also those active tramadol abusers report some behavioral changes that enforce them to keep using tramadol like strong desire(sense of compulsion) to take tramadol/opioid (63.6%) followed by difficulties in controlling opioid use behavior (18.2%) and physiologic withdrawal state when drug has reduce (18.2%) among the active users. [table 3]\u003c/p\u003e\n\u003cp\u003eTable 3. Reasons for tramadol abuse among participants who report history of tramadol use without doctor\u0026rsquo;s prescription\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"639\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eTotal (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eFrequency among abusers\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFor what reason did you started using tramadol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003ePain relief\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e32 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e32 (69.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003epeer pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e(15.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003eJoy seeking or recreational purpose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e3 (.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e3 (6.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003edifficulty of sleeping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e3 (.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e3 (6.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003elow self confidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1 (.2 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre you currently use tramadol as a habit actively?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e11 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e11 (23.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e391 (97.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e35 (76.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFor what reason you currently keep using tramadol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003eTramadol Addiction or craving\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e4 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e4(8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003efor recreational purpose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e5 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e5(10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003eTo relieve stress/ frustration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1 (.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003eto increase physical performance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1 (.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBehavioral reasons for keep using tramadol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003estrong desire(sense of compulsion) to take tramadol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e7 (63.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003eDifficulties in controlling opioid use behavior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2 (.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e2 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003ephysiologic withdrawal state when drug has reduced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2 (.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e2 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e4. \u0026nbsp; Factors associated with tramadol abuse\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe result of Bivariate analysis shows that having a friend who abuse drugs, having a family member who abuse drugs, knowing about tramadol and having history of taking tramadol under physician prescription had significant association with tramadol abuse. [table 4].\u0026nbsp;History of tramadol abuse had no significant association with gender, marital status, level of study, residential status, discipline, using other psychoactive substance and satisfactions [table 4].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4. Factors associated with tramadol abuse\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eTramadol abuse history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eCOR[95% CI]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eKnow about tramadol\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e44 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e135 (33.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40.159[9.576-168.417]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2 (0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e230 (57.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eHaving a friend who use drugs\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e75 (28.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.5[0.259-0.966]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.039\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e30 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e281 (69.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eRef\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eHaving family member who use drug\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e45 (11.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.460[0.218-0.971]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.042\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e35 (8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e311 (77.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eHistory of taking tramadol by Dr\u0026rsquo;s prescription\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e32 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e33 (8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e14 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e323 (80.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e22.372[10.857-46.10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eSatisfaction with City of study\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVery high\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e145 (36.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.180\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eHigh\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e8 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e127 (31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e1.97[0.829-4.686]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eModerate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e11 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e36 (9.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e0.406[0.176-0.936]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.334\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eLow\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2 (0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e19 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e1.179[0.254-5.485]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.833\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eVery low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7 (1.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e29(7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e0.514[0.197-1.343]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.174\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eSatisfaction with University\u003c/p\u003e\n \u003cp\u003eVery high\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e14 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e109(27.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.045\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eHigh\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e9 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e132 (32.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e1.884[0.785-4.519]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eModerate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e54 (13.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e0.991[0.378-2.598]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.985\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eLow\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e29 (7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e0.523[0.197-1.440]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.214\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eVery low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e9 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e32 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e0.457[0.181-1.152]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eSatisfaction with Department\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVery high\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19 (4.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e135(33.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.184\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eHigh\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7(1.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e105(26.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e2.111[0.855-5.210]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eModerate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e8(2.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e53(13.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e0.932[0.385-2.259]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.877\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eLow\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e3(0.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e27(6.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e1.267[0.350-4.582]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.719\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eVery low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e9(2.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e36(9.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e0.563[0.235-1.349]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCOR-Crude odds ratio, CI-confidence interval, Ref-reference\u003c/p\u003e\n\u003cp\u003eThe result of multivariate analysis shows that having a friend who use drugs (p=0.041, OR=1.691), knowing about tramadol (p=0.001, OR=13.766) and having the history of taking tramadol with physicians prescription in their life time (P\u0026lt;0.001, OR=12.951) were the significant predictors of tramadol abuse. The other factor having a family member who use drugs and satisfaction with university, city and department were not significantly associated with tramadol abuse. [table 5]\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;5. Predictors of tramadol abuse\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eCOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAOR(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eP Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Knowing about tramadol\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003cp\u003eNO\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e40.159 (9.576-168.417)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e13.766(3.003-63.113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eRef\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eHaving history of taking tramadol with prescription?\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;YES\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;No\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e22.372 (10.857-46.101)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e7.960(3.603-17.587)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eRef\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;Have you a friend who use drugs?\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYES \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e1.998 (1.035-3.859)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.691(0.718-3.980)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.041\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eRef\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAOR- Adjusted odds ratio \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e"},{"header":"4.\tDISCUSSION ","content":"\u003cp\u003eThe result of this study shows that from the recruited 402 study participants 11.4% [95% CI 8.5-14.7] of the study participants had history of the tramadol abuse at least once in their life time, of whom 23.9% were active users. Whereas 16.2% of the respondents used tramadol under physician prescription.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe prevalence of tramadol abuse found in present study is in line with findings of study by Bashirian et al. who reported 12.5% prevalence of tramadol abuse among college students in Iran (20). The finding by Bassiony et al. 2015 in Egypt is also in line with our finding that they reported the prevalence of tramadol abuse was 8.8% among school students (10).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhereas, The prevalence of tramadol abuse in current study is higher than the prevalence of 1.8% and 1.9% reported on the studies done in Egypt among Sohag University and Zagazig University students respectively (21,22 ). It is also higher than the prevalence of history of tramadol abuse in school children reported by Pourmohammadi et al. 2019 in Iran which was 4.71% (23).\u0026nbsp;Khafagy et al. 2021 found 18.9% prevalence of life time tramadol abuse among Mansoura University students in Egypt (24).which is very higher than current study. The likely explanation for those difference on prevalence of tramadol abuse among these studies might be the variability regarding access to the drug among these countries, since tramadol is not yet under international control.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudy by Lord et al. in 2008 reported the life time opioids abuse among pharmacy students were 8% which was lower than the finding of this present study (25). The possible explanation regarding the reason for such lower prevalence among pharmacy students may be the contribution of the pharmacological knowledge gained from their study as protective shield against drug abuse. Since our study sample incorporate students from four different campus dispersed among different disciplines and departments.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn our findings 42.3% of the participants know about tramadol abuse. However compared to the above study by Lord et al. 2018 what they know about tramadol might not be with detailed risks and benefits based pharmacological scientific background. \u0026nbsp;This finding agrees with finding by Abdulfetah et al. 2019 done in Egypt who reported more than one third of university students had good knowledge toward tramadol abuse(14).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOn the other hand tramadol abuse is significantly associated with knowledge about tramadol use in this present study. Those who had knowledge \u0026nbsp;about tramadol use had almost thirteen times risk of developing tramadol abuse compared to those who had no information about tramadol (P-0.001, OR=13.766[3.003-63.113]. This might be due to half of the respondents’ with history of tramadol abuse were from college of medicine and health science and hence majority of health science students know about tramadol use. Khafagy et al. 2021 also reported tramadol as the most commonly used drug among medical students with prevalence of 1.8% (24).\u003c/p\u003e\n\u003cp\u003eThe prevalence of tramadol abuse is significantly associated with having a history of tramadol intake under physician prescription drug (P\u0026lt;0.0001, AOR= 7.960[3.603-17.587]). The possible explanation according to WHO studies report is tramadol may cause physical dependence if it is used daily for couple of weeks (3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHaving a friend who practice non-medical drug use is one of the significant associated factors of tramadol abuse in this current study. This result agrees with the finding of the study reported by pourmohammadi et al. 2019 (23). \u0026nbsp;Danso et al. 2021 also reported having a friend who abused drugs significantly associated with tramadol abuse which agrees with the finding of our current study (12). Peer pressure plays major role in every area of people’s life including that of drug abuse.\u003c/p\u003e\n\u003cp\u003eNormally tramadol is opioid analgesics that used to treat acute and chronic pain. However there are a misconception as it is perceived by recreational users as a means of improving mood and boosting energy (3). In this study the reasons that the participants with history of tramadol abuse started using tramadol was majorly for pain relief constituting the 69.6% of the abusers, but also peer pressure \u0026nbsp;(15.2%), joy seeking or recreational purpose (6.5%), difficulty of sleeping (6.5%) and low self-confidence(2.2%) were the reasons some of them started using tramadol.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe predominant reasons active tramadol abuser were currently keep taking this drug was the strong desire (sense of compulsive urge or craving) to take tramadol followed by recreational purpose. This is consistent with finding by Ibrahim et al. 2017 in Nigeria that reported compulsive urge or craving for the drug as third reason to continual abuse of tramadol (14). Another Study done in Egypt by Mohamed et al. 2022 reported that the most common reason for tramadol abuse was for the pleasure effect to have good time which the similar with the second common reason in this current study (10).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlmost 36 (9.0%) participants or more than two third of the participants with history of tramadol abuse used the oral or tablet form of tramadol. The study by Ibrahim et al. 2017 reported 96.1% of participants used tablet form of tramadol which is higher than our finding (14). The likely reasons for this difference may be tramadol (all formulation) was over-the-counter medicine in Ethiopia till the time of announcement by EFDA in November 2022 (1). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study is not without limitations. This study is done only in one University it is better if it incorporate different universities in Ethiopia just to generalize the prevalence of tramadol among Ethiopian university students at national level. The other limitations of this study is its cross-sectional nature. Even though this study has so many limitations it has its own qualities and strengths. From these good qualities the data collection process was done by using software application called Kobo Tool box, which is simple, easy and amazing technology that reassure the participants to give the right information without any fear of privacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1 Conclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe life time prevalence of tramadol abuse among university students is high and it demands attention of government and general public. The outcome of this study shows that the prevalence of life time tramadol abuse was 11.4%, of whom 23.9% of them were active users. \u0026nbsp;Tramadol abuse was significantly associated having a friend who use drugs, knowing about tramadol and having the history of taking tramadol under physician’s prescription in their life time.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2 Recommendation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe recommend the future researcher to do large nationwide multicenter study. We recommend the higher education administrates to give health education on tramadol abuse risks and consequences for university students. We also recommend health professional to be cautious and responsible regarding rational prescription of tramadol.\u003c/p\u003e"},{"header":"DECLARATION","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ethical clearance with reference number IRB/189/15 was received from institutional review board of Hawassa University College of medicine and health science. Oral informed consent was also taken from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePublication consent:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e: data are available by correspondence author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest:\u0026nbsp;No\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding source\u003c/strong\u003e: Hawassa University funded this research and covered all the expenses of data collection and analysis process and payment for data collectors, supervisors and investigators. The funding institution had no role in decision to publish or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor’s contributions:\u0026nbsp;\u003c/strong\u003eThe corresponding author contributes in the study by conceptualization, study design, supervision, data analysis, and drafting the manuscript. Wudinesh Tamiru, Fetiya Mohammed and Zewengel Bisrat have made a significant contribution in conceptualization and supervision of data collection process. Getu Ataro has made a significant contribution in conceptualization, study design and editing the final draft. All Authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eWe would like to express our gratitude to Hawassa University for giving us grant for this work. We would also appreciate the willingness of data collectors, supervisors and study participants to participate in and play major role in this study.\u003c/p\u003e"},{"header":"REFERENCES","content":"\u003col\u003e\n \u003cli\u003eDawit. Tramadol is listed and under strict control of narcotic drugs - Ethiopian Food and Drug Authority. https://wwwmohgovet/site/node/414. 2022.\u003c/li\u003e\n \u003cli\u003eSubedi M, Bajaj S, Kumar MS, Mayur Y. An overview of tramadol and its usage in pain management and future perspective. Biomedicine \u0026amp; Pharmacotherapy. 2019;111:443-51.\u003c/li\u003e\n \u003cli\u003eDrugs UNOo, Crime. World Drug Report 2018. United Nations publication, Sales No. E. 18. XI. 9 2018.\u003c/li\u003e\n \u003cli\u003eOrganization WH. WHO Expert Committee on Drug Dependence: thirty-sixth report: World Health Organization; 2015.\u003c/li\u003e\n \u003cli\u003eHernandez SH, Nelson LS. Prescription drug abuse: insight into the epidemic. Clin Pharmacol Ther. 2010;88(3):307-17.\u003c/li\u003e\n \u003cli\u003eAkerele E. Global Drug Use. In: Akerele E, editor. Substance and Non-Substance Related Addictions: A Global Approach. Cham: Springer International Publishing; 2022. p. 211-8.\u003c/li\u003e\n \u003cli\u003eSaapiire F, Namillah G, Tanye V, Abubakari A. The Insurgence of Tramadol Abuse among the Most Active Population in Jirapa Municipality: A Study to Assess the Magnitude of the Abuse and Its Contributory Factors. Psychiatry journal. 2021;2021.\u003c/li\u003e\n \u003cli\u003ePhing LTS, Aslam MS. A review study on tramadol abuse among egyptian university students. Journal of Pharmaceutical Research. 2020;5(1):53-7.\u003c/li\u003e\n \u003cli\u003eMohamed NR, El Hamrawy LG, Shalaby AS, El Bahy MS, Abd Allah MM. An epidemiological study of tramadol HCl dependence in an outpatient addiction clinic at Heliopolis Psychiatric Hospital. Menoufia Medical Journal. 2015;28(2):591.\u003c/li\u003e\n \u003cli\u003eMohamed N, El Hamrawy L, Shalaby A, El Bahy M, Abd Allah M. An epidemiological study of tramadol HCl dependence in an outpatient addiction clinic at Heliopolis Psychiatric Hospital. Menoufia Medical Journal. 2015;28(2):591-6.\u003c/li\u003e\n \u003cli\u003eAbdelfattah HH, Abdelaal E, Sobhy DM. Assessment of Non-Medical Use of Tramadol among University Students. Menoufia Nursing Journal. 2019;4(1):115-26.\u003c/li\u003e\n \u003cli\u003eDanso M, Anto F. Factors associated with tramadol abuse: A cross-sectional study among commercial drivers and assistants in the Accra metropolitan area of Ghana. Drugs-Real World Outcomes. 2021;8(3):337-47.\u003c/li\u003e\n \u003cli\u003eSaapiire F, Namillah G, Tanye V, Abubakari A. The Insurgence of Tramadol Abuse among the Most Active Population in Jirapa Municipality: A Study to Assess the Magnitude of the Abuse and Its Contributory Factors. Psychiatry Journal. 2021;2021:1-10.\u003c/li\u003e\n \u003cli\u003eIbrahim A, Yerima M, Pindar S, Onyencho V, Ahmed H, Machina B, et al. Tramadol abuse among patients attending an addiction clinic in North-Eastern Nigeria: outcome of a four year retrospective study. Advances in Psychology and Neuroscience. 2017;2(1-2):31-7.\u003c/li\u003e\n \u003cli\u003eFuseini AG, Afizu A, Yakubu YH, Nachinab G. Facilitators to the continuous abuse of tramadol among the youth: A qualitative study in Northern Ghana. Nursing open. 2019;6(4):1388-98.\u003c/li\u003e\n \u003cli\u003eBassiony MM, Salah El-Deen GM, Yousef U, Raya Y, Abdel-Ghani MM, El-Gohari H, et al. Adolescent tramadol use and abuse in Egypt. The American journal of drug and alcohol abuse. 2015;41(3):206-11.\u003c/li\u003e\n \u003cli\u003eLyman MD. Drugs in society: Causes, concepts, and control: Routledge; 2013.\u003c/li\u003e\n \u003cli\u003eDrugs UNOo, Crime. UNODC World Drug Report 2018. 2018.\u003c/li\u003e\n \u003cli\u003eHawassa University; https://www.hu.edu.et/index.php/hu/overview/background\u003c/li\u003e\n \u003cli\u003eBashirian S, Barati M, Fathi Y. Prevalence and factors associated with tramadol abuse among college students in west of Iran: An application of the theory of planned behavior. Avicenna Journal of Neuro Psycho Physiology. 2014 Aug 10;1(1):26-30.\u003c/li\u003e\n \u003cli\u003eAmin DM, Elnagdi SA, Amer SA. Drug abuse in Zagazig University students, Egypt: Cross sectional study. Occupational Diseases and Environmental Medicine. 2019;7(02):37.\u003c/li\u003e\n \u003cli\u003eMeray MS, Ahmed FH, Rania AR. Study of drug abuse among university students in Sohag, Egypt. Journal of Forensic, Toxicology and Medicolegal Analysis. 2016 Oct;1(2):19-23.\u003c/li\u003e\n \u003cli\u003ePourmohammadi B, Jalilvand MA. Tramadol abuse and its related factors among higher education students in the city of Damghan, Semnan Province, Iran. Quarterly Journal of Iranian Chemical Communication. 2019;7(4. pp. 352-471, Serial No. 25):415-23.\u003c/li\u003e\n \u003cli\u003eKhafagy M, Gomaa Z, Elwasify M. Substance use patterns among university students in Egypt. Middle East Current Psychiatry. 2021;28(1):1-9.\u003c/li\u003e\n \u003cli\u003eLord S, Downs G, Furtaw P, Chaudhuri A, Silverstein A, Gammaitoni A, Budman S. Nonmedical use of prescription opioids and stimulants among student pharmacists. Journal of the American Pharmacists Association. 2009 Jul 1;49(4):519-28.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"tramadol, abuse, misuse, non-medical use, drug abuse, drug misuse, Opioid abuse","lastPublishedDoi":"10.21203/rs.3.rs-4044566/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4044566/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003eTramadol abuse is a current public health concern in Ethiopia. Drug abuse including that of tramadol is a significant public health issue that causes health, economic, and social problems to individual drug users, their families, the community, and the entire nation. Therefore this study delivers information regarding current tramadol abuse among students of an Ethiopian University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003eThe aim of this study is to assess the prevalence of tramadol abuse and associated factors among Hawassa university students, February to June 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods and materials\u003c/strong\u003e: A cross-sectional study was performed among 402 randomly selected Hawassa university students. Data was collected from participant through self-administered researcher made questionnaire using kobo toolbox software applications. Data from kobo toolbox were directly exported to and analyzed by using SPSS version 26 software. Binary logistic regression was applied to identify the factors associated with tramadol abuse. In the final model, Adjusted Odds Ratio, and 95% CI was used to measure the strength of association and P-value less than 0.05 considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult:\u003c/strong\u003e\u003cu\u003e \u003c/u\u003eA total of 402 students were enrolled in this study of which 46 students (11.4%) had history of tramadol abuse once in their lifetime with 23.9% of them were active tramadol abuser with some dependence behaviors. The result of multivariate analysis shows that having a friend who use drugs (p=0.041, OR=1.691), knowing about tramadol (p=0.001, OR=13.766) and having the history of taking tramadol with physicians prescription in their life time (P\u0026lt;0.001, OR=12.951) were the significant predictors of tramadol abuse.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eThe life time prevalence of tramadol abuse among university students is high and it demands attention of government and the general public.\u003c/p\u003e","manuscriptTitle":"Prevalence of Tramadol Abuse and Associated Factors among Hawassa University Students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-09 03:29:18","doi":"10.21203/rs.3.rs-4044566/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d2e7b0f2-0cd2-455c-bd38-07515f740356","owner":[],"postedDate":"December 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-09T03:29:18+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-09 03:29:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4044566","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4044566","identity":"rs-4044566","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}