“I have absolutely no pleasure in the stimulants in which I sometimes so madly indulge. It has not been in the pursuit of pleasure that I have periled life and reputation and reason. It has been the desperate attempt to escape from torturing memories, from a sense of insupportable loneliness and a dread of some strange impending doom.” Edgar Allan Poe.
In recent times, there have been many stories about the abuse of tramadol by some youth in Ghana. From kayayie to driver’s mates, through manual labourers and even armed robbers. Some are even said to use it to enhance libido and sexual drive. I have been following this commentary with considerable caution wondering what intervention I could make from a public service standpoint. There are times when some of the reportage has made me cringe and others that have made me chuckle in hilarious laughter. The fact is, like anything Ghanaian it seems we have been taken unawares by this and are even confused as to how to shut the stable doors, knowing perfectly well that the horses have bolted.
Tramadol is an opioid analgesic considered to be less addictive than many of its more renowned classmates. That notwithstanding, if used indiscriminately, it can cause considerable harm to abusers. It is relatively young. The drug having been created by a German drug company that specializes in treating pain in 1962. It was subsequently tested for 15 years in Germany, was approved and brought to the foreign market in 1977 under the name Tramal and hailed as a success by its makers.
This pharmaceutical success was followed in its wake by reports of drug abuse, dependence and addiction, especially in the United States. In recent years however reports of abuse have been more prevalent in sub-Saharan Africa and Asia. According to the World Health Organisation (WHO), “There is growing abuse of tramadol in some African and West Asian countries, as evidenced by recent large seizures of such preparations in North and West Africa. Abuse of tramadol has become a serious problem in Egypt and abuse has also been reported in Iran, Jordan, Lebanon, Libya, Mauritius, Saudi Arabia and Togo.” That Togo had been named in this 2014 WHO report was clear indication that considerable stocks of this medication had arrived at our border. Typically, very little notice was taken then until anecdotal evidence began emerging that this drug was being implicated in many violent armed robberies, a few resulting in deaths.
Some have argued that regulators and law enforcement have failed us by allowing the markets to be flooded with this product. Though I empathise with their sentiments, I struggle to agree with the logic. My reason is that most of the illicit stocks of tramadol come through our very porous borders and cannot be tracked even with the best will by our regulators based on current resources. Secondly, there is considerable evidence that many who previously dealt in hard narcotics have shifted into the manufacture and trafficking of tramadol because the punishment if caught is less punitive in many countries and the risk of the death penalty virtually non-existent. This view is supported by the fact that, between February and October 2016; Benin, Ghana, Senegal and Togo all in West Africa, together seized tramadol, totalling more than 132 tons. The preparations had been concealed in sea containers sent from India and were intercepted by the local law enforcement authorities.
This new dynamic in my view calls for a rethinking of the manner in which tramadol is managed and supplied even in the regulated pharmaceutical market. Ideas like limiting supply to me are non-starters. They are because tramadol by its current classification is a prescription only medication and also a controlled drug. Ordinarily, therefore, it cannot be obtained unless with a valid prescription from a doctor and supplied under the supervision of a pharmacist. These provisions if properly enforced in itself will cut illicit supply if any from the regular supply chain. Another measure that will help, is to discourage prescribers from using tramadol as a routine medicine for the management of pain. This is actually the recommendations of the Ministry of Health’s Standard Treatment Guidelines but I am also aware that some in the same ministry are organising training sessions and encouraging the use of this product routinely. This situation if not discouraged will not help in the control of this medication. I advocate that even prior to its prescribing doctors have conversations with their patients regarding any potential risks and associated side-effects.
Legally, based on the available information, there may be a case for a rethink around the classification of tramadol. It may also be necessary for punitive measures relating to the illicit activity surrounding it to be enhanced. I hold this view because the amount of money that has been moved from the trafficking of Class A narcotics to fund this new illicit trade is such that the sanctions under Ghana’s Pharmacy Act and other similar legislation are not stiff enough. Countries in North Africa and the Middle East have long realised the impact of tramadol abuse on their youth and crime rates that some have banned the medication outright, whilst others have increased the jail terms its possession attracts considerably. In Egypt, for example, the option of a death penalty is now on their status books for crimes associated with the trafficking of tramadol, an indication of the seriousness they have attached to this new frontier of illicit activity.
There is also an urgent need for the education of our youth especially those in the second cycle and tertiary institutions, with menial jobs and the unemployed about the dangers associated with the use of tramadol. In my view, this is one area in which we have failed as a country. Our approach to illicit drugs has always been hash-hash, with little open conversations to change the dynamics of demand and supply. We have done this because of our long-held views that ignorance is bliss. Sadly, however, this approach leads to peer pressure conversations on the grapevine, resulting in the demand part of this trade becoming curious and increasing the potential clients for suppliers. Invariably, compound the problem and enriching the illicit suppliers. This chain has to be broken.
We need to be open and make it public that tramadol is addictive. People need to be aware that its use can lead to the following unwanted effects even in very low doses; nausea, severe vomiting, constipation, fever, dizziness, appetite loss, troubled concentration, muscle aches, depression and sweating. More severe symptoms of tramadol abuse typically occur when higher doses of the drug are taken or when tramadol is taken in combination with another substance. These symptoms include sever seizures, central nervous system depression, manic attacks and even suicidal tendencies due to what is termed serotonin syndrome. This syndrome occurs when too much serotonin, a chemical that relays signals in the brain, is produced or remains in the brain. People, as a result, become agitated, confused, jerk badly, show a lack of coordination and can in some instances slip into a coma. Clearly, these are not effects anyone will wish on even their worst enemy. To think that we will hash up and see a significant number of our youth go down this route is a risk even this drunkard will shiver the nation to take.
Finally, it is important that this conversation is taken up by advocacy groups to pressure the government to retool organisations like the Food and Drugs Authority, Customs and the Narcotics Control Board to deal with this new frontier of crime. We cannot continue to expect these organisations to use the same old tools to tackle new problems. I accept that the said organisations should be making these requests ordinarily but the fact is we are a country that dwells in reactionary rather than proactive mode. The only way, therefore, that government listens is when citizens agitate and agitate consistently.
We need to remember that inaction is not an option as those agitated especially if they are involved in violent crime may kill or maim us should they ever encroach on our property. Should that happen it is us, our families and loved ones that will feel the real pain of their transgression. Transgressions that could have been prevented and or avoided if we had been truthful to our conscience and made a stand. To this end I have sought today, not to bend it; not to water down; not to ignore this menace; not to sit on the fence or edit the inner consciousness of my own soul but to follow my most intense obsessions challenging the status quo in a frank and merciless approach.