Introduction

introductin:Tramadol misuse is a significant problem in Egypt, yet little is known about tramadol users.

Objectives

objective: to examine the motivations for use of tramadol or heroin among

patients in substance use disorder treatment in order to understand their unique treatment

profiles.

Methods

A cross-sectional observational study was conducted with 100 treatment-seeking

men who reported either tramadol or heroin as their primary substance. Patients were

recruited in 2014–2015 from inpatient and outpatient addiction treatment units in a public

and private hospital in Cairo. A clinical assessment examined their motives for initiation and

continuation of use of either substance based using the following categories: Negative

reinforcement (Pain Avoidance), Positive reinforcement (Pleasure Seeking), Incentive salience

(Craving), Stimulus-response learning (Habits), Impaired inhibitory control (Impulsivity), and

Quasi-medical. Bivariate comparisons of mean scores on motive items and aggregate categories

were conducted for tramadol vs. heroin groups; multivariate regression analyses

controlled for demographic covariates and treatment site.

Results

A majority of the sample

endorsed multiple motives for initiation and continuation of use of their primary substance.

Primary heroin users were more likely to initiate use due to pain avoidance, whereas

primary tramadol users were more likely to initiate use for pleasure seeking (p¼0.002). Pain

avoidance was the strongest motive category for continuation of use for both groups.

Craving was a stronger motivation for initiation and continuation of use among heroin

patients.

Conclusions

Patients in treatment for primary use of tramadol or heroin display unique profiles

of motivations for initiation and continuation of use, which should be considered within

treatment interventions.