West Africa – and particularly its most populous nation, Nigeria – is battling an opioid abuse crisis. Medicines such as tramadol, legally and legitimately prescribed by doctors for pain relief, are also being taken in life-threatening doses by millions in search of a fix or a release from poverty, unemployment and lack of opportunity.
People & Power sent filmmakers Naashon Zalk and Antony Loewenstein to Nigeria to investigate how the drug is smuggled, traded and abused, as well as the widespread corruption that follows this illicit trafficking, and the appalling health consequences for those in its grip.
In 2019, the United Nations Office on Drugs and Crime (UNODC) released its first-ever drug use survey. The results were damning.
Out of a population of 200 million people, UNODC found that just over 14 per cent of Nigerians aged between 15 and 64 abused drugs – more than twice the global average of 5.6 per cent. Although cannabis is the most abused narcotic, tramadol – an opioid painkiller – is causing the biggest societal problems.
We started investigating this story because we had heard that West Africa in general, and Nigeria in particular, was experiencing an unprecedented explosion of tramadol abuse. What we discovered was surprising and disturbing. The drug is legally prescribed by doctors around the world to treat acute pain but it is also being taken in dangerously high doses for a variety of non-medical purposes.
What we uncovered was a huge international trade in “abuse-grade” tramadol. Tablets of the drug are being manufactured and sold in dosages many times higher than the legal limit for medical use. The maximum legal dose for a single tablet is supposed to be 100mg, yet at one Nigerian port, we saw shipping containers that had been found to be crammed full with packets containing 225mg tablets.
We were told by doctors that they had seen tablets with doses as high as 600mg a pill and that some drug abusers were taking up to 10 of these a day. These dangerously high concentrations are predominantly manufactured illicitly in India and exported from there, via South East Asia, to Africa and the Middle East.
We wanted to know how billions of pills of tramadol get into Nigeria, how they are distributed and traded thereafter and, perhaps most importantly, follow up some of the disturbing stories we’d heard about the role tramadol might be playing in Boko Haram’s rebellion in the north-east of the country.
Over and over again we were told how the drug had become the popular tonic for a score of ills, the go-too palliative for sex workers, manual labourers, cooks and street cleaners, for bored young men and women, for the poor, the unemployed and desperate, and yes, even for Boko Haram rebels; all of them craving a tramadol fix and able to get one because a single pill is so cheap and so easily accessible from street drug dealers.
Despite the chaos unleashed by tramadol abuse, trying to ban the drug entirely is fraught with significant problems. In its legal form, tramadol can be a genuinely important prescription therapy for those in great physical pain.
But what we found in Nigeria was something else entirely – how the very poorest have also now become major targets of those same criminal distribution networks, how a new generation of desperately poor consumers has been cleverly sold the idea that otherwise ‘respectable’ pain relief medicines are in some way a remedy for the day-to-day drudgery of lives without hope or opportunity. It doesn’t take a genius to work out the thinking of those behind this trade; the value of each individual sale may be tiny, but make enough of them and the profits will really stack up.
Yet, despite the chaos unleashed by tramadol abuse, trying to ban the drug entirely is fraught with significant problems. In its legal form, tramadol can be a genuinely important prescription therapy for those in great physical pain. Numerous Nigerian doctors told us of this, in one instance inviting us to meet the children wracked by the agony caused by sickle cell anaemia – a genetic blood disorder that’s widespread across Africa – whose lives would be intolerable without tramadol, one of the few affordable treatments available.
But policing of this sort is hard to achieve in a part of the world where corruption is widespread and low-paid officials can all too often be “encouraged” to look the other way. The scale of illicit tramadol usage in Nigeria is now so vast that very big sums of money – hundreds of millions of dollars – are being made out of this business, and that kind of cash can oil many wheels and open many doors.
Source: Al Jazeera