There has been a rise in reports about the escalating use of the prescription drug Tramadol, a synthetic opioid roughly one tenth as strong as morphine, in Africa. Much of the rhetoric echoes the situation in the United States – blaming an incipient ‘African opioid crisis’ for everything from psychosis to the rise of Boko Haram.
There is certainly some kind of crisis in Africa. While the world’s attention has been focused on the epidemic in the US, UN figures indicate that opioid seizures in Africa now actually account for 87 percent of the global total – with annual seizures in sub-Saharan Africa soaring from 300kg to three tons between 2013 and 2017.
African nations now stand at a pivotal crossroads in how to deal with this issue. In late 2018, Egypt formally moved to place Tramadol under international controls – with the same restrictions as morphine and other medical opioids. It is a move being considered by the UN.
However, experts on the ground have told VICE that our entire understanding of what is happening in Africa might be based on faulty evidence and assumptions.
I spoke to Maria-Goretti Loglo, Africa Consultant for the International Drug Policy Consortium (IDPC), who recently co-authored an in-depth study of Tramadol use across West Africa. She told me one of her key findings was that Africa’s Tramadol is most often not Tramadol.
“We were hearing stories about people taking one pill and immediately having seizures. That just doesn’t fit the chemical profile of Tramadol,” she begins. “So, we sent samples to the lab – and what we found was that not a single one of the samples we tested was actually medical grade Tramadol. Many pills 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.”
What this means is that the majority of the so-called “Tramadol” being used illicitly in Africa does not come from the medical supply chains at all. Cheap, generic pills labelled “Tramadol”, manufactured in labs in China and India, are pouring through West Africa’s weakly governed borders, and creating a booming street trade. So any international move to restrict medical Tramadol will have no real impact on this market.
As Loglo explains: “Ninety percent of the people we spoke to obtained their Tramadol from informal sellers and street hawkers. In big cities, like Accra in Ghana, there are plenty of pharmacies – but in rural areas, people rely on street traders, who are supplied form overseas. The problem of Tramadol in Africa is less about drug enforcement and more about medicine fraud – restricting the medical supply will never stop the street trade.”
Unfortunately, this is where potentially effective action comes into conflict with the structure of the global war on drugs. Drug enforcement strategies in Africa are heavily promoted by the international community, and often funded by the EU. Meanwhile, medicine fraud is almost completely neglected as an issue – despite the WHO calculating that falsified antimalarial drugs alone cause 72,000–267,000 additional deaths annually in sub-Saharan Africa. The discrepancy in these priorities is mind-boggling.
These fake pills are often used, as opium is used by child labourers in Afghanistan, as a way of easing the pain during gruelling work shifts.
“You need to understand who is actually using these drugs and why,” Loglo says. “The vast majority of users are manual labourers, who take this ‘Tramadol’ so that they can work longer hours, day after day. 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.”
It’s not just being used by workers. Some young people are experimenting with so-called ‘Tramadol’ as a party drug, and it seems to be becoming part of popular culture, for instance, featuring in the video for rapper Olamide Adedeji’s hit song, “Science Student’’. “A few people reported using Tramadol as an aphrodisiac, and some are mixing it with energy drinks or alcohol – which can make it more dangerous,” says Loglo.
Throughout Africa and the Global South, access to medical opioids for pain management is made extremely difficult by the structures of international drug prohibition. Doctors are scared to prescribe them, governments have to apply for strictly enforced quotas, and there is a pervasive, media-driven social stigma. In total, 90 percent of the world’s medical morphine goes to the richest 10 percent of its population.
In the almost complete absence of medical morphine, Tramadol is the only form of pain relief available for millions of people across Africa and beyond. If the international community were to criminalise Tramadol, it would be denying pain relief to hundreds of thousands of cancer patients and other sick people. As Loglo puts it, “to take this step would be essentially to criminalise being in pain.”
In the rich world, people rightly view pain relief as a virtual human right. To deny that to Africans by scheduling Tramadol – which will not even address the actual various opioid crises the continent is facing – would be a disaster.
The history of the War on Drugs is a history of the world following policies and rhetoric set in the United States. In this case the international community must realise that simply assuming that the African “opioid crisis” mirrors that of the US – and that policies that failed in America might work in Africa – is not the way to address these complex issues.