{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T08:54:01Z","timestamp":1788684841240,"version":"build-2803163510"},"reference-count":117,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T00:00:00Z","timestamp":1705536000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Tramadol is a widely prescribed painkiller around the world. As a synthetic opioid, it offers a valuable substitute for morphine and its derivatives in African countries. However, the adverse health effects of tramadol use resulting from illicit trafficking, like those caused by fentanyl and methadone in North America, have not been well-documented in Africa. This scoping review aims to shed light on the nature and scope of the nonmedical use (NMU) of tramadol in Africa and its associated health consequences. To carry out our scoping review, we used Arksey and O\u2019Malley\u2019s (2005) five-step approach for exploratory analysis and followed Joanna Briggs Institute guidelines for scoping reviews to ensure systematic and replicable studies. We then searched six databases: Medline, Global Health (EBSCO), Scopus, Web of Science, the African Journals online database, and for grey literature via Google Scholar without any time restriction. The articles were imported into Covidence and reviewed by two independent researchers. Eighty-three studies on NMU of tramadol\u2019s prevalence or health consequences were selected from 532 titles\/abstracts screened, including 60 cross-sectional and six qualitative studies from 10 African countries. Findings from the included studies highlighted five distinct groups significantly affected by the NMU of tramadol. These groups include: 1) young adults\/active populations with varying degrees of prevalence ranging from 1.9% to 77.04%, 2) professionals, where drivers exhibit a relatively high prevalence of tramadol NMU, ranging from 7.2% to 35.1%, and commercial motorcyclists, with a prevalence of 76%, 3) patients, who have a high rate of tramadol NMUs, with prevalence rates ranging from 77.1% to 92%, 4) academics, with a considerable rate of tramadol misuse among substance-using undergraduates (74.2%) and substance-using high school students (83.3%), and 5) other individuals impacted in various ways. The health consequences are classified into four distinct types: intoxication, dependence syndrome, withdrawal syndrome and other symptoms. Despite providing a comprehensive global overview of the phenomenon described in the African literature, this systematic scoping review\u2019s main limitations stem from the relatively limited exploration of various consequences of the NMU of tramadol, notably those of a social and economic nature. Our review shows that tramadol misuse affects diverse populations in Africa. The prevalence of misuse varies within sub-populations, indicating the complexity of the issue. Professional and academic groups have different rates of misuse across regions. This highlights the need for targeted interventions to address unique challenges contributing to tramadol misuse. Future studies should focus on the social and economic costs of abuse on households to better understand the impact on well-being.<\/jats:p>\n                  <jats:p>\n                    <jats:bold>Systematic review registration:<\/jats:bold>\n                    Open Science Framework:\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/osf.io\/ykt25\/\" xlink:type=\"simple\">https:\/\/osf.io\/ykt25\/<\/jats:ext-link>\n                    .\n                  <\/jats:p>","DOI":"10.1371\/journal.pgph.0002784","type":"journal-article","created":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T13:27:15Z","timestamp":1705584435000},"page":"e0002784","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":23,"title":["Prevalence and health consequences of nonmedical use of tramadol in Africa: A systematic scoping review"],"prefix":"10.1371","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0461-6876","authenticated-orcid":true,"given":"Saidou Sabi","family":"Boun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olumuyiwa","family":"Omonaiye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6003-139X","authenticated-orcid":true,"given":"Sanni","family":"Yaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,1,18]]},"reference":[{"key":"pgph.0002784.ref001","volume-title":"41st Expert Committee on Drug Dependence Meeting","author":"WHO","year":"2018"},{"key":"pgph.0002784.ref002","author":"A Klein","year":"2018","journal-title":"Tramadol in Africa: Scarcity and Excess of Pain Medication in a Poorly Regulated Market"},{"key":"pgph.0002784.ref003","volume-title":"The Growing Complexity of the Opioid Crisis.","author":"ONUDC","year":"2020"},{"key":"pgph.0002784.ref004","volume-title":"WHO Expert Committee on Drug Dependence: forty-first report.","author":"WHO","year":"2019"},{"key":"pgph.0002784.ref005","doi-asserted-by":"crossref","first-page":"879","DOI":"10.2165\/00003088-200443130-00004","article-title":"Clinical pharmacology of tramadol","volume":"43","author":"S Grond","year":"2004","journal-title":"Clinical pharmacokinetics"},{"key":"pgph.0002784.ref006","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1111\/j.1460-9592.2006.02030.x","article-title":"Tramadol infusion for the pain management in sickle cell disease: a case report","volume":"17","author":"E Erhan","year":"2007","journal-title":"Pediatric Anesthesia"},{"key":"pgph.0002784.ref007","doi-asserted-by":"crossref","first-page":"25","DOI":"10.2165\/00003495-199700532-00007","article-title":"Le tramadol dans les douleurs aigu\u00ebs.","volume":"53","author":"KA Lehmann","year":"1997","journal-title":"Drugs"},{"key":"pgph.0002784.ref008","first-page":"156","article-title":"World Health Organization essential medicines lists: where are the drugs to treat neuropathic pain?","author":"PR Kamerman","year":"2015","journal-title":"PAIN"},{"key":"pgph.0002784.ref009","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1007\/s13546-011-0306-3","article-title":"Tramadol overdose: review of the literature.","volume":"20","author":"R Afshari","year":"2011","journal-title":"R\u00e9animation"},{"key":"pgph.0002784.ref010","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1097\/ADM.0000000000000380","article-title":"Opioid Use Disorders Attributed to Tramadol Among Egyptian University Students","volume":"12","author":"M Bassiony","year":"2018","journal-title":"Journal of Addiction Medicine"},{"key":"pgph.0002784.ref011","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1080\/14659891.2019.1604842","article-title":"Tramadol misuse in the Niger Delta; A review of cases presenting within a year","volume":"24","author":"U Chikezie","year":"2019","journal-title":"Journal of Substance Use"},{"key":"pgph.0002784.ref012","first-page":"55","article-title":"Mesusage du tramadol par les adolescents et jeunes adultes en situation de rue.","volume":"13","author":"D Maiga","year":"2012","journal-title":"Pan Afr Med J"},{"key":"pgph.0002784.ref013","first-page":"24","article-title":"Seizure in Tramadol and caffeine abusers: about 8 cases and review of literature","volume":"13","author":"D Maiga","year":"2012","journal-title":"Pan African Medical Journal"},{"key":"pgph.0002784.ref014","article-title":", m\u00e9dicament et drogue du pauvre en Afrique de l\u2019Ouest et au Sahel.","author":"A. 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