Evaluation of knowledge, prevalence and effects of opioid abuse among undergraduate students in a public university

In Nigeria currently, opioids are the second most widely used substances among young individuals after cannabis. A review of several literatures reported the prevalence of drug abuse, especially tramadol and codeine, among Nigerian students as 20% - 40%. The aim of this study was to determine the knowledge, prevalence, factors and effects associated with opioid abuse among final year undergraduate students. A cross- sectional study was carried out at a public University. A validated questionnaire was self-administered to 395 respondents. Data obtained were organized and analysed with Microsoft Excel and SPSS version 25. Descriptive statistics was done; frequencies and proportions were used to summarize variables of interest. Chi square test was done for association between variables and opioid abuse. Ethical considerations were observed. A response rate of 98.48% was obtained from the respondents. A total of 101 (26%) respondents used opioids. The most popular opioids abused among the respondents are codeine and tramadol (60 and 63 respondents respectively). A total of 5 respondents used heroin, 3 use pentazocine while only 1 respondent uses oxycodone and morphine. It was observed that majority of the users were males (76%). Peer pressure was the major factor, effects of opioid abuse observed were drowsiness, absence from lectures, examinations and altered daily activities (eating, sleeping and mood). The study revealed a good knowledge of opioid drugs and a high prevalence of opioid abuse among final year students. Tramadol and codeine were the most abused opioids among the respondents. Major effects of opioid abuse were alteration in daily functions and absence from academic activities.

Managing acute opioid withdrawal with tramadol during COVID-19 lockdown in a peri-urban setting

Background: The coronavirus disease 2019 (COVID-19) has highlighted the scope of heroin dependence and need for evidence-based treatment amongst marginalised people in South Africa. Acute opioid withdrawal management without maintenance therapy carries risks of increased morbidity and mortality. Due to the high costs of methadone, Tshwane's Community Oriented Substance Use Programme (COSUP) used tramadol for opioid withdrawal management during the initial COVID-19 response. Aim: To describe demographics, route of heroin administration and medication-related experiences amongst people accessing tramadol for treatment of opioid withdrawal.Setting: Three community-based COSUP sites in Mamelodi (Tshwane, South Africa). Methods: A retrospective cross-sectional study was conducted. Data were collected using an interviewer-administered paper-based tool between April and August 2020. Descriptive statistics were used to analyse data. Results: Of the 220 service users initiated onto tramadol, almost half (n = 104, 47%) were not contactable. Fifty-eight (26%) people participated, amongst whom most were male (n = 55, 95%). Participants' median age was 32 years. Most participants injected heroin (n = 36, 62.1%). Most participants experienced at least one side effect (n = 47, 81%) with 37 (64%) experiencing two or more side effects from tramadol. Insomnia occurred most frequently (n = 26, 45%). One person without a history of seizures experienced a seizure. Opioid withdrawal symptoms were experienced by 54 participants (93%) whilst taking tramadol. Over half (n = 38, 66%) reported using less heroin whilst on tramadol. Conclusion: Tramadol reduced heroin use but was associated with withdrawal symptoms and unfavourable side effects. Findings point to the limitations of tramadol as opioid withdrawal management to retain people in care and the importance of access to first-line opioid agonists.

An overview of analgesics: opioids, tramadol, and tapentadol (Part 2)

Pain can be caused by several mechanisms, and the development of chronic pain (also known as pain chronification) is a complex and often unpredictable process. Opioids, tramadol, and tapentadol provide pharmacological solutions to chronic pain of cancer or non-cancer origins, particularly if central sensitization is present. It may also be indicated for short-term use in acute pain.Despite large studies and meta-analyses of opioids for a variety of pain conditions, the evidence for its clinical effectiveness is still unclear. This is, however, mostly due to significant heterogeneity and bias between studies assessed. The dual analgesic mechanisms of tramadol and tapentadol appear to be effective options for pain relief, with an overall lower incidence of opioidrelated adverse effects. Tapentadol has an analgesic effect comparable to the strong opioids,which appearto be mediated by itsgreater mu opioid receptor activity and more selective noradrenaline reuptake inhibition. Tramadol produces less analgesia than tapentadol, but it is also associated with reduced opioid-related adverse effects and dependence. The opioids and tramadol may be significantly affected by polymorphisms of CYP2D6, while this effect is lessened with tapentadol

Is intravenous long-acting opioid (morphine) associated with more postoperative hypoxemia than short-acting opioid (fentanyl) after non-cardiac surgery?

Background: morphine is a potent analgesic in decreasing postoperative pain; however its use is accompanied by many complications especially respiratory one. On the other side, fentanyl titration may cause less postoperative respiratory complications. Objective: To compare between intravenous long-acting opioid (Morphine), and short-acting opioid (Fentanyl) regarding postoperative hypoxemia after non-cardiac surgery. Patients and methods: A prospective randomized clinical study done on 52 patients, they were divided equally into two groups: Group M (Morphine) received (0.1mg/kg), and Group F (Fentanyl) received (1ug/kg) on induction, and supplemented by effective rescue analgesia. When postoperative VAS score ≥4 , patients in Group M received 5mg morphine as bolus ,and re-assess pain every 5 min to give another bolus ( the total allowed dose was 15mg/3-4h).For Group F 50ug fentanyl was given as a bolus ,and could be repeated (total allowed dose was 100 ug/1-2h.). Result(s): There were no significant difference between two groups as regard respiratory rate (RR) nor peripheral O2 saturation (SPO2) (P value0.05). Conclusion: Intravenous morphine as effective rescue analgesic is not associated with more postoperative hypoxemia, or respiratory depression than fentanyl

The Medical Management of Opioid Dependence in South Africa

Objective : With the increase in opioid dependence in South Africa; medical practitioners are increasingly confronted with requests to treat patients with opioid use disorders. Many medical practitioners; however; do not possess the required knowledge and skills to effectively deal with these patients. An overview of the medical treatment of opioid dependence is provided. Method : A working group of key doctors working in the field of substance dependence; was elected at an Opioid Experts Meeting and compiled guidelines for the management of opioid dependence. This article provides a summery of these guidelines. Recommendations are based on current best practice as derived from scientific evidence and consensus of the working group. It should never replace individual clinical judgment

Postoperative Nausea and Vomiting in Korle Bu Teaching Hospital

Objective: Postoperative nausea and vomiting (PONV) is one of the most distressing morbidities associated with surgery. Even though the incidence can be as high as 30 elsewhere no work has been done to assess the incidence in any health facility in Ghana. This study was carried out to find out the incidence; risk factors and the management of PONV in a tertiary healthcare facility. Design: This was a prospective study. Setting: The study was carried out in Korle Bu Teaching Hospital (KBTH). Subjects and Methods: All patients above the age of 18 years who had surgery including general surgery were included in the study. Information obtained using a questionnaire included demographic data; the type of anaesthesia; the incidence of PONV and its management. Results: Three hundred and six (306) completed forms out of 322 questionnaires were analyzed. One hundred and six patients (34) had episodes of PONV of whom 82 (77.4) had intra-operative opioids. Of the other factors only age was found to be a risk factor with patients in the 20-49 age group constituting 71.8(p= 0.007). Eleven out of 93 patients who reported the episode to a health worker received medication for their PONV. Drugs used included promethazine and antimalaria. Conclusions: Thirty-four percent of patients in the study had PONV indicating that the problem is not uncommon among post-surgical patients in KBTH. Awareness of the problem should be highlighted and adequate management should be given to all patients. Patients at risk should be identified and appropriate management instituted