One consequence of African poverty is that quality medication is often unavailable. Health-care systems tend to be weak, and the marketing of pharmaceuticals is not regulated effectively. Many patients depend on sub-standard or even counterfeit drugs. In this setting, a powerful opioid has become easily available – addiction is spreading in West Africa.

Tramadol is an opioid pain medication. Unlike other powerful and addictive opioids, such as methadone or fentanyl, for example, it is not regulated by the International Narcotics Control Board. The consequence is that every country must pass its own regulation. Governments only do so, however, once they see a problem.

Tramadol is valuable for medical purposes, but it can also be abused as a stimulant. It can improve peoples’ mood and enable them to work harder. Those who get used to the drug, however, need ever higher dosages to keep functioning at all.

Sub-Saharan Africa is currently experiencing a serious tramadol crisis. The medical journal The Lancet published a report in May in which it likened the West African scenario in particular to the current opioid crisis in the USA. A huge black market has emerged. High potency pills with up to 250 mg are available, though doctors would hardly subscribe more than 100 mg pills for medical purposes. An increasing number of addicts overdose and die. There are hardly any rehab facilities for those who want to kick the habit to find professional support.

According to The Lancet, African governments have begun to wake up to the problem. The painkillers are typically manufactured in Asia. Some are generic pharmaceuticals, but there are also counterfeit versions. Yearly seizures of tramadol in sub-Saharan Africa are said to have risen from 300 kg five years ago to more than three tons.

However, governments struggle to pass appropriate laws and enforce them stringently. The depressing truth is that many African countries lack effective regulatory systems for medical drugs. The mind-altering opioid tramadol is part of a bigger problem, which has several dimensions. Quality pharmaceuticals are often unaffordable or unavailable, so sub-standard, counterfeit and fake drugs are sold. Generics, most of which are produced in India, flood African markets. The quality, however, tends to be unreliable. Researchers from the London School of Hygiene and Tropical Medicine have found that some 64,000 to 158,000 people die of malaria every year because of low-quality or falsified antimalarial drugs.

Read more at D+C