The National Drug Law Enforcement Agency
has intercepted a container load of tramadol in Lagos.
The Nigerian Customs Service
has destroyed smuggled tramadol valued at 168.3 million naira.
Over the past decade,
while the world has been transfixed by the horrors of the opioid crisis
tearing apart communities in North America,
another opioid crisis, at least as serious,
has been unfolding, almost unreported, across Africa.
Tramadol is a synthetic opioid about ten times weaker than morphine.
It’s commonly used by doctors to treat mild pain,
with tens of millions of prescriptions
written each year all over the world.
But right across Africa, non-medical use of tramadol is exploding.
[The War on Drugs Show]
[Tramadol]
In 2013, 300 kilos of illicit tramadol
was seized across the continent.
By 2017, that had rocketed to three tons.
UN figures indicate that opioid seizures in Africa
now actually account for 87 percent of the global total.
But the situation with tramadol in Africa
is far more complex than it first appears.
The first thing we have to understand is who is using the drug and why.
If you look at the data,
farmers, fishermen, and those in laborous activities
dominated in terms of the consumption of this particular drug.
A lot of this work involves a lot of staying up for long hours.
I use tramadol.
I dig water wells, pits...
I some areas, I dig 20 meters down.
It’s very hard work.
It’s dangerous work...
I realized that when I take a tramadol pill,
I could sweat, work without feeling tired.
You have to move your body all the time.
If I’m in pain, it will help.
I don’t feel like stopping.
And I tell myself that when I’m in my coffin,
I’ll still have a pill in my jacket pocket.
That’s it.
But while the majority of users are taking tramadol
to help them cope with hard labor over long hours,
it's also spilling over into youth culture,
with people often mixing the pills with energy drinks
or, more dangerously, with alcohol,
to use as a party drug or aphrodisiac.
And this is perhaps the source of the moral panic
that seems to be sweeping across Africa around tramadol.
Tramadol is used as a tonic water...
When the Nigerian rapper Olamide
mentioned the drug in his song
a reference to mixing up chemicals,
it was immediately banned
by the Nigerian National Broadcasting Commission.
I have a friend who was using.
He was just using for his own pleasure.
But he went up to the level of an overdose.
So much tramadol has been used in Africa
that there are now concerns that it’s actually affecting local ecosystems.
In 2013, a French Cameroonian team discovered tramadol
present in the roots of the plant Nauclea latifolia,
which is widely used in traditional African medicine.
This sparked a wild round of speculation.
Either a synthetic man-made chemical created in a lab
happened, by complete coincidence,
to also be naturally occurring in the roots of this plant,
which would be almost unheard of in scientific history.
For me, it was a mental, let’s say, revolution as a scientist.
For me, there was no former experience,
or even in literature, of any kind of similar parallel.
Or it could mean that people in West Africa
were taking so much tramadol
that it was now seeping into the groundwater through their urine.
Due to the vast scale of this issue, there were even theories that
it must mean farmers were feeding tramadol to their cattle
to help them cope with harsh conditions.
Given the difficulty of gathering accurate data on drug use in Africa,
the jury is still out.
But one thing’s for sure,
this problem is serious and widespread.
Many African countries
seriously lack proper provision for drug treatment services.
States like Cameroon are reported to only have
one rehabilitation facility.
Meanwhile, many African governments
are scrambling to crack down on tramadol,
most using the old war on drugs methods
of repression and restriction.
In 2017, Egypt formally lobbied the UN
to place the drug under international controls,
with the same restrictions as morphine
and other medical opioids.
These methods have failed to contain illicit drug use
in pretty much every other context they’ve been tried,
and West Africa already seems to offer a fairly clear lesson
that this region will be no different.
In the case of Nigeria, what they did was ban the medication,
introduce very punitive measures.
If they arrest you, you go to prison for more than ten years and above.
What we saw in Nigeria happening was that
immediately, the grid went underground,
creating a huge black market.
However, Nigeria started to use a different method,
and they couldn't actually address the problem.
What they did was to even magnify the problem.
Ghana, over time, has adopted
a very collaborative or cognitive approach
in addressing a specific issue
concerning drug consumption in this country.
So, what Ghana has done is to kind of look at the problem
and see in what dimension could it be addressed
and properly propose activities to be able to address these challenges
by doing a lot of education,
engagement with community members, and all of that.
And what Ghana also did was to kind of review its law.
So, as we speak now, Ghana currently has a new narcotics law,
which has sought to remove
the aspect that sends people who use drugs to prison.
So that is why, as advocates, we have always said that
governments will need to begin to
look at their drug policy holistically
by approaching it from all angles as a development issue,
as a health issue,
as a human rights issue.
And also, above all, we need to be humane
in trying to address most of these challenges.
The main repressive strategy being deployed across Africa
is to restrict the supply of medical tramadol
so that it can't be diverted to the criminal market.
But there are two major problems with this approach.
The first is that the war on drugs
already restricts the supply of medical morphine
across the Global South.
So, for millions of people in Africa,
tramadol is the only option they have for actual pain relief.
Because when we did the interviews with health workers,
they admitted that tramadol was
the most potent pain-relieving medication for post-surgery
and after-pain medication
for people who are probably cancer patients and all that.
So, if you banned this, it’s going to be like morphine,
which now is difficult for pain management officers
to be able to access morphine for their patients.
And that is going to create a very serious toll on Africa
because that is one of the best
pain-relieving medications we have as a continent.
If we seek to ban or schedule tramadol,
what is going to happen is that
I think that you are indirectly criminalizing pain
because people will have to suffer with their pain
without having access to tramadol to be able to address their pain.
So, if you ban it, Africa will bear the toll of the problem
in terms of availability and accessibility of pain medicine.
But there’s another, even more serious problem
with trying to fight tramadol by restricting medical supply,
and this is the big twist in the story of the African opioid crisis.
Most of the tramadol doing the rounds
on the streets of Lagos, Dakar, and Accra
isn’t actually tramadol at all.
There were reported cases of people collapsing,
people going into seizures, and all that.
And that is not traditional reaction of tramadol consumption.
Lo and behold, from the analysis,
we saw that many of these were just substances
that were probably put together by some of these labs coming from China,
passing through to the region, and trafficked into the country.
Ultra-cheap generic pills labeled tramadol
are being produced in labs largely in China and India,
containing any number of synthetic opioids
and other dangerous chemicals.
They’re then smuggled by the billion
through West Africa’s corrupt seaports and porous borders,
creating an extraordinarily dangerous situation
where people simply don’t know what they’re taking
and can end up dying as a result.
The problem here is that while drug enforcement strategies
are aggressively pushed across Africa by the international community,
medical fraud, which is really what’s happening here,
doesn't carry nearly the same political weight as an issue.
And this is despite the fact that the World Health Organization
estimates that fraud in antimalarial drugs alone
might cause up to 267,000 additional deaths
in sub-Saharan Africa each year.
Disturbing reports are also emerging
of how the trade in so-called tramadol feeds into terrorism
and local insurgencies.
I don’t know exactly how many people I killed.
I was asked to slit their throats like sheep.
I cut the throats of more than 20 of them.
That’s why I deserted.
Ibrahim says he was taking tramadol,
a powerful painkiller and the jihadists’ drug of choice.
We were under the influence of drugs, which we took as medication,
and we were also given injections.
Sometimes they made us drink date juice,
but we quickly realized that it was not date juice
because we were possessed afterwards.
The link between tramadol usage among terrorist groups in West Africa
has been an interesting conversation lately.
What was happening in the case of Boko Haram was that
a lot of these young ladies and gentlemen are fed with tramadol.
And so that is why a lot of them
were able to do those kind of atrocities.
West Africa stands at a crossroads in dealing with its opioid crisis.
It can try to crack down
following the same war on drugs policies that have failed in the US
and in so many other places across the world.
Or just maybe
West African governments might examine the evidence,
learn from the mistakes made in the West,
and end up leading the way to a more rational,
effective, and humane approach.
We’d like to congratulate drugs for winning the war on drugs.