(13 Dec 2019) Mass abuse of the opioid tramadol spans continents, from India to Africa to the Middle East, creating international havoc some experts blame on a loophole in narcotics regulation and a miscalculation of the drug's danger. The man-made opioid was touted as able to relieve pain with little risk of abuse. Unlike other opioids, tramadol flowed freely around the world, unburdened by international controls that track most dangerous drugs. But some countries now consumed by tramadol abuse are asking international authorities to intervene. Grunenthal, the German company that originally made the drug, is campaigning for the status quo, arguing international regulations make narcotics difficult to get in countries with disorganized health systems, and adding tramadol to the list would deprive patients access to any opioid at all.
Tramadol is considered medically important only because it is unregulated and can be used where other painkillers aren't available. But it is widely abused for the same exact reason.
Lacking international control, individual governments from the U.S. to Egypt to Ukraine have realized the drug's dangers are not as narrow as believed and worked to rein in the tramadol trade.
The north Indian state of Punjab, the center of India's opioid epidemic, was the latest to crack down. The pills were everywhere, as legitimate medication sold in pharmacies, but also illicit counterfeits hawked by street vendors.
Amandeep Kaur was pregnant when her husband died of a heart attack. She turned to the sex trade to make ends meet. She wanted not to feel, and a fellow sex worker suggested tramadol. She had no idea she'd get addicted, but eventually needed three pills to get through the day.
Indian regulators knew the massive quantities manufactured in the country were spilling over domestically and scores of Indians were addicted. But S.K. Jha, responsible for the northern region of India's Narcotics Control Bureau, said he was shocked to learn in 2018 that tramadol was ravaging African nations. They realized then they needed to act, he said.
India scheduled tramadol in April 2018. Regulators say exports overseas and abuse at home came down. But they acknowledge that the vastness of the pharmaceutical industry and the ingenuity of traffickers makes curtailing abuse and illegal exports all but impossible. Tramadol is still easy to find.
The crackdown on tramadol coincided with the opening of dozens of addiction clinics that administer medicine and counseling to more than 30,000 each day.
Countries' efforts to control tramadol on their own often fail, the Center for Strategic and International Studies, particularly in places where addiction has taken hold.
India has twice the global average of illicit opiate consumption. Researchers estimate 4 million Indians use heroin or other opioids, and a quarter of them live in the Punjab, India's agricultural heartland bordering Pakistan, where some of the most vulnerable are driven to drugs out of desperation.
Grunenthal maintains that tramadol has a low risk of abuse; most of the pills causing trouble are counterfeits, not legitimate pharmaceuticals. The company submitted a report to the WHO in 2014, saying that the abuse evident in "a limited number of countries," should be viewed "in the context of the political and social instabilities in the region."
But some of wealthy countries worried about increasing abuse also have acted to contain the drug.
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