AVOIDING FISCAL CRISIS
Janice Mackinnon is the mind behind Jason Kenney’s review panel
MAIDUGURI, NIGERIA Six years on from the day when Boko Haram gunmen stormed his hometown of Bama, Abel Habila still has trouble blotting out the memories. Prayer has helped, but far more effective are the red and yellow pills that he buys from the street dealers near his home.
“At first they just helped me to forget the trauma of the attack, and how we had to run for our lives,” he said, voice drowsy from the two doses he has had this morning. “But now I take them for other reasons too: just to blot out the pain of life here in Nigeria, the boredom and hopelessness. My consumption has rocketed.”
The medical name for what Habila knows as “Red Caps” is tramadol, an opiate-based painkiller used for conditions such as migraine and severe arthritis. Here in war-torn northeast Nigeria, it is now at the centre of an addiction epidemic affecting millions of people.
Yet the chief “pushers” are not just the street dealers who supply the likes of Habila. The tramadol abuse epidemic was started by Boko Haram fighters themselves, who took it to suppress fear during battle and to treat injured comrades. They now consume so much that Nigerian army units hunting Boko Haram in the bush look for discarded tramadol packets as evidence of the militants’ presence.
Boko Haram fighters also give it to thousands of young boys and girls that they have abducted and brainwashed. Many who have fled the fighters carry on taking it, spreading its use into the wider population.
The result is an opioid crisis on a scale with that now gripping the Rust Belt regions of the United States, where nearly two million people are addicted and fatal drug overdoses reached a record high last year. Nigeria has far fewer resources to deal with the problem.
The city of Maiduguri, where Habila now lives, is one of the few
At first they just helped me to forget the trauma of the attack, and how we had to run for our lives But now I take them for other reasons.
to have a hospital with a ward that treats drug-addicted patients.
Dr. Ibrahim Abdu Wakawa, who runs the 80-bed facility at the Neuropsychiatric Hospital, said the decade-long Boko Haram conflict had led a huge “upsurge” in tramadol abuse.
“Previously, our studies showed that the tramadol use was relatively low among our drug users, at about four per cent, but as of 2014, about 45 per cent of all clients referred to this facility were using it,” he told The Sunday Telegraph.
“We understand that some of those taken captive by Boko Haram or who have fought with the group are given the drug to numb their feelings. We’ve had soldiers brought on for addiction treatment as well.”
Tramadol misuse is no longer just confined to those who have witnessed the trauma of war.
The rickshaw drivers who work Maiduguri’s dusty streets take it to help get them through a long day behind the wheel. Farm labourers, who call the drug “Horse Leg ”, believe it gives them extra strength. College students use it to help them study, and claim it acts as an aphrodisiac. Nigerian rappers sing its praises in their songs.
Prolonged abuse can lead to seizures, psychosis and potentially fatal overdoses, while withdrawal symptoms can induce the very pain tramadol is designed to inhibit. Some in-patients have to be restrained from trying to escape.
“At first, tramadol just makes you feel good and full of energy, taking all your body aches away,” said Ahmed Muhammed, an in-patient who took the drug to help him get through long shifts of farm labouring work. “But soon I needed to take it all the time. My family made me come here, but when I realized I wasn’t going to be able to get tramadol any more I became very aggressive. I’m clean now, but I kept a diary of my treatment to remind of how bad things got.”
Tramadol misuse is part of a wider substance abuse epidemic gripping Nigeria, where nearly 15 per cent of the 200 million population report a “considerable level” of psychoactive drug abuse, nearly three times the global average. While there are no precise figures on the amount of tramadol consumed, customs officials regularly seize hundreds of millions of tablets, most of it illegally imported from Asian manufacturers.
The Nigerian government has made tramadol prescription-only, pushing its black market price up twenty-fold. But even now, a single 200mg capsule still costs less than $1.60, making it affordable to users like Habila.
“I could get some right now if I wanted,” he said. “There is a dealing spot just round the corner.”
Pressure is growing on the World Health Organization to put tighter international controls on the trade, but it has so far resisted, pointing out doing so would remove one of the few cheap painkillers available in hospitals and clinics in Africa.