VOA Special English
'Safer Opioid' Fuels Crisis in Poor Nations, Conflict Areas


    Opioid abuse is not just a problem in the United States. There is another opioid crisis that is just as serious. In fact, the United Nations has called it “the other opioid crisis.”

    It is the mass abuse of the pain killer tramadol, and it reaches from India to the Middle East to Africa. Experts say the crisis has resulted from problems in regulating the drug and a misunderstanding of its danger.

    The man-made opioid was believed to be a way to reduce pain without risk of substance abuse. Now, some countries are asking for international agencies to stop its export.

    The German drug manufacturer Grunenthal was the first company to manufacture tramadol. Grunenthal still makes the drug, but no longer controls rights to its production.

    The company argues, however, that the drug crisis comes mainly from counterfeit pills that are made illegally, mostly in India.

    “This is a huge public health (problem),” says Doctor Gilles Forte. He is the secretary of the World Health Organization’s committee that proposes how drugs should be controlled.

    In this Thursday, Oct. 31, 2019, photo, a medic administers medicine to a recovering drug user at a de-addiction center in Kapurthala, in the northern Indian state of Punjab. (AP Photo/Channi Anand)
    In this Thursday, Oct. 31, 2019, photo, a medic administers medicine to a recovering drug user at a de-addiction center in Kapurthala, in the northern Indian state of Punjab. (AP Photo/Channi Anand)

    Tramadol is available in conflict areas and poor nations because it is unregulated.

    Tramadol has not been as deadly as other opioids, and the crisis is not killing as many people as it does in the United States. However, many officials have begun to understand the danger is greater than was believed. The pills are everywhere. Real ones are sold in drug stores. Illegal, counterfeit ones are sold on the streets.

    The north Indian state of Punjab is the center of India’s opioid crisis. This year, officials there seized hundreds of thousands of pills, closed down pill factories and banned most drug store sales. The price of tramadol quickly rose from 35 cents for a box of 10 pills to $14. The government opened several treatment centers because it was afraid those who had come to depend on the drug would start using heroin.

    For some users, tramadol had become as important as food.

    “Like if you don’t eat, you start to feel hungry. Similar is the case with not taking it,” said Deepak Arora, a thin, 30-year-old who took 15 tablets a day. “You are like a dead person,” he added.

    Jeffery Bawa works for the UN’s Office on Drugs and Crime. In 2016, he traveled to Mali in western Africa, one of the world’s poorest countries. He and his team asked people about their most pressing problems. They did not say hunger or violence. They said tramadol.

    Nigerian officials said at a UN meeting that the number of people there living with addiction to tramadol is now far higher than the number with AIDS or the virus that causes the disease.

    In Cameroon, so many people were using tramadol that scientists believed it came naturally from trees. They later found farmers were feeding it to farm animals, whose waste put tramadol into the soil and then into the trees.

    Police began finding pills on terrorists. They sold the drug to finance their activities, Bawa said.

    Most of it was coming from India. The country’s large drug industry makes less costly generic drugs. Pill factories ship them around the world, in amounts far greater than medical limits.

    In 2017, law enforcement officials reported the seizure of $75 million worth of tramadol from India. They said the drug was being sent to the self-declared Islamic State group. Officials stopped 600,000 pills from going to Boko Haram fighters in Nigeria.

    The UN agency released an international warning about tramadol. “We cannot let the situation get any further out of control,” it said.

    Grunenthal states that tramadol has a low risk of abuse. In a 2014 report to the WHO, the company said the abuse was in “a limited number of countries” that it described as politically and socially “unstable.”

    But some wealthy countries worried about increasing abuse also have also tried to contain the drug.

    Britain and the United States both regulated it in 2014. Denmark began regulation in 2017, after doctors examined studies that claimed tramadol was safer than other opioids. The doctors all agreed that the documents did not prove it is safer.

    I'm Susan Shand.

    The Associated Press reported this story. Susan Shand adapted it for VOA Learning English. George Grow was the editor.

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    Words in This Story

    opioid - n. a drug that dulls pains

    regulate – v. to control or direct the use of

    counterfeitadj. maPde as copy or imitation of something else

    pilln. a small rounded medicine

    heroin – n. a powerful illegal drug that is made from morphine

    genericadj. something that does not have a name given by the manufacturer to a product or products