Title : Non-medical tramadol use among adolescents in Lagos state: An emerging public health threat

The non-medical use of pharmaceutical opioids among adolescents has emerged as a growing public health concern in West Africa, with tramadol increasingly implicated as a substance of misuse. Although tramadol is clinically indicated for the management of moderate to severe pain, its widespread availability through informal and poorly regulated markets has facilitated non-medical use among young people. Tramadol misuse has been linked to dependence, neuropsychiatric complications, poor academic performance, and engagement in other high-risk behaviors. In rapidly urbanizing settings such as Lagos State, Nigeria, adolescents may face heightened vulnerability due to increased access, peer influence, and limited regulatory enforcement. This study examined the prevalence, patterns, and correlates of non-medical tramadol use among secondary school students in Lagos State to inform prevention strategies and policy responses.

A school-based descriptive cross-sectional study was conducted among 800 secondary school students selected using a multistage sampling technique across public schools in Lagos State. Data were collected using a World Health Organization–adapted student drug-use questionnaire that assessed lifetime, past 12-month, and past 30-day tramadol use, age at initiation, frequency of use, and selected sociodemographic and behavioral factors. Non-medical tramadol use was defined as use without a prescription or for non-therapeutic purposes. Data were analyzed using Epi Info statistical software. Descriptive statistics were used to summarize prevalence and patterns of use, while chi-square tests examined associations between tramadol use and sociodemographic variables. Statistical significance was set at p<0.05.

Overall, 48 participants reported a lifetime history of tramadol use, yielding a prevalence of 6.0%. Among adolescents who had ever used tramadol, 83.3% reported use within the past 12 months, indicating largely recent consumption. Past 30-day use was common, with 50.0% reporting use on 1–5 days, 12.5% reporting use on 6–19 days, and 2.1% reporting use on 20 or more days in the preceding month. Early initiation was notable, as 25.0% reported first use at age 10 years or younger, while another 25.0% initiated use between ages 13 and 14 years. Tramadol emerged as the most commonly misused pharmaceutical opioid and the second most prevalent substance overall after alcohol. Use was significantly higher among male students and older adolescents, and peer introduction was frequently reported as the primary pathway to initiation.

Non-medical tramadol use among secondary school students in Lagos State represents a significant and emerging public health threat. The observed prevalence, early initiation, and frequent recent use underscore the urgency for action. Findings highlight the need for strengthened pharmaceutical regulation, enforcement against informal sales, and adolescent-focused prevention efforts. Integrating tramadol-specific messaging into school health programs and community-based interventions that address peer influence and risk perception may help reduce opioid-related harms among adolescents in urban, resource-constrained settings.

Tolulope Olagoke Kolawole is a PhD candidate in Social and Behavioral Sciences at Virginia Commonwealth University School of Public Health. He is a Graduate Research Assistant with extensive experience in adolescent substance use research, cancer survivorship, and public health program leadership. He holds a DVM, MSPH, MBA, and is a Fellow of the Royal Society of Public Health. His work focuses on substance use prevention, health equity, and community-engaged public health interventions in low- and middle-income settings.