” — by the United Nations. Instead, each country has to set up its own rules and regulations for tramadol production, import, export, distribution and use.
The pills non-medical users of the drug buy from market women or roadside vendors are typically between 120 and 250 mg, though some speak of strengths of up to 500 mg. They usually cost between 250 and 500 francs , depending on the dosage. The minimum wage in Togo is 35 000 francs per month. Around the region, the few formal options that do exist for people who use drugs and want to stop are often embedded in psychiatric hospitals. But the stigma around checking into such an institution is strong.
“We have seen an increase in seizures of tramadol in various countries, especially those with sea [ports] where tramadol usually enters the region — Benin, Ghana, Côte d’Ivoire and Nigeria,” says Jeffery Bawa, drug control and crime prevention officer for the United Nations Office on Drugs and Crime Sahel programme., North, Central and West Africa accounted for 87% of pharmaceutical opioids seized worldwide, a development due almost entirely to tramadol trafficking.
Neighbouring Ghana has also taken steps to combat tramadol abuse and there, the medication is now a controlled substance. Ghanaian authorities are also teaching people that this is a substance with health implications. Two streets on, she enters a courtyard, where she is greeted by Kodjo Touré*. The nurse, dressed in a white coat, runs a little neighbourhood clinic from his house.
“If the pain wants to be kind to me, it comes slowly, but most of the time it just suddenly pops up in my body,” Grace says. The day before, a combination of fever and pain made her vomit. “The pain felt like something was squashing my lungs.” Touré breaks open one of the tramadol capsules, draws the liquid into a syringe and injects it into Grace’s arm. For just an instant Grace’s self-control cracks. She looks exhausted.
Unlike tramadol, step 3 substances such as morphine are internationally scheduled, and countries must put forward annual estimates of their needs. “This is often a problem,” explains UNODC expert Thomas Pietschmann, from Vienna.
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