Risk and Protective Factors of Tramadol Abuse in the Gaza Strip: The Perspective of Tramadol Abusers and Psychiatrists

We sought to identify the perceptions of users and medical providers regarding the recreational use of tramadol in the Gaza Strip, a society that is affected by severe political and military violence. We conducted qualitative interviews with psychiatrists and tramadol users to identify their perceptions of the individual, community, and socio-political determinants of tramadol use, its effect on quality of life, and the challenges experienced in the recovery process. Thematic analysis was applied to the narratives of 26 interviewees; 13 psychiatrists (12 males, one female; age range = 32-58, mean age = 44.5, SD,=6.9; years of experience = 6-29, mean = 16.6, SD = 6.3), and 13 tramadol users (13 males; age range = 24-52, mean = 35.1, SD = 8.98). Three main themes emerged, namely,conditions contributing to the misuse of tramadol,challenges in recovering from tramadol misuse, andconsequences of misuse on individuals and social networks. Participants stated that critical environmental and living conditions, such as unemployment, poverty, stress, health, and mental health-related determinants have led to the use of the opioid. Also, disrupted and weak social services that are unprepared to manage widespread substance use cannot safeguard and assist tramadol users. We conceptualize the data in terms of a socio-ecological model drawing on individual, social and cultural determinants of tramadol use, and discuss the clinical and research implications of the findings.