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Non-medical purposes tramadol use was associated with a confluence of factors, ranging from enhanced sexual performance to economic reasons. Based on the findings of the study and the dependence and addictive potentials of tramadol, there is the need for psychoeducational programmes for persons who misuse tramadol and enhancement of operational capacities of regulatory agencies.
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As tramadol is not prescribed to participants in this study, information on the drug mostly became known to them through recommendations and interactions with friends, relatives and members of the community within which they live. It became known from the interviews that participants follow recommendations and testimonies from friends and others who had used or are using the drug for other purposes aside from its medical functions. The following explanations were provided by some of the participants:
I was introduced into tramadol use through my master that I was working with three years ago. He forced me to take the drug because I was too dull for this work, and the drug will make me very active. In the first instance, I declined to take it, but he constantly threatened of sacking me if I decide not to take the drug. I gave up and took it, and from there I have been enjoying it (25 years old, male, assistant)
Aside from the pressure, few of the participants reported curiosity as a factor that led them to tramadol use. These participants noted two sources of their curiosity: the continuous hyping of the drug by friends and other people who use the drug; and the constant public campaigns on radio and television. It emerged that the perceived good accounts that those who use the drug often give about the drug, as well as the public outcry of the misuse of the drug, have further given the drug much more popularity. Meanwhile, it was evident that the growing public misconceptions about the possible benefits of the drug also made the participants curious about the drug. As a result, these participants first took the drug with the objective of confirming or verifying the various conceptions and misconceptions they heard about the drug. One participant noted:
Participants in this study opined that tramadol is readily available in most chemical shops. It was revealed that though tramadol is a prescription drug, participants obtained it without any prescription note. They specifically explained that no seller has ever requested a prescription note from them before selling the drug to them.
Interestingly, all the participants were aware of some side effects associated with the misuse of tramadol. A myriad of possible adverse effects of tramadol misuse was reported by the participants, whereas some elaborated further their experiences on some of the adverse effects they encounter as a result of the misuse. The adverse effects that emerged from the interviews and analysis were categorised into three: physical, psychological and social effects.
Though participants indicated no sign of stopping non-medical use of tramadol, they rather expressed strong support for the ongoing fake tramadol seizures and prosecution of illegal tramadol peddlers. They further expressed their willingness to collaborate with health officials and security agencies in finding fake and illegal tramadol peddlers. They claimed of knowing some of the illegal and fake tramadol peddlers and they could serve as whistle-blowers to health officials and security officers involved in the fight against tramadol proliferation in Ghana. For their interest, helping officials to eradicate fake tramadol and illegal sellers would help them acquire safe, quality and standard tramadol from certified sellers.
Aside from the underpinning objectives of the present study which have been sufficiently analysed and discussed, four main interesting themes/findings surfaced which are worth mentioning and discussing: First, the study revealed that those who use tramadol are aware of the possible adverse physical, psychological and social effects of their usage. Most of the participants had experienced or continue to experience some unpleasant side effects of tramadol misuse such as vomiting, seizures, loss of appetite, agitation, irritability, stigma, headache, hallucinations, among others. These findings are in line with previous findings [7, 22] on the common adverse effects of tramadol. It also mirrors trend on the common effects of tramadol where majority of the respondents responded to know the side effects of aphrodisiac products particularly tramadol . Whilst the mechanism(s) through which tramadol causes these adverse effects is largely difficult to explain in this study, the side effect of a headache could possibly be an indication that usage of these substances increases blood pressure which may result in cardiovascular disorders with prolonged use. Second, participants of the study offered some praise to those who introduced them into tramadol use. This finding in a way appears surprising as one may think that the misuse of the drug has harmful side effects on the health and wellbeing of those who use it and therefore the users will rather blame their initiators for introducing them to tramadol use. Third, knowing the effects of tramadol misuse, participants showed no willingness of stopping using tramadol for non-medical purposes which suggests the dependence and addictive potentials of the drug . Participants valued the perceived benefits they derive from the drug over stopping using the drug. Interestingly, few of the participants who expressed a desire to quit tramadol misuse were looking for alternative drugs that work as tramadol. These findings contradict previous results of Fuseini et al.  where their participants expressed a desire to quit the misuse of the drug as a result of the adverse effects they experience and more importantly, as a result of lessons learnt from colleagues who have suffered seizures as a result of misuse of the drug. These two findings of the study are indications of how complex and complicated the tramadol misuse fight in Ghana is. Fourth, one good revelation from this study is that many of the participants expressed willingness and desire to support the ongoing efforts of health officials and security agencies to curb tramadol misuse. Most of the participants claimed knowing most of the unlicensed chemical shops and people selling what they see as fake tramadol. With this, they were willing to collaborate with officials to help seize and eradicate fake tramadol and sellers. The authors see this as a useful ground where health officials and other stakeholders can utilise to form partnerships and alliances to influence those who use it to quit tramadol use.
This study has provided knowledge and evidence regarding motivations for non-medical tramadol use in Ghana from the perspective of those who use the drug. Thus, this study offers a depth of understanding to support the ongoing effort toward addressing tramadol misuse in Ghana. However, two important caveats must be acknowledged here: Our findings cannot be regarded as representative to other groups of people who use tramadol and different settings as the study is purely qualitative with aim of identifying contextual themes that cannot be independent of the individuals and context involved. To this, a larger quantitative study would be required.
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79. Our present-day culture exploits the image of the young. Beauty is associated with a youthful appearance, cosmetic treatments that hide the traces of time. Young bodies are constantly advertised as a means of selling products. The ideal of beauty is youth, but we need to realize that this has very little to do with young people. It only means that adults want to snatch youth for themselves, not that they respect, love and care for young people.
84. In some young people, we can see a desire for God, albeit still vague and far from knowledge of the God of revelation. In others, we can glimpse an ideal of human fraternity, which is no small thing. Many have a genuine desire to develop their talents in order to offer something to our world. In some, we see a special artistic sensitivity, or a yearning for harmony with nature. In others, perhaps, a great need to communicate. In many of them, we encounter a deep desire to live life differently. In all of this, we can find real starting points, inner resources open to a word of incentive, wisdom and encouragement.
100. Thank God, those who committed these horrible crimes are not the majority of priests, who carry out their ministry with fidelity and generosity. I ask young people to let themselves be inspired by this vast majority. And if you see a priest at risk, because he has lost the joy of his ministry, or seeks affective compensation, or is taking the wrong path, remind him of his commitment to God and his people, remind him of the Gospel and urge him to hold to his course. In this way, you will contribute greatly to something fundamental: preventing these atrocities from being repeated. This dark cloud also challenges all young people who love Jesus Christ and his Church: they can be a source of great healing if they employ their great capacity to bring about renewal, to urge and demand consistent witness, to keep dreaming and coming up with new ideas.