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As a result, the World Health Organisation (WHO) has given much attention to the dependence on tramadol, and four different estimates have been made between 1992 to 2006 by Expert Committee on Drug Dependence (ECDD) [18,19,20,21]. However, these estimates failed to determine the control of tramadol internationally, largely due to inadequate information on the misuse potential and side effects . With this, in most countries including West African sub-region countries, tramadol is not on the list of controlled substances regulated by regulatory authorities making the drug readily available in pharmacies, chemical shops and the black market and can be acquired without a prescription [5,6,7]. Evidence suggests that the misuse of tramadol has some effects including nausea, vomiting, constipation, sweating, dizziness, seizures and postural hypotension [1, 22, 23]. Several reports also indicate that tramadol misuse can have some effects on the brain, mind, heart, respiratory or breathing system and can even lead to coma and death .
In Ghana, though epidemiological data on tramadol misuse are scarce, reports from the Food and Drugs Authority, media and other stakeholders suggest that the use of tramadol in higher doses continues to remain a major public health concern in the country  and stakeholders are alarmed at the rate at which people are misusing tramadol . The Ghana Health Service has declared the issue as a national concern and putting in place measures such as seizures to control it. Since 2017, over 500,000 capsules of tramadol have been seized from chemical stores (licensed and non-licensed) and drug peddlers in the country . However, despite warnings of possible side effects of tramadol, empirical studies on motivations for escalating use of tramadol for non-medical purposes are limited, thereby limiting evidence-based policies. Based on this premise, the overall aim of this study was to offer a qualitative evidence on motivations for non-medical purposes tramadol use in Ghana. The paucity of research and its relevance for the health of the youth especially explains the need for the study. Findings from this study would guide the fight against tramadol misuse by helping authorities and policymakers to design strategies to lessen tramadol misuse among the youth.
Aside from the pressure, few of the participants reported curiosity as a factor that led them to tramadol use. These participants noted two sources of their curiosity: the continuous hyping of the drug by friends and other people who use the drug; and the constant public campaigns on radio and television. It emerged that the perceived good accounts that those who use the drug often give about the drug, as well as the public outcry of the misuse of the drug, have further given the drug much more popularity. Meanwhile, it was evident that the growing public misconceptions about the possible benefits of the drug also made the participants curious about the drug. As a result, these participants first took the drug with the objective of confirming or verifying the various conceptions and misconceptions they heard about the drug. One participant noted:
Some of the study participants also highlighted myriad of perceived psychological problems as additional adverse effects of tramadol. The participants repeatedly mentioned irritability, anger, overactive reflexes, loss of consciousness, discouragement, general feeling of discomfort and sad and loss of interest or pleasure. The participants recounted experiencing either one or a combination of these psychological problems associated with tramadol misuse.
In relation to empirical literature [2, 7, 25] participants got introduced to tramadol use by two main factors including pressure from friends, relatives and members of the community they live, and curiosity. These pressures as narrated by the participants were in the forms of threats, coercion, and allurement by friends and workmates and superiors. For most of the participants, their inability to resist the pressure and fear of being sacked from work by their superiors led them into non-medical purpose tramadol use. It is also interesting to note that the constant public campaigns and education on radios and televisions by health officials and private individuals against tramadol misuse have in a way raised the curiosity levels of those who use the drug as reported by some of the study participants. In the quest to satisfy their curiosity concerning the functions that the drug could perform as widely reported by the public, friends and colleagues, participants got into the use of the drug for non-medical purposes. Wasify et al.  in their study also cited peer pressure and curiosity as some of the main causation factors for non-medical purposes tramadol use.
Aside from the underpinning objectives of the present study which have been sufficiently analysed and discussed, four main interesting themes/findings surfaced which are worth mentioning and discussing: First, the study revealed that those who use tramadol are aware of the possible adverse physical, psychological and social effects of their usage. Most of the participants had experienced or continue to experience some unpleasant side effects of tramadol misuse such as vomiting, seizures, loss of appetite, agitation, irritability, stigma, headache, hallucinations, among others. These findings are in line with previous findings [7, 22] on the common adverse effects of tramadol. It also mirrors trend on the common effects of tramadol where majority of the respondents responded to know the side effects of aphrodisiac products particularly tramadol . Whilst the mechanism(s) through which tramadol causes these adverse effects is largely difficult to explain in this study, the side effect of a headache could possibly be an indication that usage of these substances increases blood pressure which may result in cardiovascular disorders with prolonged use. Second, participants of the study offered some praise to those who introduced them into tramadol use. This finding in a way appears surprising as one may think that the misuse of the drug has harmful side effects on the health and wellbeing of those who use it and therefore the users will rather blame their initiators for introducing them to tramadol use. Third, knowing the effects of tramadol misuse, participants showed no willingness of stopping using tramadol for non-medical purposes which suggests the dependence and addictive potentials of the drug . Participants valued the perceived benefits they derive from the drug over stopping using the drug. Interestingly, few of the participants who expressed a desire to quit tramadol misuse were looking for alternative drugs that work as tramadol. These findings contradict previous results of Fuseini et al.  where their participants expressed a desire to quit the misuse of the drug as a result of the adverse effects they experience and more importantly, as a result of lessons learnt from colleagues who have suffered seizures as a result of misuse of the drug. These two findings of the study are indications of how complex and complicated the tramadol misuse fight in Ghana is. Fourth, one good revelation from this study is that many of the participants expressed willingness and desire to support the ongoing efforts of health officials and security agencies to curb tramadol misuse. Most of the participants claimed knowing most of the unlicensed chemical shops and people selling what they see as fake tramadol. With this, they were willing to collaborate with officials to help seize and eradicate fake tramadol and sellers. The authors see this as a useful ground where health officials and other stakeholders can utilise to form partnerships and alliances to influence those who use it to quit tramadol use.
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No matter how well-intentioned, the people who love us most will often project their dreams, fears, and beliefs onto us. In my experience, this is especially common for children of first-generation immigrants, many of whom face significant pressures to lead better lives in return for the sacrifices their parents have made.
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Sentiment analysis is performed on the entire input field, as opposed to extracting sentiment for a particular entity in the text. In practice, there's a tendency for scoring accuracy to improve when documents contain one or two sentences rather than a large block of text. During an objectivity assessment phase, the model determines whether an input field as a whole is objective or contains sentiment. An input field that is mostly objective does not progress to the sentiment detection phrase, resulting in a .50 score, with no further processing. For input fields continuing in the pipeline, the next phase generates a score above or below .50, depending on the degree of sentiment detected in the input field. 2b1af7f3a8