The risk and protective factors of tramadol abuse in the Gaza strip: The perspective of tramadol users and psychiatrists

Background In the context of ongoing political and military violence and economic and social disruption, data from the Ministry of the Interior have indicated an increase in the prevalence of substance use among youth and adults in Gaza. Many substance users visit psychiatrists for treatment for their mental health problems. The aim of our qualitative study was to explore the perceptions of a convenience sample of psychiatrists and tramadol users about the risk and protective factors of substance abuse among those users. Method We recruited a convenience sample of 13 psychiatrists (12 M, 1 F; age range 32-58, mean age 44.5, SD, 6.9; years of experience 6-29, mean 16.6, SD, 6.3) from the Ministry of Health and a local NGO as well as a sample of 13 tramadol users (13 M, 0 F; age range 24-52, mean 35.1, SD, 8.98). We conducted semi-structured in depth interviews in Arabic. Interviews were recorded, transcribed, translated into English and subjected to thematic content analysis. Results A number of main themes emerged from the data. The first theme was risk and protective factors, the second theme was the impact of tramadol on the quality of life of tramadol users, the third theme was challenges of treatment and recovery, and the fourth theme was concerns and perceptions of tramadol users and psychiatrists. The Participants stated that the ongoing siege on Gaza, frequent military attacks by Israel, other human rights violations in Gaza, and the availability of illicit substances such as Tramadol were risk factors for substance abuse. Moreover, religiosity and perceived social support emerged as protective factors from tramadol abuse. Conclusion Psychiatrists and tramadol users perceived the risk and protective factors of substance abuse as being multi-factorial including individual, micro, and macro social dimensions. They perceived community and social factors as protective, while individual factors were perceived as being related to risks. Community-based interventions such as awareness programmes may strengthen the competencies of at-risk individuals and thus contribute to a reduction in substance use in Gaza.