The figures were disclosed in the latest UN world drug report, which noted that opioids were the most harmful global drug trend, accounting for 76% of deaths where drug-use disorders were implicated.
The report said that while fentanyl and its analogues remain a problem in North America, tramadol – used to treat moderate and moderate-to-severe pain – has become a growing concern in parts of Africa and Asia.
The report added that the global seizure of pharmaceutical opioids in 2016 was 87 tonnes, roughly the same as the quantities of heroin impounded that year.
The figures on pharmaceutical opioids were rivalled by global cocaine manufacture, which the agency said had reached the highest level ever reported in 2016, with an estimated 1,410 tonnes produced.
Most of the world’s cocaine comes from Colombia, but the report also showed Africa and Asia emerging as cocaine trafficking and consumption hubs.
From 2016-17 global opium production also jumped by 65% to 10,500 tonnes, the highest estimate recorded by the agency since it started monitoring global opium production nearly 20 years ago….
We need to raise the alarm about addiction to tramadol, rates of which are soaring in parts of Africa. Non-medical use of this opioid painkiller, which is not under international control, is also expanding in Asia. The impact on vulnerable populations is cause for serious concern, putting pressure on already strained healthcare systems,” said the UNODC’s executive director, Yury Fedotov.
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7-23-19 Tramadol can be a sedative, but if taken orally at high enough doses it can produce a stimulating euphoric effect similar to heroin.
Refugees in northern Nigeria reportedly use tramadol to deal with post-traumatic stress. In Gabon it has infiltrated schools under the name kobolo, leading to kids having seizures in class, while in Ghana the ‘tramadol dance’ is trending, basing its zombie-like moves on the way people behave when they’re high on the painkiller.
Musicians from Sierra Leone, Togo and Nigeria have written songs about it. It is popular in Mali, Niger and Burkina Faso. Among the ranks of Boko Haram and Islamic State, tramadol tablets are taken by fighters, leading them to be dubbed ‘jihadist pills’.
But because it’s only about one-tenth the strength of morphine, tramadol is deemed to have a low abuse potential. It’s therefore not internationally controlled--or ‘scheduled’--by the United Nations. Instead, each country has to set up its own rules and regulations for tramadol production, import, export, distribution and use. The efficacy of these is mixed. Across North Africa, West Africa and the Middle East, tramadol abuse is rife….
Ayao’s parents in Lomé, Togo’s capital, know that their son takes the drug. “If it is for work, he can take it, but if not, it’s out of the question,” says his mother. While she thinks tramadol is OK if it helps Ayao earn money, she does worry about him abusing it. “It destroys people. I see this. They become crazy and do stupid things.”…
There is a burly man with an empty look in his eyes who hangs out on the steps of a shop at the Grand Marché, a few hundred metres from Lomé’s palm-studded beach. He speaks of an inhuman energy rushing through his body when taking tramadol, pointing to a truck driving along the crowded street. “When a car comes towards you you think it is a toy and you can just pick it up. But in reality death is rolling towards you.” The man says he has had nearly a dozen tramadol-induced seizures.
A sex worker who has been taking tramadol daily for two years says it helps her cater to more customers and walk the streets all night. The 225 mg tablet she takes every day doesn’t have the same effect it used to, but she doesn’t want to increase her dosage. She has seen what it does to others. Some lose control, they get nervous and into fights, while some fall asleep while having sex with a customer. She can tell when her customers are high on the drug, too: “they are more horny and rough-rough.”
Users buy single blisters from medicine peddlers but also from market women, dealers and roadside tea and coffee vendors for between 250 and 500 francs (45–90 US cents), depending on the dosage. The minimum wage in Togo is 35,000 francs (US$60) per month. (Wholesale tramadol cost—US 5 cents/dose in 2018.)
A 36-year-old motorcycle taxi driver recounts that he once managed to quit for three months. His body hurt all over. “It was a mental battle that I lost,” he says. Other withdrawal symptoms include profuse sweating, breathing difficulties, anxiety, stomach cramps and depression. Everyone around him takes tramadol. Many want to stop. They just don’t know where to find help. In Togo, and most other countries, tramadol is officially a prescription-only drug. While there might be pharmacies that will sell it without one, in sub-Saharan Africa a large proportion of people buy their medicines in the informal sector. Often neither vendor nor customer really understands what’s being bought and sold, especially given that pills frequently don’t contain what is stated on the packet. This is because the bulk of tramadol used for non-medical purposes is not diverted from legitimate pharmaceutical sources. Rather, it’s made up of unlicensed, counterfeit or substandard pills manufactured primarily in India and China, which are then trafficked to North and West Africa.
“We have seen an increase in seizures of tramadol in various countries, especially those with sea borders where tramadol usually enters the region – Benin, Ghana, Côte d’Ivoire and Nigeria,” says Jeffery Bawa, drug control and crime prevention officer for the United Nations Office on Drugs and Crime (UNODC) Sahel Programme. In 2018 alone Nigeria seized 6.4 billion tramadol tablets.
From the ports of West Africa the cargo is then dispersed throughout the region. According to the 2018 UNODC World Drug Report, North, Central and West Africa accounted for 87 per cent of pharmaceutical opioids seized worldwide, a development due almost entirely to tramadol trafficking.
“Tramadol is trouble,” says one medicine peddler at the Grand Marché. “If the police find you with it, it is a problem.” Everyone has become more secretive. Even Ayao says he never buys more than one or two pills at a time. “It would not be good if the police catch me with it,” he says.
As a result of the crackdown, prices have risen sharply in the past few months. Whereas a 120 mg capsule costs 50 francs (9 US cents) before, it now costs up to 300 francs. The 225 or 250 mg pills sell for up to 500 francs.
Neighbouring Ghana has also taken steps to combat the abuse of tramadol on its streets, after the problem intensified in 2017. On a national level tramadol is now a controlled substance. Alongside an increase in law enforcement, the country has held nationwide pharmaceutical crime training so that “police would treat counterfeit drugs with the same urgency as they do arms,” explains Olivia Boateng, head of the Tobacco and Substances of Abuse Department at Ghana’s Food and Drugs Authority. in recent years Egypt has put the painkiller under strict national control. In 2017 more than 60 per cent of those treated in a state-run addiction facility still named tramadol as their main substance of abuse. So in response Egypt called for tramadol to be internationally controlled. However in March 2019 the UN Commission on Narcotic Drugs declined to add tramadol to its list of scheduled substances.
-An itinerant medicine peddler’s wares on display in a market in Lomé © Nyani Quarmyne at Panos for Mosaic
Last year, India introduced measures to control the drug under its narcotics law, giving its authorities the power to deal with illicit manufacturing and smuggling. And in May, the UNODC and the International Narcotics Control Board organised a trilateral meeting between India, Ghana and Nigeria to look at how to counter tramadol trafficking….
back in Lomé, Ayao is hanging out with a friend in his neighbourhood. They’re talking about a little white pill that’s new on the streets, nicknamed écouteurs (headphones) after the motif on its face. They don’t know exactly what it is, only that it is much stronger than tramadol and cheaper too, now that the price of tramadol has gone up….They recount stories they’ve heard about its mind-muddling effects. In fact Ayao says he already regrets the impact tramadol has had on his life. He feels left out when his former classmates talk about things that are happening at school. Perhaps if someone had told him about the dangers of tramadol before he started taking it, things would look different today. https://mosaicscience.com/story/opioid-epidemic-you-havent-heard-about-tramadol-Togo-Africa/
