An examination of motives for tramadol and heroin use in an Egyptian sample.

Tramadol misuse is a significant problem in Egypt, yet little is known about tramadol users. The aim of this study is to examine the motivations for use of tramadol or heroin among patients in substance use disorder treatment in order to understand their unique treatment profiles. A cross-sectional observational study was conducted with 100 treatment-seeking men who reported either tramadol or heroin as their primary substance. Patients were recruited in 2014-2015 from inpatient and outpatient addiction treatment units in a public and private hospital in Cairo. A clinical assessment examined their motives for initiation and continuation of use of either substance based using the following categories: Negative reinforcement (Pain Avoidance), Positive reinforcement (Pleasure Seeking), Incentive salience (Craving), Stimulus-response learning (Habits), Impaired inhibitory control (Impulsivity), and Quasi-medical. Bivariate comparisons of mean scores on motive items and aggregate categories were conducted for tramadol vs. heroin groups; multivariate regression analyses controlled for demographic covariates and treatment site. A majority of the sample endorsed multiple motives for initiation and continuation of use of their primary substance. Primary heroin users were more likely to initiate use due to pain avoidance, whereas primary tramadol users were more likely to initiate use for pleasure seeking (p = 0.002). Pain avoidance was the strongest motive category for continuation of use for both groups. Craving was a stronger motivation for initiation and continuation of use among heroin patients. Patients in treatment for primary use of tramadol or heroin display unique profiles of motivations for initiation and continuation of use, which should be considered within treatment interventions.