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Physician’s role in prescribing opioids in developing countries
  1. Jorge A Roa1,
  2. Alexandra Guevara2,
  3. Carolina Guevara2 and
  4. Jaime Guevara-Aguirre1,2,3
  1. 1 Department of Diabetes and Endocrinology, College of Medicine, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
  2. 2 Instituto de Endocrinologia y Metabolismo, IEMYR, Quito, Pichincha, Ecuador
  3. 3 Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, Limburg, The Netherlands
  1. Correspondence to Dr. Jaime Guevara-Aguirre, jguevara{at}


In developed countries, addressing the growing opioid addiction epidemic is focused on preventive measures, developing better overdose-reversal medications and designing newer strategies to treat addiction. Primary prescribers of the therapeutic use of opioids might play a definite role in the aetiology of the epidemics. Developing countries could be affected by similar issues; however, given that no updated statistics are available, it is possible that their populations undergo problems similar to those for which current data is available. Concerns have arisen regarding synthetic opioid tramadol which, given its fast and potent analgesic effects, low cost and easy availability is widely prescribed. A debate remains as to whether tramadol induces addictive effects like those of stronger analogues such as oxycodone or fentanyl. Here we present a case of tramadol dependence in an Ecuadorian patient and find that substance abuse can occur in normal individuals affected by chronic pain, otherwise treatable with standard methods.

  • global health
  • general practice/family medicine
  • pain (neurology)
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  • Contributors JAR collected most of the bibliography, wrote some paragraphs. AG helped in writing, edited all the versions of this paper. CG checked all the versions, helped in writing. JG-A wrote the paper, supervised all the authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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