Opioid Crisis Hits Africa, UN Declares

A worldwide drug report from the UN shows an emerging crisis in opioid drug use in Africa. Specifically highlighted is the drug Tramadol, an opioid pain medication used to treat moderate to moderately severe pain. The report stated that synthetic opioid use is booming. 

"Opioids" refers to drugs ranging from opium and derivatives such as heroin to synthetics like Fentanyl and Tramadol. In 2017, the estimated number of people using opioids worldwide was 56% higher than in 2016, according to the U.N. Office on Drugs and Crime (UNODC). 

Part of the increase was due to more data being available, thanks to surveys in Nigeria and India. However, the increased percentage also highlighted the scale of the problem despite a drought-related fall in opium production last year in the world's biggest opium producer, Afghanistan.

“The opioid crisis that has featured in far fewer headlines but that requires equally urgent international attention is the non-medical use of the painkiller Tramadol, particularly in Africa. The limited data available indicates that the Tramadol being used for non-medical purposes in Africa is being illicitly manufactured in South Asia and trafficked to the region, as well as to parts of the Middle East,” the UNODC 2019 World Drug Report said.

“Some consume Tramadol for its calming, analgesic and anti-fatigue effects in order to improve intellectual, physical and working performances, and to lessen the need for sleep and decrease appetite,” the report said.

“In farming communities, there are reports of Tramadol being used by humans and fed to cattle to enable them to work under extreme conditions. Others use Tramadol as a recreational drug on account of its stimulant and euphoric effects, or to improve sexual stamina.”

Most African countries have not documented the crisis properly. Egypt is one of the countries that have. A 2015 study by the Egyptian ministry of health and the UNODC found that 100,000 people are dependent on opioids, with half of that number being dependent on Tramadol. 68% of patients seeking addiction treatment in government facilities did so because of Tramadol addiction.

Globally, seizures of Tramadol have increased from less than 10 kg in 2010 to almost 9 tonnes in 2013 and 125 tonnes in 2017, according to the report. The problem was particularly severe in West, Central and North Africa. In 2015, 40 million tablets of Tramadol were seized in the port of Cotonou in Benin. The port is a hub for Tramadol shipments. 

From Benin, the tablets make their way across West Africa and the Sahel regions into the hands of terror groups such as Al Qaeda, who have taken to the illicit trade in Tramadol as a source of funding, according to the UNODC. 

In November last year, Italian authorities seized a Tramadol shipment destined for Libya from India worth 50 million euros. Six months prior, they had seized a shipment worth 75 million euros still intended for Libya. Authorities believe they were destined for ISIS bases in Libya. 

Several West African countries have reported that Tramadol is one of the most widely used drugs for non-medical purposes after cannabis, which remains by far the most popular globally. WHO reports that cannabis is the most widely-used illicit substance in Africa, with the highest prevalence and increase in use is being reported in West and Central Africa with rates between 5.2% and 13.5%.

Africa also remains to be one of the regions least served with effective pain relief medicine. This contributes to the crisis. Although Tramadol is not the strongest of analgesics, it is one of the most prescribed ones. This is because unlike other opioids such as Methadone and Fentanyl, Tramadol is not internationally regulated, hence it is cheap and readily available for patients. Doctors prescribe Tramadol in cases of post-surgical pain, bone deficiencies and cancer. Additionally, Médecins Sans Frontières (Doctors Without Borders) classify it among its ‘essential drugs’ list. 

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