Palliative care and pain relief are an important cause of world sufferings, and about 80% of these sufferings are thought to occur in lowincome countries. 1 Opioids are very important in pain management, and, unfortunately, they are the second most abused psychoactive drugs and present the greatest harm to the health of users. 2 Tramadol and codeine are the most abused opioids in Africa. 2

Objectives: Although the importance of ketamine in clinical practice and in resource-poor settings and disaster zones, several attempts were made to reschedule it because of the issues around its misuse. Resisting future moves to reschedule ketamine is important for its continuous availability where needed. This scoping review addresses the question of whether ketamine should or should not be banned and the state of preparedness of low resource settings if ketamine petitions become successful in the future. Methods: A search was performed using PubMed and Google Scholar to identify articles published in the English language from March 2015 to August 2020. The articles were searched with a wide range of priori search terms related to the research questions. The selection of articles was based on relevance and eligibility. Results: Seventy-five articles were selected and grouped into 4 ethical themes. The search revealed that several articles addressed the importance of ketamine, pharmacology, misuse, supply, and consequences of a ketamine ban; however, none addressed how resource-poor countries should prepare for a future without the overreliance of ketamine. Conclusion: Four ketamine petitions in about 10 years are an indication that another may resurface soon; therefore, it is important to continue to study the clinical importance of ketamine while discouraging its overreliance for clinical practice.

BACKGROUND Tramadol is a unique analgesic because of its serotonin, gamma-aminobutyric acid (GABA), norepinephrine and opioid effects, as such, it is famous as a postoperative analgesic; regrettably, it has gained notoriety as a major source of drug abuse in West Africa. Despite its licit and illicit popularity, few studies have focused on the pharmacokinetics of oral tramadol in blacks who reside in Africa. This study aimed to assess the pharmacokinetic parameters of tramadol in postoperative patients, a common drug in postoperative pain management. METHODS AND EXPERIMENTAL APPROACH After ethical clearance and informed consent, the researcher conducted time kinetics of tramadol and its metabolite on 12 postoperative patients after a single oral dose of tramadol at 100 mg. Concentrations of tramadol and its O-desmethyl tramadol metabolite were assayed using HPLC (UV detection) after liquid-liquid extraction. The internal standard used was phenacetin. RESULTS None of the patients experienced severe adverse effects. Data on validation, robustness, linearity, precision and accuracy for tramadol and O-desmethyl tramadol were within acceptable limits. Maximum plasma concentration (Cmax), half-life, and time to reach Cmax for tramadol and its metabolite were found to be 5.11 ± 2.95 and 4.68 ± 2.9 mg/L; 9.17 ± 6.94 and 5.75 ± 4.52 hours; 4.71 ± 3.77 and 3.38 ± 2.13 hours respectively. CONCLUSIONS The findings in this study were higher than the therapeutic level described in previous studies reviewed without any acute adverse severe effect, further studies are needed in the studied population to verify these findings.