BACKGROUND AND AIMS Misuse of tramadol, an opioid prescription analgesic, is known as a public health challenge globally. We aimed to systematically review studies on the prevalence of non-prescribed use, regular tramadol use and dependence, tramadol-induced poisoning and mortality in Iran. METHODS Consistent with PRISMA guidelines, international (Medline, Scopus, Web of Science) and Persian (SID) databases were systematically searched up to June 2019. Other relevant data were collected through personal contacts and review of reference lists. Pooled estimates of prevalence of tramadol use in subgroups of males and females, percentage of tramadol poisoning among admitted poisoning cases, tramadol-associated seizures and mortality among tramadol poisonings and percentage of tramadol as a cause of death among fatal drug-poisoning records were estimated through a random-effects model. RESULTS A total of 84 records were included. Pooled estimates of last 12-month use of tramadol in Iranian general population were 4.9% (95%CI: 4.1-5.9) and 0.8% (95%CI: 0.2-1.8) among males and females, respectively. The estimates for last 12-month use among Iranian male and female university students were 4.8% (95%CI: 1.9-8.9) and 0.7% (95%CI: 0.3-1.1), respectively. Six heterogeneous reports indicated existence of regular use of tramadol and dependence in Iran. Sixty-two studies provided data on tramadol-induced poisoning, seizures and mortality. The pooled estimate of percentage of tramadol poisoning among all-drug poisoning patients was 13.1% (95CI: 5.7-22.9). The overall estimates of seizures and mortality among tramadol poisoning patients were 34.6% (95%CI: 29.6-39.8) and 0.7% (95%CI: 0.0-1.9), respectively. The pooled percentage of tramadol-related fatalities among drug-poisoned cases was 5.7% (95%CI: 0.5-15.4). CONCLUSION Despite control policies, tramadol use is as prevalent as the use of illicit opioids in Iran. Numerous cases of tramadol abuse, dependence, poisonings, seizures, and hundreds of tramadol-related deaths have been reported in recent years.

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伊朗的曲马多使用和公共卫生后果：系统评价和荟萃分析

背景和目的曲马多（一种阿片类处方镇痛剂）的滥用被公认为全球公共卫生挑战。我们旨在系统地回顾有关伊朗非处方使用、常规曲马多使用和依赖、曲马多引起的中毒和死亡率的流行情况的研究。方法 与 PRISMA 指南一致，系统搜索了截至 2019 年 6 月的国际（Medline、Scopus、Web of Science）和波斯语 (SID) 数据库。其他相关数据是通过个人联系方式和参考文献列表的审查收集的。男性和女性亚组中曲马多使用流行率的汇总估计值、已确诊中毒病例中曲马多中毒的百分比，通过随机效应模型估计了曲马多中毒中曲马多相关的癫痫发作和死亡率以及作为致死药物中毒记录中曲马多死因的百分比。结果 共纳入 84 条记录。伊朗一般人群过去 12 个月使用曲马多的汇总估计值在男性和女性中分别为 4.9%（95%CI：4.1-5.9）和 0.8%（95%CI：0.2-1.8）。伊朗男大学生和女大学生最近 12 个月的使用率估计值分别为 4.8%（95%CI：1.9-8.9）和 0.7%（95%CI：0.3-1.1）。六份不同的报告表明伊朗存在经常使用曲马多和依赖的情况。62 项研究提供了有关曲马多引起的中毒、癫痫发作和死亡率的数据。在所有药物中毒患者中曲马多中毒百分比的汇总估计值为 13.1%（95CI：5.7-22.9）。曲马多中毒患者癫痫发作和死亡率的总体估计分别为 34.6% (95%CI: 29.6-39.8) 和 0.7% (95%CI: 0.0-1.9)。药物中毒病例中曲马多相关死亡的汇总百分比为 5.7%（95%CI：0.5-15.4）。结论 尽管有管制政策，曲马多的使用与伊朗非法阿片类药物的使用一样普遍。近年来报道了多起曲马多滥用、依赖、中毒、癫痫发作和数百起与曲马多相关的死亡事件。在伊朗，曲马多的使用与非法阿片类药物的使用一样普遍。近年来报道了多起曲马多滥用、依赖、中毒、癫痫发作和数百起与曲马多相关的死亡事件。在伊朗，曲马多的使用与非法阿片类药物的使用一样普遍。近年来报道了多起曲马多滥用、依赖、中毒、癫痫发作和数百起与曲马多相关的死亡事件。