Tramadol: Less famous than codeine, but probably deadlier
Not too early. Just 8am. Benjamin Terveer drove through his street, toward the Keffi-Abuja highway on his way to work. A bike operator rode toward him. “He started falling, like in slow motion,” Terveer said. “Until he was completely on the ground. And he didn’t feel like anything was wrong. He didn’t scream for help. He was dazed, just dazed.”
In any other situation, if the distance between the car and bike was close, he could have been accused of knocking down a bike rider.
“Nothing of such. Everyone knew he was on tramadol,” said Terveer confidently.
News of use of the drug has been known for a long time, but the dimensions of use are only now widening-and commanding attention after recent revelations about the extent of abuse of codeine-containing cough syrup.
Tramadol is a strong painkiller, legitimately prescribed to treat severe pain. It has been used in cancer care, bone pain management, with tight prescription control.
But loose drug control means the prescription-only drug is available on the open market. It isn’t just available, it is designed to suit tastes.
Recommended dosage means legal production makes tablets or capsules of 50mg tramadol at least. Series of confiscations have seen dosages up to 100mg, 200mg and 250mg tramadol on sale.
The drug numbs pain centres. It also creates a sense of euphoria. Numbing pain centres means the areas of the body where you feel pain after an accident or a hard day’s work simply seem to disappear for a while. That helps when the use of tramadol is controlled.
Without control, when the pain areas return, users are tempted to take higher doses to keep the pain areas away as long as possible.
That’s why hardwork labourers are using tramadol increasingly. National Drug Law Enforcement Agents in Ebonyi have found higher consumption of tramadol among farmers, young people and minersp-typically demographics that engage in menial labour demanding physical strength and exacting pain on their system.
“The addicts believe and take tramadol for the purpose of energy to do work,” said Silas Orji, spokesman for NDLEA in Ebonyi.
“We have equally caught National Youth Corps members posted to serve in Ebonyi state in possession of tramadol.”
In the first four months of this year alone, it has seized packs of tramadol that boast of 435gm of the substance at a pop from pharmacies in the state capital.
The recent rage about tramadol just follows the rage that rent airwaves about deep codeine abuse revealed in reports that led to the shattering BBC documentary on codeine abuse epidemic in Nigeria.
Last Wednesday, Customs officials intercepted a container loaded with tramadol. Its content had been declared to be electrical appliances, said Musa Ahmed, area controller for Tin Can Islands customs.
In feburary, customs intercepted for container loads of tramadol.
Seizures have followed the high-dosage content of the drug coming into Nigeria, said Jerome Attah, of the anti-smuggling unit of Custom’s federal operations unit.
Attah said tramadol according to NAFDAC should be in 25mg, but, importers preferred to import 100mg and 225mg, which he said supersedes the recommended regulation.
The interceptions have been constant and ongoing, and have nothing at all to do with the recent ban on codeine.
Tramadol has been around, is cheap, affordable and easily abused.
Some pharmacists still insist on a doctor’s prescription to sell a N150 sachet. But the drug is becoming more available for less cost in motorparks and from hucksters carrying cartons of drugs on their heads.
Many of the customers are in need of psychiatric care. Abayomi Ojo is a consultant psychiatrist at the Federal Neuropsychiatric Hospital, Yaba.
For every 10 people he sees at the drug abuse clinic in the hospital, three of them use tramadol alone. The other seven use tramadol with other drugs-indian hemp, codeine, alcohol-regularly, and become addicted.
“Tramadol is used majorly for pain. It makes people feel agile, excited,” says Ojo.
“It makes people to work for a longer period particularly the okada riders. Some others use it to feel good and excited.”
Using the pain killer medication may be for everyone, but for someone to become addicted to it to the extent of abusing it, the psychiatrist said, “The usual 25mg may not be enough for them. After some time, they want to increase the dose to a higher level. The way the brain of some people reacts to drugs differs to others and that is why some people react to it and others don’t. For those who react, they end up at the hospital. Meanwhile, there are several of them who never end up at the Psychiatric hospital despite abusing the drug due to the way their body reacted to it. When somebody who has the tendency to develop a psychiatric problem uses tramadol and other medications, it tampers with the brain and they end up having a psychiatric problem.”
Ojo attends to patients as young as 19 and as old as 40 years. More elderly people have presented at the hospital but more with alcohol abuse.
Dr John Abraham has been campaigning against tramadol and codeine abuse, but is seeing abuse of the drugs rise instead.
One patient he was on tramadol for a fracture, another for burns. One was on tramadol for two years, the other for six months. Both have become addicted, after going off their doctors’ prescription.
“One took 5,000mg tramadol per day. That’s like 50 capsules a day,” says Abraham.
On prescription, tramadol dosage is regulated for days or weeks. But the addictive tendency means people on the drug discover no-pain numbness and euphoria it induces. The dosage wears off quickly. And users demand higher quantities.
One case he cites is a senior police officer’s son hooked on tramadol. The youth overdosed, crashed his head against bathroom tiles and lay there bleeding, without a pain or care in the world. Unable
National Drug Law Enforcement Agents in Ebonyi have found higher consumption of tramadol among farmers, young people and minersp-typically demographics that engage in menial labour demanding physical strength and exacting pain on their system
to scream for help, he died in a pool of his own blood and brain matter.
Tramadol induces numbness to pain, and that side effect is sparking another trend of use-as an aphrodisiac.
“Some people have attested it gives them sexual enhancement,” says Abraham. Okay, so it doesn’t increase blood flow to the penis to aid erection, or lock blood flow in penile tissue to make erection last, but some have discovered properties to tramadol that rival Viagra. The property is the numbness. “The good feeling, the euphoria it gives is one. Then that numbness to pain. It keeps the pain from the central nervous system, not from the local part but directly from the brain. The male organ is erect but the excitement that will make you get orgasm easily is blunted,” explains Abraham.
“You are getting reward from your brain that you are lasting. So that give ssatisfaction but the sensation you feel during sex that makes you want to reach orgasm fast is being blocked. And the euphoria it gives makes you feel macho. And when you feel that way, it produces dopamine, the feel-good hormone. It is feedback loop, and you achieve what you want.’
A 55-year-old patient of his took two capsules a day and increased the dosage when the effect started waning.
In pain the couple visited and needed a prescription for tramadol.
“The wife said, ‘my husband likes tramadol’” said Abraham. “It just slipped out and she didn’t know why he did.”
Away from the bedroom, young people are taking tramadol to “belong” with the right crowd.
One Kano addict, name withheld, said most of his crowd who also take codeine see it as a fashion or a form of civilization: if you are not into it, you are primitive.
“So both those who take it as fashion and those who take it to cast away worries could resort to some other drugs that are in the same line and can give the same ‘charging’ effect, if they could not lay their hands on codeine,” he says.
“But those that take tramadol are destitutes that require energy to work. So you can see that we are parallel,” he brags.
Garba Magaji, a self confessed addict in Kano, prefers codeine to tramadol, when he can afford it. When he can’t, there’s a caboodle of choices that can serve.
“All you need is to take enough to get you charged. And they are available everywhere in the markets and medicine stores,” he says.
Even before the ban on codeine, the Nagarta Youth Development Initiative, which works in counselling and rehabilitating drug users, estimates four in 10 drug users it worked with used codeine, and the other six in 10 used tramadol.
“So, with the ban on codeine, it means that this percentage will increase,” says Aminu Idris, president of the group.
The group sees two categories of users: people involved in hard labour wanting to keep away pain of physical labour, and people involved in thuggery who take tramadol to get brave and fearless when they fight or attack.
“So, when you look at the number of these two categories, vast majority of whom are poor people, one could imagine how huge their population is in Kano and imagine how high is the rate of consumption of tramol is in Kano,” he says.
Drug law enforcement has seized more than 6 tonnes of psychotropic substances in the first four months of this year alone, including codeine and tramadol, rohypnol and valium.
Hundreds of users and traffickers have been arrested, convicted and jailed. Dozens have gone through rehab and been reintegrated with families.
But it is far for stanching the flow and use of tramadol.
The danger is in the different uses. Codeine depresses, tramadol stimulates. And it is a slippery to abusing other drugs that enforcement agents haven’t even thought of.
“Somebody who is used to codeine may not likely resort to tramadol because they don’t have the same effect. There are other substances which may not be appropriate to mention here but we are keeping a close look on them,” says Adamu Karami, chief superintendent of narcotics at Kano’s NDLEA.
Psychiatrists believe a ban on tramadol could flop as much as the failure anticipated in a ban on codeine.
“Banning such drugs will not solve the addiction problem of the youths. They will always find alternatives and another drug to abuse,” says Ojo. “Aside helping the abusers find alternatives, the government are encouraging smugglers to make money. If they are able to smuggle guns into the country, they can easily smuggle tramadol too. They smuggle fuel out of this country to Ghana and other countries to sell, so, who says they won’t use the avenue to make money. The cost of the drug will increase. “Banning importation or production will not solve the problem of drug abuse, rather, they need to do a massive education about the danger of taking it. That doesn’t mean they should not regulate, but, they should avoid outright ban because that will encourage underground.”
Psychiatrists also blame drug regulator NAFDAC for inadequacies in regulating prescription drugs that could potentially be beyond the reach of patients who legitimately need them.
Tramadol is another blot on the horizon of medicine. Not just on your way to work.
When somebody who has the tendency to develop a psychiatric problem uses tramadol and other medications, it tampers with the brain and they end up having a psychiatric problem
Tragedy of Tramadol: Loose drug control means the prescription-only drug is available on the open market
Psychiatrists also blame drug regulator NAFDAC for inadequacies in regulating prescription drugs
Tramadol, seized by Customs, recently.