In a groundbreaking study published in BMC Psychiatry, researchers from the University of Gondar Comprehensive Specialized Hospital (UoGCSH) in Northwest Ethiopia have shed new light on the prevalence and predictors of non-medical use of controlled prescription drugs among patients engaged in mental health services. This hospital-based investigation, conducted over six weeks in mid-2022, offers profound insights into the complex interplay between mental health challenges and the misuse of prescription medications, an issue that remains underexplored in African healthcare contexts.
Nonmedical prescription drug use (NMPDU) constitutes a critical public health concern globally, especially within vulnerable populations such as individuals suffering from psychiatric disorders. Although widely recognized in Western countries, the extent of this problem in Ethiopia has remained largely undocumented until now. NMPDU involves consuming medications without a prescription or using them in ways other than prescribed, which can exacerbate existing mental health conditions, foster dependence, and create additional complications in clinical management.
The research team employed a cross-sectional design, recruiting 146 patients attending both outpatient and inpatient mental health services at UoGCSH. Using a semi-structured questionnaire administered during face-to-face interviews, investigators collected detailed data concerning lifetime use and non-medical utilization of controlled prescription drugs (CPDs). Statistical analysis, including multivariate logistic regression, allowed the researchers to parse out key predictive factors associated with CPD misuse, lending rigor and depth to their findings.
One of the study’s most striking discoveries was the identification of tramadol — an opioid analgesic available in both oral capsules and intravenous forms — as the most widely misused controlled drug among participants. Over 90% of those reporting non-medical use disclosed tramadol consumption, underscoring its central role in the substance abuse patterns observed. A smaller proportion of participants reported non-medical use of amitriptyline, a tricyclic antidepressant, pointing to the diversity in drug misuse profiles within this patient population.
The overall lifetime prevalence of nonmedical CPD use among mental health patients stood at 8.2%, reflecting a significant, yet previously undocumented, burden. This prevalence is alarming given the known risks associated with uncontrolled opioid use, including overdose, increased psychiatric symptomatology, and the potential for developing chronic dependence. The implications for clinical care and public health policy in Ethiopia are profound, highlighting an urgent need for targeted interventions.
A particularly notable finding related to treatment settings: individuals receiving outpatient mental health services demonstrated over sevenfold increased odds of engaging in CPD misuse compared to their inpatient counterparts. This disparity suggests possible differences in drug accessibility, monitoring, or support mechanisms between inpatient and outpatient care. Outpatient patients may face fewer restrictions and more opportunities to acquire and misuse medications without appropriate oversight.
Exploring the motivations behind non-medical CPD consumption revealed that pain relief was a primary driver. Three-quarters of the individuals using these drugs non-medically did so to alleviate post-operative pain, signaling a potential gap in pain management protocols within the healthcare system. Another notable reason for misuse was relief from restlessness, a symptom frequently associated with various psychiatric conditions, which may not be adequately addressed through conventional treatments.
Technically, the study’s utilization of multivariate logistic regression models allowed for adjustment of confounding variables, lending confidence to the association between outpatient treatment and CPD misuse. The confidence interval for this association (AOR = 7.609, 95% CI = 1.429–40.507) suggests a robust link, albeit with some variability likely due to the sample size. Nonetheless, these quantitative findings offer essential evidence to inform policy and clinical guidelines.
The implications for mental health care providers are significant. It is paramount to integrate routine screening for non-medical CPD use into psychiatric evaluations, especially within outpatient settings. Furthermore, establishing clearer prescribing guidelines, promoting patient education about the risks of medication misuse, and enhancing post-operative pain management could collectively reduce the risk of abuse.
From a broader perspective, this study uncovers systemic challenges in Ethiopia’s mental health service delivery, where limited resources may impede comprehensive management of co-occurring substance use and psychiatric disorders. The data advocate for strengthening multidisciplinary approaches that encompass addiction specialists, psychiatrists, and pain management experts working collaboratively.
Moreover, by focusing on a university hospital setting, the research highlights the need for similar studies in diverse regions and healthcare tiers across Ethiopia and sub-Saharan Africa. Establishing the prevalence and predictors of CPD misuse across settings will be critical for designing scalable interventions suited to local healthcare infrastructures.
In conclusion, the pioneering work from Tadesse and colleagues at the University of Gondar has illuminated an intricate and pressing public health issue—non-medical use of controlled prescription drugs among mentally ill patients. The predominance of tramadol misuse and the heightened vulnerability of outpatients call for urgent attention. As Ethiopia and similar nations strive to strengthen mental health services, addressing prescription drug misuse will be integral to improving both psychiatric outcomes and overall patient safety.
By recognizing the interaction between mental health and substance use disorders through data-driven research, healthcare policymakers can better allocate resources and sculpt interventions that resonate with the lived realities of patients. With careful surveillance, enhanced clinical protocols, and community engagement, the tide of controlled prescription drug misuse might be stemmed, ultimately elevating the quality of mental health care across the region.
Subject of Research: Prevalence and predictors of non-medical and lifetime use of controlled prescription drugs among patients accessing mental health services in Northwest Ethiopia.
Article Title: Prevalence and predictors of non-medical and lifetime use of controlled drugs among patients accessing mental health services at the university of Gondar comprehensive specialized hospital: Northwest Ethiopia.
Article References:
Tadesse, T.Y., Kifle, Z.D., Adugna, M. et al. Prevalence and predictors of non-medical and lifetime use of controlled drugs among patients accessing mental health services at the university of Gondar comprehensive specialized hospital: Northwest Ethiopia.
BMC Psychiatry 25, 638 (2025). https://doi.org/10.1186/s12888-025-07092-9
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