The non-medical use and trafficking of tramadol remain most concentrated in North Africa, West and Central Africa, and the Near and Middle East and South-West Asia, though there remains significant localized non-medical use in other regions.

• There remains a significant data gap on tramadol use and trafficking, but sex differences in the non-medical use of tramadol may be smaller than those for other drugs, as shown in the case of data on fatal poisonings in England and Wales.
• Seizures of tramadol continue to be heavily concentrated in West and Central Africa (accounting for 98 per cent of the reported quantities seized between 2019 and 2024), with smaller quantities seized in North Africa and South Asia (the region where much of the drug originates from.