PLOS ONE | https://doi.org/10.1371/journal.pone.0317036 March 7, 2025 1 / 24
Citation: Onohuean H, Oosthuizen F (2025)
1 Biopharmaceutics Unit, Department of Pharmacology and Toxicology, Kampala International University
Western Campus, Ishaka-Bushenyi, Uganda, 2 Discipline of Pharmaceutical Sciences, School of Health
Sciences, Westville Campus, University of KwaZulu-Natal, Durban, South Africa
* onohuean@gmail.com
Abstract
Introduction
There is an ongoing global upsurge of opioid misuse, fatal overdose and other related
disorders, significantly affecting the African continent, due to resource-limited settings and
poor epidemiological surveillance systems. This scoping review maps scientific evidence
on epidemiological data on unlawful opioid use to identify knowledge gaps and policy
shortcomings.
Method
The databases (PubMed, Scopus, Web of Sciences) and references were searched
guided by Population, Concept, and Context (PCC) and PRISMA-ScR. The extracted
characteristics examined were author/year, African country, epidemiological distribution,
age group (year), gender, study design and setting, common opioid/s abused, sources of
drugs, reasons for misuse, summary outcomes and future engagement.
Results
A population of 55132 participated in the included studies of 68 articles, with the
largest sample size of 17260 (31.31%) in a study done in South Africa, 11281(20.46%)
in a study from Egypt and 4068 (7.38%) in a study from Ethiopia. The gender of the
participants was indicated in 65(95.59%) papers. The mean and median age reported
in 57(83.82%) papers were 15.9-38, and 22-31years. The majority of study-designs
were cross-sectional, 44(64.71%), and the most used opioids were heroin, 14articles
(20.59%), tramadol, 8articles (11.76%), and tramadol & heroin, 6 articles (8.82%)
articles. Study-settings included urban community 15(22.06%), hospital 15(22.06%),
university students 11(16.18%), and secondary school learners 6(8.82%). The highest
epidemiological distributions were recorded in the South African study, 19615(35.60%),
Egyptian study, 14627(26.54%), and Nigerian study 5895(10.70%). Nine (13.24%)
papers reported major opioid sources as black market, friends, and drug dealers. To
relieve stress, physical pain and premature ejaculation, improve mood and sleep-related
PLOS ONE | https://doi.org/10.1371/journal.pone.0317036 March 7, 2025 2 / 24
PLOS ONE The burden of unlawful use of opioid and associated epidemiological characteristics in Africa
problems and help to continue work, were the major reasons for taking these drugs as
reported in twenty articles (29.41%).
Conclusion
The findings of this scoping review show significant knowledge gaps on opioid usage in
the African continent. The epidemiological distribution of unlawful use of opioids among
young adults, drivers, and manual labourers in both genders is evident in the findings.
The reason for use necessity scrutinises the role of social interaction, friends and family
influence on illicit opiate use. Therefore, there is a need for regular epidemiological
surveillance and investigations into multilevel, value-based, comprehensive, and strategic
long-term intervention plans to curb the opioid problem in the region.
Introduction
Opiate use disorders and overdoses are an emerging global health concern. Both prescriptions
and non-clinical indications contribute to the escalating global opioid use disorder
problem (OUD). The opioid crisis has metamorphosed through the Use of: methadone in
1999, heroin in 2010, and the current wave of a combination of heroin, counterfeit pills,
and cocaine [1–8]. An estimated 62 million people globally used opioids in 2019, and
36.3 million were impacted by its associated problems [9]. In the US estimated use has
increased from 70029 in 2020 to 80816 in 2021 [10], and in Canada, 7560 opioid-related
fatalities occurred in 2021 [11]. In Italy opioid addiction affects more than five people per
1000 [12], while a regional study in Germany conducted amongst 57 million adults, found
opioid prescription prevalence of 38.7 or 12.8/1000 persons of low- and high-potency
opioids in 2020 [13]. However, little is known about the epidemiological characteristics in
Sub-Saharan Africa.
There are reports of opioid abuse, although not specifically on opioid fatal overdose or
its related disorders, in some African countries, including Egypt, Nigeria, Kenya, Tanzania,
and South Africa [14–24]. Some of these studies report the increasing use of tramadol
and heroin among university and secondary school students, factories and site workers,
long-distance drivers, sex workers, as well as unemployed youth [14–16,23,24]. However,
in many other African countries, there is scanty or no information regarding the ongoing
opioid crisis.
The findings on the reason for illicit opioid use includes; pleasure-seeking, craving, habits,
impulsivity, improving energy [25], relieving stress [26], peer pressure from friends [27],
engendering “morale” and “courage” to engage in sex work and “fight” potentially abusive
clients [28]. Some of the reported sources are the black market [29], friends and drug dealers
[30], roadways, bus terminals or intercity stands, low-income residential areas, abandoned or
unfinished buildings, and fishing camps along the Indian Ocean [31].
Global opioid trafficking channels exist from Afganistan, through the india ocean and
East Africa to the west [19,32,33]. This impacts heroin use among the population living in the
coastal region of Comoros, Tanzania, Kenya, northern Mozambique, Madagascar, Mauritius
and Seychelles [34–36]. Unlawful use of opioids could aggravate the already sporadic spread
of infectious diseases like malaria, cholera, and HIV [37–41]. In 2018, the UNODC [42,43]
predicted with insufficient evidence that another opioid crisis was developing in Africa. Inadequate
vital record-keeping and surveillance systems make it challenging to comprehend the
incidence burden and effects of opioid overdose in Africa [44].
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