The prevalence of tramadol use and its dependence for the pain management in Al Ahsa district of Saudi Arabia: A chart review study

Background: Tramadol hydrochloride, synthetic centrally acting opioid analgesics is being widely used throughout the world. In many Middle East countries, tramadol abuse was raised as a major public health issue. This study was aimed to determine the prevalence of tramadol use and abuse among Saudi patients living in Al-Ahsa region, the risk factors associated with tramadol use/ abuse. Material and methods: This was a cross-sectional chart review study which was conducted at a single center, King Fahad Hospital in Al Hofuf, Saudi Arabia from January 2020 to December 2021. The data were collected from three main sources: the Pharmacy medical records, from the electronic medical records, and from interviewing the patients. The incomplete information was obtained by calling the patients through the contact number they had provided to the hospital. The Epi info software was used for calculating the sample size, assuming a confidence level of 95% and margin of error at 5% and a power of 80% and with the assumption of the prevalence of tramadol use in the population to be 26% (as reported from one similar study ) with 5% deviation. The total sample size calculated was 277.The data were collected on the data collection sheet especially prepared for this study based on the similar study.. The data were entered and analyzed by using the SPSS, version 21. Descriptive statistics (e.g. number, percentage) and analytic statistics using Chi Square tests (χ2) to test for the association and/or the difference between two categorical variables were applied. Logistic regression analysis was also done. A p-value equal to or less than 0.05 was considered statistically significant. Result: The records of 277 patients who were taking pain killer for their treatment were retrieved for this study. The mean age of the participants was 43.10 years ± St. Dev. 11.30 years. Majority of the participants were in the age group of 38-47 years of age (35.4%). The majority of the participants (71.8%) were male. Likewise majority of the participants were married (90.3%) while 2.9% were never married and 6.5% were divorced. More than fifty parents of the participants were graduate (56.7%) while 30.3% were secondary educated. Almost sixty four percent of the participants were unemployed. More than thirty one percent (31.4%) of the participants were using tramadol tablet. Among them 84.5% were using it for acute pain while the rest 15.46% were using it for chronic pain. More than seventy two percent of the participants (72.71%) never used the tramadol without physician prescription while the rest took it from other source without physician prescription. Young (18-27 years) and older age group (58- 67) participants were 2 times more likely to use the tramadol as compared to other age group (AOR 2.27; 95% CI 1.36-3.41,P=0.046).Most of the elder group of the participants used tramadol for arthritis pain. Non Saudi was 7 times more likely to use and misuse tramadol (AOR 7.27; 95% CI 3.23-12.98, P=0.013). Similarly the use and dependency on Tramadol among the participants with high income group was 2.50 times more than those with middle and low income group participants (AOR 2.50,95% CI1.35-4.32,P=0.045) and the participants with arthritis were 7 times more prone to Tramadol use and dependency as compared to other participants with other diseases (AOR 7.23 ; 95% CI 3.35-14.43). Conclusion: The study has shown not only a high prevalence of tramadol use but also\ high dependency of the patients suffering from pain on tablet tramadol. This is a matter of concern especially among the young population. The strict regulation on the drug system in Saudi Arabia has not allowed it for easy access. However it is important that measures should be taken by the public health department to stop the unnecessary use of tramadol to prevent the abuse.