Global Opioid Crisis
Political pundits and policymakers have acknowledged the severity of the U.S. opioid crisis. However, there is also a drug that is quietly wreaking havoc on developing nations. Many have touted tramadol as a safer alternative to other opioids. However, it has instead fostered addiction in the poorest nations and bankrolled terrorists. Authorities fear that the drug’s growing popularity may even destabilize entire regions, causing the global opioid crisis.

Is Tramadol Safe?

At first glance, it is not clear how tramadol is fueling the global opioid crisisIn 2021, the National Institute of Health (NIH) released a study declaring that tramadol has “a low potential for abuse” and has a significantly lower rate of nonmedical use than comparator opioids.

In addition, the World Health Organization (WHO) Expert Committee on Drug Dependence has reviewed the drug several times. It recommended against regulation in its most recent report. The main reasons are its concerns that regulation may hinder access to the drug in developing nations.

However, a closer look at the drug and its effect on the developing world demonstrates clearly how tramadol is fueling the global opioid crisisTramadol is an opioid that medical professionals use to treat moderate to severe pain. It may cause nausea, dizziness, constipation, headaches, respiratory depression and even death.

Tramadol and the Global Opioid Crisis

Despite its presentation as a safe alternative to opioids such as Vicodin, there are plentiful examples of how tramadol is fueling the global opioid crisis:

  1. The illicit market for tramadol is booming. Grünenthal, a German company, originally manufactured the drug for medicinal purposes. However, inadequate access to medicine in the developing world allowed the illicit market to blossom. Lower prices and immediate access to illicit painkillers relieved the shortcomings of poor health care structures, as UNODC reported. Most of these drugs are coming from India. Pill factories have been meeting the demand for tramadol pills by shipping them across the planet in illegal amounts. The demand for these drugs and the absence of regulation keep such illicit trade profitable. U.S. law enforcement has estimated that its seizures of tramadol tablets leaving India in the 2017-2018 period exceeded 1 billion.
  2. Tramadol addiction is rampant in West Africa. According to the UNODC report, “opioids and their nonmedical use have reached an alarming state in West Africa.” The report collected data from Ghana, Burkina Faso, Benin, Niger and Togo. Tramadol seized in West Africa in 2017 accounted for 77% of the tramadol seized globally. It also acknowledged that non-medical use of tramadol is ubiquitous in Niger, where it is the narcotic people are most familiar with. The number of narcotics seized in Nigeria nearly doubled from 53 to 92 tons between 2016 to 2017. The report showed that overall, tramadol is the most popular opioid as it accounts for 91% of all pharmaceutical opioids seized in West Africa in 2017.
  3. The UNODC report on tramadol in West Africa highlighted one of the most sinister aspects of how tramadol is fueling the global opioid crisis. The report stated that “it cannot be denied…that there may be a link between tramadol trafficking and terrorist groups.” The report cited examples of Al Qaeda prompting its followers to trade tramadol to finance its terrorist operations as well as Boko Haram fighters depending on the drug before attacks. The statistics support these claims. According to CSIS, law enforcement intercepted $75 million worth of tramadol heading to the Islamic State group from India in 2017. Authorities also confiscated another 600,000 tablets bound for Boko Haram and found 3 million in a truck in Niger. In May 2017, authorities seized 37 million pills in Italy. Isis had bought them and intended to sell them for profit.

Tramadol Trouble Shooting

Despite the growing problem, many have paid attention. For instance, UNODC met in July 2019 to discuss its West Africa report. Representatives from West Africa, India, the European Union (EU), Interpol and WHO were a few of the guests that attended the meeting to discuss how tramadol is fueling the global opioid crisis.

Not only are organizations, nations and individuals paying attention, but they are also actively strategizing to mitigate the crisis. The meeting highlighted the need for international cooperation and increased law enforcement. Lastly, there was great emphasis on the need for uniform regulation of the pharmaceuticals, in hopes that cooperation would crush the illicit market while meeting demand.

– Richard Vieira
Photo: Unsplash

Drug addiction and poverty
About 35 million people suffer from drug addiction worldwide. For countless families, this illness goes hand in hand with a cycle of poverty. Many factors fuel drug addiction including unemployment, mental illness and financial status.

Poverty’s Role in Drug Usage and Abuse

Impoverished communities face significantly higher rates of addiction. Financial instability fosters stress, increasing the likelihood of addictive behaviors. Heroin addiction illustrates this link. People making less than $20,000 per year are three times more likely to have an addiction to heroin compared to those making $50,000. Beyond that, people with greater financial means face an easier recovery journey. They are less likely to suffer from severe, long-term addiction than those in poverty. Lack of education, emotional instability and discrimination all heighten the risk of addiction. However, two factors are keys to understanding the link between addiction and poverty.


Unemployment is a key driver of drug addiction. Impoverished working-age men are 18% more likely to face joblessness as poverty and unemployment form a harmful cycle. The cycle begins with unemployment heightening one’s risk of poverty. Then, once in poverty, job hunting becomes harder due to economic bias, challenges in earning a college degree, racial bias and a lack of job infrastructure in low-income areas. This cycle of unemployment-induced stress and anxiety increases the chance of falling into drug addiction.

Mental Illness

Mental illness increases the risk of drug addiction, and poverty elevates the risk of mental illness. Using data from Great Britain, the Mental Health Foundation concluded that people living in the lowest 20% of incomes are two to three times more likely to develop mental health problems than those in the highest 20%. One can explain this through higher stigma and societal trauma, unemployment and fragmented relationships in low-income environments. In addition, poverty undermines access to mental health care and support. This connection is dangerous as population surveys in the U.S. found that half of those who experience mental illnesses will develop drug addictions.

Addiction Increases the Risk of Poverty

Once someone has a substance use disorder, it can be extremely difficult to achieve financial success or maintain a stable economic status. Three main factors can explain this relationship between addiction and poverty.

  1. Addicts use some portion of their earnings on drugs. While the cost of substances differs, when added over time, even the smallest expense can affect a person’s financial well-being, especially as tolerance levels increase.
  2. Drug addiction can cause the addict to miss work, perform poorly and fail drug tests. These all threaten job security and employment status.
  3. Substance use increases the risk of costly medical emergencies and long-term conditions. Depending on the extremity of the problem, some medical visits can leave a person in financial debt, threatening economic stability.

Fighting Addiction Means Fighting Poverty and Vice Versa

Because addiction and poverty inextricably connect, viable solutions must take this into account. Countries throughout the world are fighting back against these issues in unique ways. One solution that countries like the Czech Republic, the Netherlands, Portugal and Switzerland pioneered is the decriminalization or legalization of drugs. This method recognizes drug addiction as an illness, opening the doors for better regulation of drug safety and support services such as psychiatry, housing and employment. The overall strategy of legalization shows promise. Since legalizing drugs, Portugal saw an 80% reduction in overdose deaths. Additionally, overall drug use declined. Switzerland’s decriminalization policy corresponded with an 80% reduction in first-time heroin use.

With an awareness of the interconnected relationship between addiction and poverty, policymakers can move toward real solutions to break this destructive cycle.

– Haylee Ann Ramsey-Code
Photo: Wikimedia Commons

How Substance Abuse Impacts Homeless in GreeceDue to a recession in the early 2000s and as a result of austerity measures in the mid-2000s, there has been a prominent drug problem among the homeless in Greece. The recession that hit the Greek economy led to significant depression among its citizens, and a rise in drug and alcohol abuse. The government even cut social programs for homeless people battling addictions. This led to an increase in police involvement resulting in mistreatment by law enforcement.

Economic Despair

As Greeks struggled to survive, many turned to substance abuse. In 2019, 55% of drug users seeking assistance were heroin addicts. However, although a majority of addicts were using heroin and marijuana, some were using a drug called shisha. The Guardian newspaper describes shisha as a drug containing meth-like qualities when mixed with other substances. It became popular when drug dealers began providing low-quality versions of the drug for extremely low prices. One hit of shisha only cost two euros.

The high addiction rates to shisha combined with lack of employment opportunities have led addicts to become more engaged in harmful and dangerous behaviors. A significant number of women have also resorted to prostitution as a way to finance their addictions. According to the Guardian, there has also been an increase in suicides, overdoses, HIV infections, Hepatitis C and pregnancies among the homeless in Greece.

A Personal Story of Drug and Alcohol Addiction

In conversation with The Borgen Project, Sue Silversmith, a Licensed Independent Substance Abuse Counselor, said she has worked with Native Americans facing substance abuse and alcohol addiction throughout her entire career. As a social worker and licensed counselor, Silversmith has also worked together with indigenous groups fighting against substance and alcohol addictions. While funding and accessibility are a challenge, there are organizations available for those struggling with addictions. As one-quarter Navajo, Silversmith has a strong heritage and dedication to working with native tribes. She is passionate about her culture and how addiction is killing her people. Silversmith acknowledges the sadness of people dying from this disease but says that it motivates her to help those suffering from addiction.

While alcohol and substance abuse education are core components of Silversmith’s group sessions, she also discusses her own battle and recovery from alcohol abuse. Her personal story has allowed her to help many clients in their own recovery. Community and organizational support are key to individual recovery as well, particularly when clients don’t know how to advocate for themselves. She teaches her clients that alcoholism and substance abuse is physical, emotional and spiritual. She also emphasizes that addiction is often part of an individuals’ genetics and family heritage, which can be difficult to overcome. Silversmith uses a holistic approach in helping her clients combat addiction.

Kethea Fights Substance Abuse

As the homeless in Greece continue to struggle with substance abuse and addiction, organizations such as Kethea have taken action to address the growing problem. Kethea is a therapy center for drug addicts, providing rehabilitation services for people with cannabis, alcohol and gambling addictions. It also supports people facing problems with law enforcement and those looking to reintegrate into society. While Kethea provides services for various types of addictions, the main addictions it treats are heroin and opium. It has also recognized the need to expand services for alcoholism and gambling.

Kethea is the largest network of rehabilitation centers in Greece, not only offering services to addicts but also to their friends and family. It provides all services pro bono and these services are available in many sectors of society, including in prisons. After the government initially reduced funding for social programs during the recession, efforts are now emerging to re-implement and reform these programs. Despite widespread unemployment and poverty due to the economic crisis, organizations like Kethea offer hope for people struggling to overcome drug addictions and reintegrate into society.

– Brandi Hale
Photo: Flickr

Remedy for Hunger Pain
Today, people wear masks. These masks hide people’s faces and protect them from a disease they cannot see, but not all masks are visible. Some masks are invisible. One of these masks is glue and some use it to silence the stomach’s growl. In many developing countries, teenagers use glue as an inhalant drug to quell the cries of their stomach, a remedy for hunger pain. Unfortunately, there is little statistical data readily available on this topic, making any hope of reform nearly impossible. However, research from the National Institute of Health (NIH) has made the effects of sniffing glue evident.

According to NIH, inhalants can cause the following damage to the brain: distorted speech, poor bodily coordination, euphoria and dizziness. The brain is not the only part of the body that sniffing glue negatively affects. Long-term use can result in damage to the liver, kidney and bone marrow. Loss of physical coordination and delayed behavioral development can also occur.

A Prevalent Issue

Kimberly Solórzano, who works at a Honduran orphan care center, spoke with The Borgen Project about how sniffing glue impacts the long-term health of children and adolescents. Solórzano said, “They are just sniffing glue, and that is very common among teens coming out of these kinds of shack communities. They are sniffing glue to stay warm and to feel full when they’re hungry…just kind of becoming oblivious to the world around them due to their addiction.” Solórzano made The Borgen Project aware that many children who find themselves addicted to inhalants are uneducated about the long-term effects.

Unfortunately, this is an issue that touches all four corners of the world. In Kenya, estimates determine that 250,000 children sniff glue. In Nepal, a research study found that 88.46% of street children sniff glue and 89.13% were unaware of the effects of the inhalant. These alarmingly high statistics seem to hide the good news. However, there is hope for reform.

Educational Reform

Hope is spelled “education.” Through proper education on the effects of inhalant use and methods for combating food shortages and world hunger, there is hope for drastic change. One organization that fights for educational reform in the area of global hunger is Bread for the World. Bread for the World focuses on sustainable progress, which it defines as “progress that is intended to be, and is capable of being, enduring- depends on addressing all of the issues in an interconnected manner.” Education on various food storage methods echoes sustainable progress. Specifically, Bread takes time to teach farmers in India how to properly contain vegetables, like corn.

Another goal of Bread is to witness the Sustainable Development Goals come to life. Bread states that “Universal secondary education, which is included in the Sustainable Development Goals, would no doubt lead to swifter progress in ending hunger and malnutrition.” Through secondary education for all, the remedy for hunger pain would no longer be inhalants but nutritious food. Education is key and Bread is fully aware of this fact.

Thankfully, Bread is one of many United States nonprofits working to end global hunger. Together, these organizations make a lasting impact by bringing educational and congressional reform on the topic of global hunger, provide nutritious food as a remedy for hunger pain and create a lasting impact from generation to generation.

– Chatham Kennedy
Photo: Flickr