West Africa’s Opioid Crisis

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.

FILMMAKER’S VIEW

By Antony Loewenstein and Naashon Zalk

Nigeria has a major drug problem.

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 percent of Nigerians aged between 15 and 64 abused drugs – more than twice the global average of 5.6 percent. 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.

Despite having Africa’s largest economy – surpassing South Africa’s in 2014 – there has been remarkably little reporting about Nigeria’s tramadol problems. Although a few major Western media outlets have covered the drug’s abuse in the Middle East and Africa, usually focussing on how it is used by fighters belonging to hardline groups, we soon realised that there was little concrete information about how and why millions of ordinary Nigerians are abusing it.

Mainstream media is regularly filled with startling reports on the opioid epidemic destroying communities across the United States but a similar situation for West Africans, especially Nigerians, has largely been ignored.

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.

We travelled to the four corners of Nigeria in search of answers. From Abuja to Lagos to Maiduguri to Kano, tramadol has seeped into the pores of a nation that has so much human potential yet is stymied by poor governance and pervasive corruption. It was genuinely shocking.

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.

Social and health effects

The social and health effects of this abuse are easy to see (anyone doubting the consequences should spend some time walking through the psychiatric and addiction wards of Nigerian hospitals) and successive governments have taken an increasingly punitive approach to the business, but unfortunately the efforts of Nigerian law enforcement and others don’t seem to be doing much to stem the tide.

Antony has spent the last four years investigating the “war on drugs” for a book that looks at how that struggle has been playing out around the world – from Guinea-Bissau to the Philippines, Honduras to the US, and the UK to Australia. On location we’d sometimes talk about a recurring theme he’d found during his travels: how ruthlessly the world’s poor have been exploited through their often involuntary involvement in the production and distribution of narcotics to satisfy largely Western demand – which, of course, is where much of the money to pay for them has historically come from.

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.

In truth, there are no easy answers except perhaps more education about the drug’s negative effects and more effective policing – especially more international operations aimed at those at the top of this pyramidic trade; the major manufacturers and smugglers and organised crime groups behind it all, rather than the lowly Nigerian street peddlers who sell a handful or so of the pills at a time.

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.

We got some insight into the temptations people face while filming with customs and drug enforcement officials at Apapa docks near Lagos. They wanted to show us an intercepted shipment of illegal tramadol. It was an impressive sight – hundreds of cardboard boxes, each containing thousands of illegal individual high concentration doses – but even as we pressed for details about who was behind the shipment and what action had been taken against them (it turns out that distressingly few people have ever been prosecuted for tramadol smuggling in Nigeria), we caught sight of some of the boxes being thrown over the port security fence a few feet away. Someone was busted for it, but when we tried to film the arrest we were briefly detained on the orders of a senior officer, clearly embarrassed that a carefully choreographed photo opportunity wasn’t going to plan.

It wasn’t the only challenge we faced. Nigeria can be a complicated place to do journalism and as we were there in the summer, it was also fearsomely hot, especially in the far north where we went in search of the Boko Haram part of the story. Nevertheless, as you’ll see from the film, it was here that we heard some of the most compelling, if disturbing, accounts of what tramadol abuse can lead people to do and how desperate cravings have been exploited by a ruthless rebellion in constant need of new recruits to do its bidding.

But in the end, this became a story as much about the victims as the perpetrators: those struggling with the consequences of addiction living in a society that has yet to find answers to a steadily worsening problem.