Methods: A cross-sectional, web-based descriptive survey was conducted from January to August 2021, using a structured questionnaire with a simple random sample of 500 students. Data were analyzed descriptively and with Chi-squared tests. Online focus groups explored in-depth perspectives, with thematic analysis employed.

Results: Among 500 student respondents (Mean age = 27.14 ± 7.3 years; 70% male), 10.8% (95% CI [8.08, 13.52]) reported tramadol use in the past year, exceeding prior estimates for the region. Specifically, 3.2% obtained tramadol without a prescription, and 3.0% used it for non-medical reasons. Chi-squared analysis revealed a significant gender disparity, with males 65.6% more likely to use tramadol compared to females (χ2(1, N=500) = 4.234, p = 0.0396). Tramadol use correlated with self-reported pain/discomfort, sleep difficulties, and anxiety/depression (p < 0.05 for all). Qualitative findings from focus groups highlighted key motivating factors such as peer influence, ease of access, and perceived enhancement of physical and cognitive performance.

Discussion/Conclusion: This study unearthed a high prevalence of tramadol use disorder among students in the Sunyani Municipality, linked to modifiable factors. Given the documented cognitive and physiological risks associated with tramadol, these findings underscore the urgent need for targeted, evidence-based interventions, including public health education, stricter regulation of access, and community-based support programs.