In most countries, the standard substances used for drug abuse are cocaine, heroin, cannabis and alcohol or even pain medications such as morphine or Vicodin. In Africa, however, there is a rising trend with the abuse of Tramadol, a painkiller usually one tenth of morphine’s strength.
This medicine was originally developed by the German pharmaceutical company Grünenthal and brought into the market in 1977. When the patent expired, generics started to flood the Indian, Chinese and specially, the African markets.
However, the high demand for tramadol in Africa began as a consequence of its low price and accessibility, since many of the regulated drugs for pain management such as morphine were rarely available, and it started being used by doctors, nurses and public health institutions to control pain driven diseases.
In spite of that, addiction to tramadol had never been seen before. It is a mild painkiller typically delivered in 50mg doses, and it has been recently discovered that the doses taken by addicts go as high as 500mg, not entirely the doctors’ recommendation when taking this medication.
But what makes Tramadol so addictive?
First of all, in Togo and many other countries, it’s listed as an essential medicine – one that the healthcare service should have available at all times to meet the population’s needs. It also has other effects. It can be a sedative, but if taken orally at high enough doses, it can produce a stimulating euphoric effect. It also turns out to be a cheap and legal pharmaceutical, not an illegal drug.
9. … not to mention dependence, addiction and death https://t.co/jPPUaUN1H1
— David Juurlink (@DavidJuurlink) October 21, 2017
As a result, particularly West Africa is now flooding with the drug. In Ghana, Tramadol – locally known as “Tramore” – is popular and even used as a potency enhancer. In Gabon, it is called “Kobolo” and students are known to take it as a performance enhancing stimulant during exams. In Sudan’s capital Khartoum, workers add a tablet of Tramadol to their tea to help them endure their physical work.
Many cases like this resonate, from the family man who works as a mason by day and a night guard who takes it to endure the physical exhaustion and avoid sleeping during his night shift. Or the young boy that now needs to take it two or three times a day just to endure his regular activities, such as his daily job or a simple football game with his friends.
In Ghana, for instance, it is very common amongst rice farmers and fishing communities. Across the region it is mainly used by working age men, aged 15-50. Tramadol is weak enough as an opioid that people can still function – but its pain killing effects mean that people can go on working hard, monotonous jobs much longer.
By being part of the local culture, Tramadol is now popular between students who are using it as a party drug. A few people reported using Tramadol as an aphrodisiac, as if the user was visiting, and some are mixing it with energy drinks or alcohol – which can make it even more dangerous.
The effects this emerging crisis has caused are concerning. In addition to opioid receptor activity, tramadol exerts some of its effects via its actions on serotonergic and noradrenergic neurotransmission. For this reason, there is also a known risk of seizures and convulsions in some patients taking tramadol, with this risk being even more elevated in abusers seeking the euphoric effects, or “high,” produced by taking large doses of the drug. Withdrawal symptoms include profuse sweating, breathing difficulties, anxiety, stomach cramps and depression. Many want to stop. They just don’t know where to find help.
“You can get tramadol everywhere on the black market,” says Togoan psychiatrist Damega Wenkourama. He also talks about how they can no longer deal with the high number of patients suffering from opioid induced seizures or that are simply trying to get help for their substance addiction.
Recent investigations have shown that many of the pills sold by the name of Tramadol, hardly ever contain what the packaging suggests. Many pills tested in a lab for research were far stronger than the recommended medical dose – which is very dangerous in itself – while in other cases there was only 10 percent actual Tramadol, with the rest being a mixture of other chemicals and impurities (Vice).
“As a recent study from the World Health Organization pointed out, the so-called “‘fake drugs” come in a variety of forms. There are the substandard drugs, which perhaps wouldn’t pass quality tests due to a manufacturing error or because they have already passed their expiry date. The second kind, known as counterfeit drugs, have been deliberately falsified. This means that they could contain entirely different chemicals than the original or might even have no medical properties at all”.
The Democratic Republic of the Congo 🇨🇩 is now part of the 3️⃣2️⃣ African countries who registered for the International Collaborative Exercises #ICE, a proficiency test to assist drug testing & toxicology labs in assessing their own performance. pic.twitter.com/tuVL55gvvE
— UNODC Forensic Services (@unodc_lab) April 16, 2020
The problem is that these countries have weak laws and weak law enforcement, don’t have access to the resources needed to deal with the issue, the need for medicine continues to rise and there is no trustworthy supply of reliable drug and health facilities.
There are already initiatives to help tackle this issue, one organization called mPedigree, developed an app which allows consumers to scan the codes on the packets, receiving a reply that tells them if it is fake or original instantly, helping them with making a smarter purchase.
It is a strong crisis, already having drawn the attention of the UN to try to find a solution, we can do nothing but suggest an institutionalization of this medications, to provide the necessary medicine and tighten the safety belts to prevent Tramadol and other synthetic drugs to be falsified and sold at an unmeasurable scale.