https://orcid.org/0000-0002-1890-6324
Figures
Abstract
Introduction
There is an ongoing global upsurge of opioid misuse, fatal overdose and other related disorders, significantly affecting the African continent, due to resource-limited settings and poor epidemiological surveillance systems. This scoping review maps scientific evidence on epidemiological data on unlawful opioid use to identify knowledge gaps and policy shortcomings.
Method
The databases (PubMed, Scopus, Web of Sciences) and references were searched guided by Population, Concept, and Context (PCC) and PRISMA-ScR. The extracted characteristics examined were author/year, African country, epidemiological distribution, age group (year), gender, study design and setting, common opioid/s abused, sources of drugs, reasons for misuse, summary outcomes and future engagement.
Results
A population of 55132 participated in the included studies of 68 articles, with the largest sample size of 17260 (31.31%) in a study done in South Africa, 11281(20.46%) in a study from Egypt and 4068 (7.38%) in a study from Ethiopia. The gender of the participants was indicated in 65(95.59%) papers. The mean and median age reported in 57(83.82%) papers were 15.9-38, and 22-31years. The majority of study-designs were cross-sectional, 44(64.71%), and the most used opioids were heroin, 14articles (20.59%), tramadol, 8articles (11.76%), and tramadol & heroin, 6 articles (8.82%) articles. Study-settings included urban community 15(22.06%), hospital 15(22.06%), university students 11(16.18%), and secondary school learners 6(8.82%). The highest epidemiological distributions were recorded in the South African study, 19615(35.60%), Egyptian study, 14627(26.54%), and Nigerian study 5895(10.70%). Nine (13.24%) papers reported major opioid sources as black market, friends, and drug dealers. To relieve stress, physical pain and premature ejaculation, improve mood and sleep-related problems and help to continue work, were the major reasons for taking these drugs as reported in twenty articles (29.41%).
Conclusion
The findings of this scoping review show significant knowledge gaps on opioid usage in the African continent. The epidemiological distribution of unlawful use of opioids among young adults, drivers, and manual labourers in both genders is evident in the findings. The reason for use necessity scrutinises the role of social interaction, friends and family influence on illicit opiate use. Therefore, there is a need for regular epidemiological surveillance and investigations into multilevel, value-based, comprehensive, and strategic long-term intervention plans to curb the opioid problem in the region.
Citation: Onohuean H, Oosthuizen F (2025) The burden of unlawful use of opioid and associated epidemiological characteristics in Africa: A scoping review. PLoS ONE 20(3): e0317036. https://doi.org/10.1371/journal.pone.0317036
Editor: Massimiliano Esposito, Kore University of Enna: Universita degli Studi di Enna 'Kore', ITALY
Received: November 6, 2023; Accepted: December 19, 2024; Published: March 7, 2025
Copyright: © 2025 Onohuean, Oosthuizen. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The datasets and information used for this study are fully available within the manuscript.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors declare that there are no conflicting interests.
Introduction
Opiate use disorders and overdoses are an emerging global health concern. Both prescriptions and non-clinical indications contribute to the escalating global opioid use disorder problem (OUD). The opioid crisis has metamorphosed through the Use of: methadone in 1999, heroin in 2010, and the current wave of a combination of heroin, counterfeit pills, and cocaine [1–8]. An estimated 62 million people globally used opioids in 2019, and 36.3 million were impacted by its associated problems [9]. In the US estimated use has increased from 70029 in 2020 to 80816 in 2021 [10], and in Canada, 7560 opioid-related fatalities occurred in 2021 [11]. In Italy opioid addiction affects more than five people per 1000 [12], while a regional study in Germany conducted amongst 57 million adults, found opioid prescription prevalence of 38.7 or 12.8/1000 persons of low- and high-potency opioids in 2020 [13]. However, little is known about the epidemiological characteristics in Sub-Saharan Africa.
There are reports of opioid abuse, although not specifically on opioid fatal overdose or its related disorders, in some African countries, including Egypt, Nigeria, Kenya, Tanzania, and South Africa [14–24]. Some of these studies report the increasing use of tramadol and heroin among university and secondary school students, factories and site workers, long-distance drivers, sex workers, as well as unemployed youth [14–16,23,24]. However, in many other African countries, there is scanty or no information regarding the ongoing opioid crisis.
The findings on the reason for illicit opioid use includes; pleasure-seeking, craving, habits, impulsivity, improving energy [25], relieving stress [26], peer pressure from friends [27], engendering “morale” and “courage” to engage in sex work and “fight” potentially abusive clients [28]. Some of the reported sources are the black market [29], friends and drug dealers [30], roadways, bus terminals or intercity stands, low-income residential areas, abandoned or unfinished buildings, and fishing camps along the Indian Ocean [31].
Global opioid trafficking channels exist from Afganistan, through the india ocean and East Africa to the west [19,32,33]. This impacts heroin use among the population living in the coastal region of Comoros, Tanzania, Kenya, northern Mozambique, Madagascar, Mauritius and Seychelles [34–36]. Unlawful use of opioids could aggravate the already sporadic spread of infectious diseases like malaria, cholera, and HIV [37–41]. In 2018, the UNODC [42,43] predicted with insufficient evidence that another opioid crisis was developing in Africa. Inadequate vital record-keeping and surveillance systems make it challenging to comprehend the incidence burden and effects of opioid overdose in Africa [44].
The rationale for this scoping review
Globally, opioid overdose and deaths are increasing, but little is known about these issues in resource-limited regions of Africa. In Africa, the burden of unlawful use of opioids, overdose deaths, and other disorders remains unquantified, and knowledge and access to possible interventions are generally limited. Again, many poor resource settings in Africa lack reliable vital records, and limited surveillance and epidemiological data have limited our understanding of the prevalence and consequences of the opioid crisis in the region [45]. Opioid issues may be hitting hard on the African continent in combination with the accelerated spread of infectious diseases like HIV [46,47], and the lack of resources available to solve these concerns may impede future advancement towards challenging objectives of the Joint United Nations Programme on HIV/AIDS [48–50]. A Scoping review on the burden of unlawful use of opioids and epidemiological characteristics in Africa will highlight the contributing drivers, public health risk factors and reason for use for effectiveness in control/management and intervention of the brewing opioid crisis in the region. The study aims to synthesise scientific evidence on epidemiological data on unlawful use of opioid/ abuse, the contributing drivers, the reason for use, sources and the impact on public health in the region.
Materials and methods
The study was conducted to answer the questions on evidence available from the existing literature on epidemiological data on unlawful use of opioid/ abuse, the contributing drivers, the reason for use, and prevention and management on the ongoing opioid-overdose crisis epidemic. The scoping review was guided by the Population, Concept, and Context (PCC) approach developed by Joanna Briggs Institute (JBI) [51,52], details in step outline in the protocol (Onohuean and Oosthuizen 2024).
The population of interest (all African countries or within the African continent), the concept covers (epidemiological data, interventions and outcomes). Details include the epidemiological characteristics, prevalence, incidences of unlawful use of opioid/ abuse, the contributing drivers, the reason for use, sources and the impact on public health in the region. Also, reported informations on evidence-based drugs medication of opioid use disorder (MOUD), or Medication-Assisted Treatment (MAT) that is the FDA-approved medication used in conjunction with a psychosocial intervention such as (methadone, buprenorphine and naltrexone) [53,54], evidence-based interventions to prevent the spread of blood-borne pathogens associated with opioids overdoses, such as needle and syringe programs (NSPs), psychoeducation program, Recovery Solutions for Opioid Patients (RSOP) [55], campaigns or advocacy or training, opioids surveillance, prescription drug monitoring programs, findings/conclusions and any additional interventions mentioned by the authors of the studies included were reviewed and meta-synthesised. The context refers to studies that were undertaken in Africa. Types of evidence sources were sources of evidence that cover studies irrespective of study design, such as quantitative studies (e.g., experimental, quasi-experimental, prospective and retrospective cohort, case-control, cross-sectional, community or population-based), observational studies (e.g., case series, individual case reports, descriptive cross-sectional studies), qualitative studies, and mixed-methods studies [52,56,57].
Search strategy
The keywords relevant to the overarching questions’ characteristics were developed to retrieve data on epidemiology, prevalence, opioids and types as details in the supplementary file (Text A1). The keyword was searched in title specific on the three databases; PubMed, WOS, Scopus and other references.
Study selection
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) were followed for the study selection process [58]. All identified research articles written in English from 1990 till 2022 were retrieved on 25 June 2022 at 2:15 PM and updated on 17 December 2022 at 12:05 AM. The data set was merged and normalised in ScientoPy and fBasics R-packages, and duplicates were removed and compiled to save in CSV or Excel file [59–61].
Inclusion and exclusion criteria
The following qualifying requirements were applied in order to include studies: research that was done in the Africa continent, reported on any opioids such as natural (morphine, codeine, and thebaine (paramorphine); semi-synthetic (hydromorphone, hydrocodone, oxycodone, and heroin); fully synthetic (fentanyl, pethidine, levorphanol, methadone, tramadol, and dextropropoxyphene), or reported opioids with other substance or in combination were eligible for inclusion. Also, studies that report mainly on the outcomes of unlawful opioid use such as incident, prevalence, mortality rates, illicit uses and opioids identified by Diagnostic and Statistical Manual of Mental Disorders (DSM-5) codes or urinary analysis, log book, law enforcement or police record, toxicological investigation, autopsy, postmortem, or determined by Substance Abuse and Mental Health Services (SAMHSA). However, research meeting abstracts, proceedings papers, editorial materials, notes, letters, review or mata-analysis review articles, early access, book chapters, news items, reprints, conference paper, short survey, opioids used in cancer treatment, opioid study based on animal experiments, studies that has no total population or cases, other substance abuse without any opioid uses, opioid associated with Covid 19 or HIV or cancer or any terminal illiness, articles on machine learning, other languages not English, e.g., French were not qualified and were excluded. While, there were no limitations to study design or method or sample size or age or sex or type of opioids and along with other drugs.
Data extraction
The two authors (HO and FO) separately examine the titles and abstracts of the retrieved dataset for possibly suitable papers. Studies that where not conducted in Africa, or literature reviews, systematic reviews, conference abstracts, and opinion publications, were omitted. The selected studies’ full texts were carefully examined, and the findings corresponding to the scoping review objective(s) and the information on authors, year of publication of the article, the country where the study was conducted, study design and setting, epidemiological characteristics, prevalence, age group (year), sex, common opioid abuse, sources of drugs, reasons, type of intervention/ summary outcomes/conclusions extracted in the data extraction form. At the same time, issues over eligibility were resolved through debate and consensus among authors. The primary research investigators were contacted when necessary to get any missing data/information from their studies.
Results
Literature search summary
Sixty-eight (n = 68) eligible articles were included in the meta-synthesis in this study, while 49 papers were excluded at full-text review, including papers on opioid prescriptions in cancer treatment (n = 20), opioid on animal experiments (n = 5), articles with no report of the population (n = 11), substance abuse with no apparent opioid uses (n = 6), opioid associated with Covid 19 and HIV (n = 5), and publication using machine learning (n = 2) as depicted in Fig 1.
Included studies characteristics
Between 1990 and 2022, the number of published articles in the African region has increased, and most 50 (73.53%) of the papers presented in the scoping review were published within the last 12 years. A total population sample of 55132 participated in these studies, with the largest sample size of 17260 (31.31%) reported in South Africa [62], 11281 (20.46%) in Egypt [63] and 4068 (7.38%) Ethiopia [64]. The gender of the participants was indicated in 65 (95.59%) papers, and breakdowns were 5 (7.35%) male and 7 (10.29%) female, and 53 (77.94%) both genders. The age bracket reported in 57 (83.82%) papers was mean, median age ranged between 15.9 and 38 years, and median age 22 and 31, as detailed in Table 1.
Study design
The majority of the studies had a cross-sectional observational study and cross-sectional study design 44 (64.71%), were as informed interview questionnaire 9 (13.24%), experimental conformation identification test and urine screen 6 (8.82%), ethnographic research design 2 (2.94%), retrospective study 2 (2.94%), mixed exploratory methods study 2 (2.94%), secondary data collection by qualitative survey 1 (1.47), focus groups 1 (1.47%), case presentations 1 (1.47%) Table 1.
Study setting
Sixty-four articles of the reported studies indicate the study settings. Majority of the studies settings include; community and urban community 15 (22.06%), hospital (neuropsychiatric hospital and Psychiatric hospital) 15 (22.06%), university students 11 (16.18%), secondary school students 6 (8.82%), commercial drivers and assistants, construction and textile industries workers 2 (2.94%), medical school students 2 (2.94%), regional survey 2 (2.94%), rehabilitation camp and treatment centre 2 (2.94%), laboratory 1 (1.47%), local government 1 (1.47%), military officers 1 (1.47%) nation-wide survey 1 (1.47%) general public 1 (1.47%) sex worker 1 (1.47%), hard-to-reach populations 1 (1.47%), Kenyan coast 1 (1.47%) Table 1.
Epidemiology of unlawful opioid use in the African region
In many African countries, misuse of opioids and other drugs continues to grow with little mainstream research notice, while some regions have no reported data. The epidemiological distributions of the majority of the identified articles were reported in nine Africa countries and West Africa (mixed countries), including South Africa 19615 (35.60%), Egypt 14627 (26.54%), Nigeria 5895 (10.70%), Ethiopia 4993 (9.06%), Kenya 4018 (7.29%), Tanzania 2393 (4.34%), Cameroon 1502 (2.735), Ghana 862 (1.56%), Sudan 817 (1.48%), West Africa 384 (0.70%) Fig 2.
Commonly unlawful used opioids in the African countries
The most commonly abused opioids reported in the included 68 studies are as follows: 14 (20.59%) papers reported misused of heroin only, heroin & others (alcohol, tobacco, cannabis, cigarettes, marijuana, khat, caffeine, magic mushroom, methylphenidate) were reported in 17 (25%) papers, heroin & cocaine was presented in 5 (7.35%), only tramadol 8 (11.76%), and tramadol & heroin documented in 6 (8.82%) articles details in Fig 3.
Sources of opioids drugs among the African countries
Most studies do not indicate the sources of opioid use in the reported studies of African countries. However, only nine (13.24%) papers reported sources such as the black market, friends and drug dealers being the major source of tramadol [29,30,72]. Heroin hotspots include roadways, concentrating near bus terminals or intercity stands, low-income residential areas, abandoned or unfinished buildings, and fishing camps along the Indian ocean [31]. According to the report of [26,111], tramadol, tobacco, cannabis, alcohol, amphetamines, tranquillisers, inhalants, opiates, cocaine, and heroin were sourced by peers in most regions. Codeine is sold by retail pharmacies, internet and patent medicine vendors [102]. Other sources for tramadol were street-level markets [117]. Cannabinoid, fub-amb (methyl(2s)-2-{[1-[(4-fluorophenyl), methyl] indazole-3-carbonyl]amino}-3 methyl butanoate) and mixed opiates where gotten by Voodoo [71].
Reasons for opioids use among the African countries
Twenty (29.41%) papers assessed the reason for unlawful use of opioids in the African region. The study by [26] in Cameroon, indicate substance use was to relieve stress. The major reason for opioid use covered in Egyptian studies included; physical, e.g., pain and premature ejaculation or psychological, e.g., mood or sleep-related problems [29]. The study by [30] highlighted improved mood, relief of pain and help to continue work. In the study by [27], peer pressure from friends stood out as the most common reason to start and continue using substances. Also, [25] reported pleasure-seeking, craving, habits, impulsivity, improved energy, staying awake, and deepening insights as the proper factors for opioid use. Similar reasons of peer influence and getting energised, were reported by [75] in Ethiopia. The study in Ghana reported pain relief and sexual enhancement as the main purpose for use [16]. However, the report of [28] in Kenya highlighted “engender “morale” and “courage” to engage in sex work and “fight” potentially abusive clients”. The report from studies in Nigeria’s literatures were not so different from other countries in the region. Among them were to control nausea and vomiting during early pregnancy [73], cultural expectations [91], to enhance their academic performance [94], to enhance their farming livelihood practices and withstand stress during farming [99]. Also, peer pressure and low level of national regulations [92], while relief from stress, self-medication to treat illness and staying awake at night to study was reported by [98]. Again, relieving tiredness and prolonged sex, cheap prices and ease of access were documented by [101], while [90] reported unemployment and poor educational status as the reason for use. In South Africa, the study of [106] documented adjusting to a new social environment or adapting to the academic load and responsibilities, peer pressure, social activities and external factors. Ecstasy stimulants enhance libido (female sex worker), injection enhances the sexual experience, snorting prolongs sexual stamina, and anal administration builds confidence (male) were reported by [31]. The study by [111] in Sudan reported curiosity as the reason for the initiation of substance use, pleasure, relief of psychological stress, and relief of fatigue. In Tanzania, similar reasons, including peer pressure, fun, family problems and influence from family, were motives for commonly used [21].
Summary outcomes and future engagement on the burden of unlawful use of Opioid and epidemiological characteristics in Africa
The summary outcomes and future engagement is highlighted in Table 2. Future studies may focus on the elements that influence incentives to change in regard to illicit opioid drug use and are likely to focus on views of the impact on social relationships, the social context of the situation, and the behaviours of friends and family that influence the patients to think about changing. The findings of this scoping review have presented the suggestion of investigators that multilevel, value-based, comprehensive, and strategic long-term intervention plans are some requirements for curbing the opioid problem [26]. Population-based longitudinal studies are needed to investigate tramadol use and the possible role of tramadol as a gateway drug [69]. Expanding coverage of current laws and occupational safety and health standards to cover workers in the informal sector, especially in developing countries, was recommended by Abbas et al., 2013 [68]. Deyessa et al., 2020 [64] suggested the implementation of the essential harm reduction strategies given by the world health organisation. Community awareness and training on needle syringe programs (NSP), and assisted therapy (MAT) were proposed by Oguya et al., 2021 [82]. Lingering on access to naloxone to lay people and community and peer-based opioid overdose prevention training in Tanzania was recommended by Saleem et al., 2021 [33], which could also be spread to other Africa nations. Psychiatric comorbidities associated with heroin use disorders patients underscore the need for substance treatment services with the capacity to diagnose and manage these comorbidities [109].
Discussion
This scoping review is done at a time when there is a global upsurge of opioid misuse and other related disorders, but little mainstream research attention is paid to the problem on the African continent, especially in resource-limited settings. However, we are confident that mapping the breadth and depth of research on the unlawful use of opioid will trigger stakeholders and government response in the African region. Here, we examine a growing corpus of research on the unlawful use of opioids and exclude opioid prescriptions or medications. We did not attempt to evaluate the quality of the included research articles since the scoping review made no assertions or conclusions about the findings. However, the gaps in the synthesised scientific evidence covering over three decades could aid in directing researchers and policymakers in managing the opioid crisis in Africa.
Epidemiology of unlawful use of opioid in the Africa population
We found 68 original research papers discussing different illicit opioid use in Africa between 1990 and 2022 (32 years). The majority of the studies were from West Africa (Nigeria), Central (Egypt), East Africa (Keyan and Tanzania), and Southern (South Africa) regions. It affects all ages. The rising illicit use of opioids and other drugs is poorly documented in Africa with zero statistics.. The paucity of epidemiologic information about unlawful use of opioid and overdose in the literature reviewed making it difficult to understand the opioid crisis in Africa.
We found few published articles on the prevalence of opoid usage, but these lack the detail of overdose crisis [2,119,120]. The methodological approach for opioid research in Africa is constrained and most of the assessment window’s timing, population and the tools employed varied. A study on Nation-wide, secondary school and university students, rural and urban communities, and hospitals, showed the evolving consequences of unlawful use of opioid and related disorders. Additionally, it was uncommon for most studies to distinguish between occasional opioid usage (e.g., tried many times in the past week) and single-use (e.g., tried once in a lifetime), and verified clinical diagnoses were not published at all. Most publications were cross-sectional investigations without effort at participant follow-up or extended beyond the cohort. Also, few studies went beyond straightforward descriptions, correlations or risk factors, and it was uncommon for any underlying theories or conceptual models to be articulated. Lastly, a good number of studies focuses on people living with HIV and students as particularly high-risk groups, while scant evidence regarding unlawful use of opioid in other vulnerable population such as hard labourers, unemployed, internally displaced (refuges camp), students with co-occurring mental health issues etc.
Demographic and burden of unlawful use of opioid in the African region
In Africa, the burden of unlawful use of opioid is not limited to specific demographics such as sex, age, occupation or population, only with some levels of variations, despite a variety of demographic, psychological, and social characteristics that have been linked to drug use in various studies [32,121,122]. The Sub-Saharan African region has been estimated to experience about a 130% increase in the burden of mental health, substance use disorders, and disability [32]. This main, further weekend, the already over-stressed health system with poor full-time equivalent (FTE) staffing needs for the health industry was estimated to be far lower than the actual FTE staffing levels recommended [123]. Nevertheless, due to a lack of estimated data and paucity of epidemiologic or clinical evidence on opioid overdoses, fatalities and other related disorders in the literature reviewed, the public health burden may be underreported. However, our findings highlighted the African nation’s distribution: young adults have been the most vulnerable population, and heroin, tramadol, and in combinations with other opioids or combination with other classes of substances are frequently misused in the region. This indicates a public health concern with other risk factors such as terrorism, violence, and the spread of infectious diseases, which require an urgent surveillance system, treatment/counselling centre and research centre for strategic prevention implementation.
Specifically, abuse of tramadol and codeine is a widespread, disturbing occurrence in the Egyptian community [25,30,72]; Nigeria [87,101], Ghana [16] particularly among secondary and university students, unemployed and long-distance drivers. Due to their easy availability on the over-the-counter (OTC), black market, low cost, and effectiveness in treating premature ejaculation, it became the most often used drug among young people and adults. However, studies reported that most work labourers and long-distance drivers admitted that tramadol helped them keep up with daily tasks, have a positive attitude, be more friendly, and not feel exhausted to accomplish challenging tasks and prevent withdrawal symptoms. This notion indicated a need for public awareness and re-orientation of the adverse effects of tramadol misuse and an awareness of regulatory authorities. At the same time, severe pain, myalgia, sleeplessness, and autonomic signs such as diarrhoea, rhinorrhea, lacrimation, and nausea were the most distressing side effects of tramadol withdrawal [72]. Heroin is also common misuse in Ethiopia [64,74], South Africa [105,107], and Western Kenya [79,80,86], while injecting heroin is becoming a more significant public health issue in Tanzania [21,28] with high potential of spreading to the country’s neighbouring regions, including Uganda, and Rwanda. Heroin trafficking and consumption have gradually increased in Tanzania over the past ten years. These implied that the East Africa nations must start assessing the likelihood of heroin use in their regions. Due to the increasing use of African trade routes by global opioid trafficking channels, the use of opioids for non-clinical purposes has increased in the continent [32,121,124].
The most alarming age population is 12-30. People in their midlife or potential life have been substantially connected with increased opioid fatal overdoses [125]. Opioid drug misuses such as morphine, codeine, hydrocodone, fentanyl, methadone, dextropropoxyphene, heroin, and tramadol, have now become a common component of adolescent experimentation, socialisation, risk-taking, and reward-seeking, especially done among a specific young group of people [126]. Sex workers often use opioid drugs such as heroin and fentanyl to enhance sexual performance, as a coping mechanism, to gain the courage to approach clients and endure the harsh street environment [126–128] with severe implication for sexually transmitted infections (STIs).
Looking at the age variability in our findings, the years spent in high school and traditional universities, differs [129,130] and there is a positive correlation between adolescence, adulthood and the emergence of substance use disorders due to adverse childhood experiences (ACEs) [131]. Also, self-reliance from parents, new communal and intimate connections alongside peers, increased access to drugs and alcohol, and the need for independent learning all give to a distinctive social environment which is at a phase of development that is characterised by the highest levels of risk-taking and its associated behavioural, mental health problems [132–134]. This is one of the certain utterly lacking crucial potential investigation areas based on this scoping review.
The discrepancy between adequate use and need for opioids in Africa
The problem of unlawful use of opioids highlighted in this study is undeniably concerning, particularly in light of its impact on patients who genuinely require opioids for medical reasons, such as those suffering from cancer, HIV, palliative care, or terminal illness etc. While the study sheds light on the issue of illicit use, it is crucial to also recognize the significant problem of undertreatment of pain in many parts of the world, particularly on the African continent [135,136]. Also, reports and the official data from the United Nations and the World Health Organization (WHO) reveal the stark reality of the undertreatment of pain in Africa [137–139], where there is a scarcity and limited availability of opioids for medical use. This shortage of essential medications has dire consequences, leading to thousands of individuals enduring unnecessary suffering and experiencing inhumane deaths due to the lack of access to adequate pain relief.
While addressing the opioid abuse crisis is crucial, it is equally important to address the systemic barriers that prevent access to essential pain management medications for those who desperately need them. This underscores the urgent need for comprehensive strategies and policy interventions to ensure equitable access to pain relief medications for all individuals, regardless of their geographical location or socioeconomic status.
Summary outcomes, prevention, treatment and future engagement
Our finding further shows an increasing illicit opioid drug use, which could soon reach or escalate to alarming levels in Africa, if not unnoticed, due to poor surveillance systems. Tramadol and heroin are commonly misused among adolescents in the region with the impact of attention-deficit/hyperactivity disorder (ADHD). However, our scoping review found insufficient published research on opioid drug-related harm reduction or prevention in the region. Psychological services or behavioural therapies for young stars and school students suffering from mental health issues associated with opioid abuse are completely lacking. This may be due to poor data from mainstream research for public awareness of the opioid crisis in the region or a result of the sluggish stakeholder response to unlawful use of opioid and its potential dangers, as well as the negative effects of stigma and legality on attempts to get help. Also, there is no report on clinical trials tailored towards delivering interventions to adolescence or adulthood-specific opioid issues in the region.
This review suggests more investigation is needed to comprehend better the mechanisms underlying adolescent and adulthood drug use and associated mental health issues
- Establishing a rehabilitation centre to correct and reform addicts or specific behaviours related to unlawful use of opioid at the early-stage diagnosis.
- surveillance initiatives and characterisation of overdose is recommended.
- Furthermore, multilevel, comprehensive, value-based, and strategic long-term intervention plans are needed.
- introduction of community peer-modeling strategies or techniques.
- • the engagement of satkeholders in sensitise young people, about illicit opioid use and its adverse impacts.
- Research engaging relevant demographics in the design of interventions for opioid uses and other drugs of abuse may boost acceptability, adherence and implementation.
- brief in-person and motivational intervention delivery may be promising.
- Continuous tracking young star opioid drug and alcohol use is essential if effective evidence-based policy and intervention initiatives are to be developed.
- studies could be focused on prevalence and risk assessment of opioids abuse in the Africa continent as recommendation.
- evaluations of novel theoretically based prevention and treatment strategies that consider recognised risk factors for opioid use and disorders.
Research limitations
Among the limitations of this scoping review is the restriction of articles written in English as mandated by inclusion criteria, while documents written in French were excluded. Additionally, no quantitative data analysis was performed in this study that could have questioned or supported our findings.
Conclusion
Our scoping review has shown significant gaps in the body of research on opioid usage in the Africa continent. The findings are evident on the epidemiological distribution of the unlawful use of opioids among young adult, drivers and manual labor in both genders. Evidence-based healthcare assessment and regulations of the illicit sources or contributing drivers to inform prevention and management strategy. The reasons for use underscores the need to examining the social interactions impact, the actions of friends and family that influence unlawful opioid uses.
Supporting Information
S1 File. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.
https://doi.org/10.1371/journal.pone.0317036.s001
(DOCX)
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