TY - JOUR
T1 - Tramadol use and public health consequences in Iran
T2 - a systematic review and meta-analysis
AU - Rostam-Abadi, Yasna
AU - Gholami, Jaleh
AU - Amin-Esmaeili, Masoumeh
AU - Safarcherati, Anousheh
AU - Mojtabai, Ramin
AU - Ghadirzadeh, Mohammad Reza
AU - Rahimi, Hosein
AU - Rahimi-Movaghar, Afarin
N1 - Funding Information:
This study was supported financially by the Iranian National Institute for Medical Research Development (NIMAD) (Grant no. 940043). The funding source had no role in the study design, implementation, analysis and interpretation of the data and in the writing of the manuscript. We would like to extend our appreciation to Marzieh Hamzehzadeh and Leila Hosseini for their help in the screening phase.
Publisher Copyright:
© 2020 Society for the Study of Addiction
PY - 2020/12
Y1 - 2020/12
N2 - Background and Aims: Misuse of tramadol, an opioid prescription analgesic, is known as a public health challenge globally. We aimed to systematically review studies on the prevalence of non-prescribed use, regular tramadol use and dependence, tramadol-induced poisoning and mortality in Iran. Methods: Consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, international (Medline, Scopus, Web of Science) and Persian (SID) databases were systematically searched up to June 2019. Other relevant data were collected through personal contacts and review of reference lists. Pooled estimates of prevalence of tramadol use in subgroups of males and females, percentage of tramadol poisoning among admitted poisoning cases, tramadol-associated seizures and mortality among tramadol poisonings and percentage of tramadol as a cause of death among fatal drug-poisoning records were estimated through a random-effects model. Results: A total of 84 records were included. Pooled estimates of last 12-month use of tramadol in the Iranian general population were 4.9% [95% confidence interval (CI) = 4.1–5.9] and 0.8% (95% CI = 0.2–1.8) among males and females, respectively. The estimates for last 12-month use among Iranian male and female university students were 4.8% (95% CI = 1.9–8.9) and 0.7% (95% CI = 0.3–1.1), respectively. Six heterogeneous reports indicated the existence of regular use of tramadol and dependence in Iran. Sixty-two studies provided data on tramadol-induced poisoning, seizures and mortality. The pooled estimate of the percentage of tramadol poisoning among all drug-poisoning patients was 13.1% (95% CI = 5.7–22.9). The overall estimates of seizures and mortality among tramadol-poisoning patients were 34.6% (95% CI = 29.6–39.8) and 0.7% (95% CI = 0.0–1.9), respectively. The pooled percentage of tramadol-related fatalities among drug-poisoned cases was 5.7% (95% CI = 0.5–15.4). Conclusion: Despite control policies, tramadol use is as prevalent as the use of illicit opioids in Iran. Numerous cases of tramadol abuse, dependence, poisonings, seizures and hundreds of tramadol-related deaths have been reported in recent years.
AB - Background and Aims: Misuse of tramadol, an opioid prescription analgesic, is known as a public health challenge globally. We aimed to systematically review studies on the prevalence of non-prescribed use, regular tramadol use and dependence, tramadol-induced poisoning and mortality in Iran. Methods: Consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, international (Medline, Scopus, Web of Science) and Persian (SID) databases were systematically searched up to June 2019. Other relevant data were collected through personal contacts and review of reference lists. Pooled estimates of prevalence of tramadol use in subgroups of males and females, percentage of tramadol poisoning among admitted poisoning cases, tramadol-associated seizures and mortality among tramadol poisonings and percentage of tramadol as a cause of death among fatal drug-poisoning records were estimated through a random-effects model. Results: A total of 84 records were included. Pooled estimates of last 12-month use of tramadol in the Iranian general population were 4.9% [95% confidence interval (CI) = 4.1–5.9] and 0.8% (95% CI = 0.2–1.8) among males and females, respectively. The estimates for last 12-month use among Iranian male and female university students were 4.8% (95% CI = 1.9–8.9) and 0.7% (95% CI = 0.3–1.1), respectively. Six heterogeneous reports indicated the existence of regular use of tramadol and dependence in Iran. Sixty-two studies provided data on tramadol-induced poisoning, seizures and mortality. The pooled estimate of the percentage of tramadol poisoning among all drug-poisoning patients was 13.1% (95% CI = 5.7–22.9). The overall estimates of seizures and mortality among tramadol-poisoning patients were 34.6% (95% CI = 29.6–39.8) and 0.7% (95% CI = 0.0–1.9), respectively. The pooled percentage of tramadol-related fatalities among drug-poisoned cases was 5.7% (95% CI = 0.5–15.4). Conclusion: Despite control policies, tramadol use is as prevalent as the use of illicit opioids in Iran. Numerous cases of tramadol abuse, dependence, poisonings, seizures and hundreds of tramadol-related deaths have been reported in recent years.
KW - Analgesics
KW - cause of death
KW - drug addiction
KW - drug overdose
KW - epidemiology
KW - meta-analysis
KW - prescription opioids
KW - substance use disorder
KW - systematic review
KW - tramadol
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U2 - 10.1111/add.15059
DO - 10.1111/add.15059
M3 - Review article
C2 - 32196801
AN - SCOPUS:85084037011
SN - 0965-2140
VL - 115
SP - 2213
EP - 2242
JO - Addiction
JF - Addiction
IS - 12
ER -