الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The abuse of illicit and prescription drugs is generally considered as a world-wide problem.
The problem is continuously progressing to be a serious public healthsocio-economic problem despite all the globally and internationally done efforts and attempts to reduce, prevent or treat the condition. According to the World Drug Report of UNODC, 2017, estimates suggest that 250million personsof all over the worldusedillicit drugs at least once, including 29.5million of them who suffer from drug use disorders. Recent data shows an increase in the extent and prevalence of illicit drugs use since 2008.
Addiction is widely accepted as a chronic, progressive and relapsing, even treatable, brain disease that affects both behavioral, physiological and perception functions of the central nervous system. It is characterized by compulsive craving for the use of drugs despite knowing its dangerous side effects.
Addiction affects the whole society since it leads to problems within families, troubles at work and an increase in crime levels. Accordingly, many international organizations are taking the responsibility to provide general interventional approachesfor the prevention, harm reductionn and treatment of addiction. Nevertheless, the WHO reports that research in this areais still neglected and further regional studies need to be conducted to answer many epidemiological questions about the prevalence of specific forms of drug abusen to bridge the gap totakeglobal evidence-based decisions about the appropriate psychosocial and pharmacotherapy interventions.
In general, there is an extensive range of drugs that are commonly abused worldwide. Cannabis, opioids, benzodiazepines, amphetamines, barbiturates and cocaine are on the top of the list. In Egypt, cannabis was recognized as the most commonly abused substance. But, throughout the recent years, particularly since 2011, there was a huge shift of addicts towards the abuse of tramadol.
Tramadol is a centrally-acting synthetic analgesic with opioid-like activity mainly introduced for cancer patients. Its mode of action can be explained by the high affinity of its active metabolite towards binding to the opioid receptors in addition to its mechanism of inhibition of re-uptake of noradrenaline and serotonin. Cases of abuse or addiction of tramadol are rarely reported, globally but the situation differs in Egypt. The working-class population started to abuse the drug few years ago with the thought that it makes them more productive. Furthermore,due to its ease of accessibilitythrough illegal trafficking in addition to itsrelatively lower prices, tramadol addiction jumped to be ranked as the firstopioiddrug being abused in Egypt. Unfortunately, tramadol has many serious side effects. Convulsions and seizures have been reported in addictsas well as in patients taking tramadol at the recommended doses. An interest was raised by many physicians involved in the field of psychotherapy of drug dependence to conduct an in-depth study to investigate the possible cause of the conflicting side effects associated with tramadoluse. The inquiry was whether this could be attributed to its intrinsic effects ordue to the presence of other additives and illicit substances formulated within the different illegal
112pharmaceutical preparations of tramadol that are available on the Egyptian streets from diverse sources. However,the value of pharmacy services should never be underestimated whenever there is a medication therapy provided.
Pharmacy as a profession is undergoing a tremendous progress lately and pharmacists are considered as the most accessible of health care professionals and.
Therefore, pharmacists should be well positioned in order to help in the prevention and treatment of substance abuse disorders and they should prepare themselves to effectively contribute in this area within the multidisciplinary health team