Naser Nasiri - Department of Public Health, School of Public Health, Jiroft University of Medical Sciences, Jiroft, Iran
Leili Abedi - HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
Ahmad Hajebi - Research Center for Addiction and Risky Behaviors AND Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Alireza Noroozi - Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine AND Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
Malahat Khalili - HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
Maryam Chegeni - HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
Sairan Nili - Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
Moslem Taheri-Soodejani - Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
Mehdi Noroozi - Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
Armita Shahesmaili - HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
Hamid Sharifi

Background: Estimating the population who use drugs is essential for planning, monitoring, and evaluation of substance use prevention and treatment. This study aims to estimate the population who misuse tramadol in urban population in Iran. Methods: We used the wisdom of the experts (WOTE) and network scale-up (NSU) methods to calculate the population of tramadol misusers in ۱۰ provincial capitals of Iran, in ۲۰۱۶. The WOTE was conducted among pharmacists in drugstores and the personnel of traditional medicinal herbs stores. They guessed the best estimation of tramadol misusers population in their cities. The NSU method was conducted among the general population and participants were questioned about ever and daily, non-medical use of tramadol during last ۱۲ months in their network. The median of the methods was used to calculate the proportion of the adult population (۱۵-۴۹ years old). Findings: The population size of tramadol misusers in studied cities was ۸۳۳۰۰ [۹۵% uncertainty limits (UL): ۴۷۹۶۰-۲۵۶۲۲۰]. This corresponded to ۶.۶ per ۱۰۰۰ (۹۵% UL: ۳.۸۸-۲۰.۳۰) of the ۱۵-۴۹-year-old population. The projected number of tramadol misusers for all ۳۱ provincial capitals was ۱۱۸۲۹۰ (۹۵% UL: ۶۸۱۰۰-۳۶۳۱۳۰۸۴۰) and ۲۱۲۴۴۰ (۹۵% UL: ۱۲۲۳۱۰-۶۵۳۴۱۰) for all urban areas. NSU also estimated the number of people who misuse tramadol on daily basis. These numbers were ۵۲۰۰۰ (۹۵% UL: ۱۹۹۴۰-۱۷۶۵۷۰) for studied cities, ۷۳۸۴۰ (۹۵% UL: ۲۸۳۲۰-۲۵۰۷۴۰) for all ۳۱ provincial capital cities, and ۱۳۲۶۱۰ (۹۵% UL: ۵۰۸۶۰-۴۵۰۳۱۰) for all urban areas in Iran. Conclusion: This study presents information on high prevalence of tramadol misuse in urban population. We need national control measures and demand reduction programs to control tramadol misuse.

Tramadol, Prescription drug misuse, Population, Network scale-up method, Wisdom of the experts, Iran