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BACKGROUND: Tramadol hydrochloride is a common prescription pain reliever that is structurally similar to morphine and codeine with its analgesic effects identified as a mu-receptor agonist. Due to its opioid-like stimulant effects, the potential for tramadol misuse is a public health concern. As such, the aim of this investigation is to estimate the prevalence of tramadol misuse in a sample of Iranian adolescents and to assess the relationship between tramadol misuse and other substance use. METHODS: This is the first phase of a prospective survey examining the prevalence of adolescent smoking status, substances use and related factors in Ilam city, Iran. Grade 10 male and female students (n=2000) were recruited using multistage sampling. Self-administered multiple-choice questionnaires were conducted with data analysed using cross tabulations and logistic regression models. RESULTS: The prevalence of lifetime tramadol misuse was 4.8% (7.6% males; 1.8% females). Adjusted odds ratios and confidence intervals for lifetime tramadol misusers reporting substance use during the past month were 2.2 (1.1-4.4) for alcohol, 5.0 (1.5-21.9) for cannabis, 8.9 (2.7-29.4) for ecstasy, 0.5 (0.03-7.0) for methamphetamine and 2.3 (0.7-7.4) for opium. CONCLUSION: Tramadol could be a related factor or co-factor for adolescent alcohol, cannabis and ecstasy use. We recommend future longitudinal studies to investigate the possible role of tramadol as a gateway drug in the development of substance abuse.

Original publication




Journal article


Addict Behav

Publication Date





333 - 337


Adolescents, Iran, Substances use, Tramadol, Adolescent, Alcohol Drinking, Amphetamine-Related Disorders, Analgesics, Opioid, Female, Humans, Iran, Male, Marijuana Smoking, Methamphetamine, N-Methyl-3,4-methylenedioxyamphetamine, Odds Ratio, Opioid-Related Disorders, Opium, Prescription Drug Misuse, Prevalence, Prospective Studies, Sex Distribution, Substance-Related Disorders, Surveys and Questionnaires, Tramadol