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 crisis. In 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 crisis. Tramadol 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
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