Tra­madol: Less fa­mous than codeine, but prob­a­bly dead­lier

Weekly Trust - - Front Page - Judd-Leonard Okafor, Ti­j­jani Ibrahim (Kano), Nabob Og­bonna (Abaka­liki) & Risikat Ra­moni (Lagos)

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

Tra­madol cap­sules

Psy­chi­a­trists also blame drug reg­u­la­tor NAFDAC for in­ad­e­qua­cies in reg­u­lat­ing pre­scrip­tion drugs

Tra­madol, seized by Cus­toms, re­cently.

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