opioid pills prescribed for a patient with chronic pain are seen in Norwich, CT
2-9-19 India’s stringent law included a 10-year mandatory minimum prison term for violations involving narcotic drugs. When this law was introduced, medicinal morphine use in the country dropped by 97 percent. When this law was relaxed, pain became big business in the Asian subcontinent….As far as the pharma industry is concerned, India is a legal cultivator of opium
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12-13-19 Mass abuse of the opioid tramadol spans continents, from India to Africa to the Middle East, creating international havoc some experts blame on a loophole in narcotics regulation and a miscalculation of the drug’s danger. The man-made opioid was touted as a way to relieve pain with little risk of abuse. Unlike other opioids, tramadol flowed freely around the world, unburdened by international controls that track most dangerous drugs….
Still, individual governments from the U.S. to Egypt to Ukraine have realized the drug’s dangers are greater than was believed and have worked to rein in the tramadol trade. The north Indian state of Punjab, the center of India’s opioid epidemic, was the latest to crack down. The pills were everywhere, as legitimate medication sold in pharmacies, but also illicit counterfeits hawked by street vendors.
This year, authorities seized hundreds of thousands of tablets, banned most pharmacy sales and shut down pill factories, pushing the price from 35 cents for a 10-pack to $14. The government opened a network of treatment centers, fearing those who had become opioid addicted would resort to heroin out of desperation. Hordes of people rushed in, seeking help in managing excruciating withdrawal.
Jeffery Bawa, an officer with the United Nations Office on Drugs and Crime, realized what was happening in 2016, when he traveled to Mali in western Africa, one of the world’s poorest countries, gripped by civil war and terrorism. They asked people for their most pressing concerns. Most did not say hunger or violence. They said tramadol.
One woman said children stumble down the streets, high on the opioid; parents add it to tea to dull the ache of hunger. Nigerian officials said at a United Nations meeting on tramadol trafficking that the number of people there living with addiction is now far higher than the number with AIDS or HIV.
India’s sprawling pharmaceutical industry is fueled by cheap generics. Pill factories produce knock-offs and ship them in bulk around the world, in doses far exceeding medical limits.
In 2017, law enforcement reported that $75 million worth of tramadol from India was confiscated en route to the Islamic State terror group. Authorities intercepted 600,000 tablets headed for Boko Haram. Another 3 million were found in a pickup truck in Niger, in boxes disguised with U.N. logos. The agency warned that tramadol was playing “a direct role in the destabilization of the region.”…
The United Kingdom and United States both regulated it in 2014. Tramadol was uncontrolled in Denmark until 2017….“We know that opioids are some of the most addictive drugs on the face of the planet, so the claim that you’ve developed one that’s not addictive, that’s an extraordinary claim, and extraordinary claims require evidence. And it just wasn’t there,” said Jorgensen. “We’ve all been cheated, and people are angry about that.”…
Grunenthal Pharma synthesized tramadol in the 1960s, as the company was embroiled in scandal over its marketing of the sedative thalidomide, which caused extreme birth defects in thousands of babies whose mothers took it. Tramadol was initially believed to have a low risk of abuse because initial trials studied injected tramadol, the most potent route for most opioids. But researchers later found that tramadol releases a far more powerful dose taken orally because of how it is metabolized by the liver….
Legitimate tramadol remains a lucrative business: market research estimates the global market amounts to around $1.4 billion, according to Grunenthal. The medication long ago lost its patent protection. It is now manufactured by many companies and sold under some 500 brand names. …
But Thiels of Mayo clinic, Minneapolis and his colleagues analyzed prescription data and were surprised to find patients prescribed tramadol were just as likely to move on to long-term use.
They published their findings this year to alert authorities, he said: “There is no safe opioid. Tramadol is not a safe alternative. It’s a mistake that we didn’t figure it out sooner. It’s unfortunate that it took us this long. There’s a lot more that we need to learn about it, but I think we know enough that we also can’t wait around to act on this.”
Indian regulators knew the massive quantities manufactured in the country were spilling over domestically and countless Indians were addicted. But S.K. Jha, responsible for the northern region of India’s Narcotics Control Bureau, said he was shocked to learn in 2018 that tramadol from India was ravaging African nations. They realized then they needed to act, he said. Regulators acknowledge that the vastness of the pharmaceutical industry and the ingenuity of traffickers makes curtailing abuse and illegal exports all but impossible.
Countries’ efforts to control tramadol on their own often fail, particularly in places where addiction has taken hold, according to the Center for Strategic and International Studies.
India has twice the global average of illicit opiate consumption. Researchers estimate 4 million Indians use heroin or other opioids, and a quarter of them live in the Punjab, India’s agricultural heartland bordering Pakistan, where some of the most vulnerable are driven to drugs out of desperation. https://time.com/5749531/opioid-crisis-tramadol/
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