Managing acute opioid withdrawal with tramadol during COVID-19 lockdown in a peri-urban setting
African Journal of Primary Health Care & Family Medicine
| Field | Value | |
| Title | Managing acute opioid withdrawal with tramadol during COVID-19 lockdown in a peri-urban setting | |
| Creator | Bhoora, Urvisha Gloeck, Natasha R. Scheibe, Andrew | |
| Description | 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.Contribution: This research contributes to the limited data around short-acting tramadol for opioid withdrawal management in the African context, with specific focus on the need for increased access to opioid agonists for those who need them, in primary care settings. | |
| Publisher | AOSIS | |
| Date | 2022-09-28 | |
| Identifier | 10.4102/phcfm.v14i1.3386 | |
| Source | African Journal of Primary Health Care & Family Medicine; Vol 14, No 1 (2022); 9 pages 2071-2936 2071-2928 | |
| Language | eng | |
| Relation |
The following web links (URLs) may trigger a file download or direct you to an alternative webpage to gain access to a publication file format of the published article:
https://phcfm.org/index.php/phcfm/article/view/3386/5661
https://phcfm.org/index.php/phcfm/article/view/3386/5662
https://phcfm.org/index.php/phcfm/article/view/3386/5663
https://phcfm.org/index.php/phcfm/article/view/3386/5664
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