Given the socio-economic impacts and the high prevalence of non-medical use, it is prudent to assess the prevalence and predictors of non-medical and lifetime use of CPD among patients accessing mental health services at an Ethiopian university medical center. The current study was conducted for the first time in the UoGCSH and the findings revealed a high prevalence of CPD non-medical use (8.2%) among patients with mental disorders, which is slightly lower as compared to the global prevalence of controlled drug non-medical use in the general population, which stands at 11.4% [1].
A study reported that among U.S. adults who misused prescription stimulants, 56.3% cited their motivation for the most recent misuse as staying alert or concentrating. This was followed by motivations to help with studying (21.9%) and reasons such as getting high, being hooked, adjusting the effects of other drugs, or experimenting (15.5%) [10]. In contrast, our findings showed that among NMPDU users, 75% [9] used these medications to relieve operative pain, mainly after bullet injuries, while the remaining users were motivated by mental illness. This difference may be attributed to socio-demographic variations, income disparities, and limited awareness of the stimulating effects of drugs, including opioids, among the population in the study area. Additionally, the small sample size and short study period could have contributed to the limitations in participant selection and the final prevalence rate.
Among U.S. adults with past-year prescription stimulant misuse, the most commonly reported sources for obtaining prescription stimulants were friends or relatives, either for free (56.9%) or through buying or stealing from them [10]. In our study, however, the primary source of CPDs was healthcare professionals (83.3%), with the remainder 16.7% obtained from friends. This finding suggests that, in our study setting, healthcare professionals have been involved in CPD misuse. Furthermore, healthcare professionals’ attitude towards non-medical uses of CPD needs mitigation in the study area.
A national survey conducted in the U.S. found that 27.5% of adolescents and young adults had used a prescription opioid in the past year, with 3.8% of adolescents and 7.8% of young adults engaging in opioid misuse or having a use disorder [11]. This is significantly higher compared to our findings, where the rate of opioid misuse was 7.5%. This difference can be attributed to the limited availability of opioids in the study area and the low involvement of adolescents in non-medical CPD use. Additionally, factors such as the small sample size, single study setting, and short study duration may have contributed to this variation.
In Uganda, the odds of lifetime CPD use were significantly higher among patients treated in inpatient settings (p < 0.001) compared to those treated in outpatient settings [1]. However, in our study, CPD use was notably higher among patients treated in outpatient settings compared to those treated as inpatients. This finding suggests that in our study area, individuals receiving inpatient care may have limited access to CPDs for misuse.
Non-medical use of CPD can impose various socioeconomic burdens on users [10] and requires close attention in Ethiopia. A multimodal approach should be implemented, including assessing prevalence in different settings, evaluating healthcare providers’ attitudes toward NMPDU, and identifying factors associated with CPD use among adults.
The findings of this study revealed that half of the CPD non-medical users were soldiers injured during the war in the northern region of Ethiopia. It is assumed that this figure might decrease if the study were conducted at a different time or in other settings. Most participants began using CPDs non-medically due to bullet injuries.
Additionally, in our study, approximately 83.5% of the participants had a low level of education. This, along with religious and cultural influences in Ethiopia regarding the misuse of CPD, may explain the lower prevalence of non-medical CPD use outside the military population. However, further research is recommended to include a broader population across different study settings. In contrast, in Uganda, most non-medical CPD users had attained a Master’s degree or higher educational level [1].
Based on the findings of this study, along with evidence from other research, healthcare professionals should carefully consider the risk of opioid addiction when prescribing CPDs, particularly for post-operative patients and those with severe mechanical injuries. This approach is crucial to reducing the prevalence of non-medical CPD use [1, 3].
Our research findings revealed that the non-medical use of controlled drugs among patients accessing mental health services at UoGCSH predominantly involved intravenous and capsule forms of tramadol. We also found a significant association between outpatient status and non-medical CPD use. In Jirapa, the prevalence of tramadol use among respondents in the municipality is 36.2%, with 77.6% of users engaging in inappropriate use or misuse of the drug. On average, the daily intake of tramadol was 100 mg ± 42.6 mg. Notably, 32.9% of participants misused tramadol without being aware of the strength or dosages they were consuming. Regardless of the strength, 17.1% of participants reported taking at least four tablets or capsules at once. A significant majority of respondents used dosages of ≥ 100 mg [12]. However, in our study, the prevalence of tramadol use was relatively low (7.5%) compared to the findings of the aforementioned study. The limited availability of the drug and lower interest among adults with less exposure to it may explain the lower prevalence of tramadol misuse in our findings.
Strengths and limitations of the study
The study was conducted for the first time to assess the prevalence and predictors of non-medical and lifetime use of controlled prescription drugs among patients accessing mental health services in the study area. A validated and standardized tool, comprising multiple-domain questions, was used. The findings may serve as a baseline for the prevention and control of non-medical use of controlled prescription drugs in Ethiopia.
Since the data were collected at a single Ethiopian university medical center during wartime, when a significant number of study participants were bullet-injured soldiers, the extrapolation and generalization of the results may not accurately reflect the larger population. Additionally, the small sample size and short study period limited the recruitment of more participants, further affecting the generalizability of the findings.
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