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Tramadol Abuse: Metaphor For An Urgent Need To Address Drug Abuse

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Despite several efforts by government, civil society groups and non-governmental organisations to educate people on the dangers of drug and substance abuse, the phenomenon seems to be increasing at an alarming rate. The reckless desire to get high, displayed by a large youthful population, is quickly turning to a norm and a culture in Nigeria, regardless of the consequences of such practices. ISABEST OMOREGBEJI writes on the implications of Tramadol abuse especially, on the hills of authority’s seizure of container after container load of the drug at our ports.

Kassim is a tall, skinny looking water vendor who each day, appears with his truck loaded with rubber gallons of water to sell to his customers who rely on his water supply as an alternative to the nonexistent water board services around the suburb of Mararaba. Very early in the morning, he is usually the first to wake the occupants of the houses around the neighborhood with a big bang on their gates, followed by a repeated shout of ‘water board,’ to announce his arrival. Everyone in the compound praised Kassim’s strong and dedicated spirit to what he does as well as how he is able to put up with a trade that requires so much physical energy, going by the bad conditions of the roads – he has to pull and push his rickety truck, bumping in and out of potholes every day, to deliver his services.

On this fateful morning, Kassim came as usual, packed at the entrance while everyone placed their orders. But, something was off about the young man – he was not his usual self, he was not smiling as he used to. He also did not crack jokes with his customers like he usually would. Then he suddenly stopped, pulled out a card containing some white and green coloured capsules and in split seconds, popped a few into his mouth and swallowed. That was all he needed because after a few minutes, he beamed with a big smile and began to move swiftly from door to door to collect the empty containers from the verandas.

Maybe the energy with which he moved became too much for his chest because in a most shocking manner, he soon dropped down into cardiac arrest. Foam came out of his mouth and he jerked furiously, filling the whole place with palpable fear and confusion. No one knew what was really going on – is he dead? Some fear stricken occupants inquired. Only a few people summed the courage to draw close to Kassim’s near lifeless body. And after gallons of water was emptied on him, he began to show signs of life again. Thereafter, he was rushed to the hospital where doctors confirmed that he had an overdose of Tramadol mixed with some other solution.

It is no longer news that the abuse of Tramadol is a major issue around Nigerian middle and low income societies. Those who cannot afford the means to indulge in cocaine or other hard drugs see Tramadol, Rephanol and the likes of Codeine as an easy substitute not just because they are relatively cheap, but because of their availability at every turn. But since the ban on codeine most of these people are turning their drug attitude toward Tramadol.

A visit to one of the hot spots where Tramadol is abused in Aso Mararaba – revealed how some of these youths and teenagers, some as young as 14, prove their might by indulging this drug in broad day light even daring to smoke weed alongside. More than half of the number that came to buy the drug where young teens in school uniform. The faces of these young lads had one thing in common – dry lips and terribly Rastafarian looking haircuts with some scary looking chains around both hands and neck.

I spoke with one of the retailers of Tramadol around the area in Mararaba and was shocked when he told me he was neither aware of the health implications of the drug, nor that most young people who buy the drug use it to get high.

“I have been a retailer of medicine for three years; I sell all kinds of medicine at a far cheaper price from what pharmacies would sell. Yes I sell Tramadol, I even take it myself, it is one of the pain killers that my customers like to buy. I just sell to earn a living. My customers actually confess that the drugs I sell gives them energy, takes away their pain and even helps them stay a long time without eating. Most of them know what their head can carry so I advise them to stick to that, but some of them still increase their dose. I do not know what dosage is adequate, it just depends on what they need and I sell it to them. Some of the drugs do not carry expiry date so in some cases I have no way of knowing they could be expired.”

Tramadol like the recently banned codeine lies at the heart of Nigeria’s drug problem. For many Nigerian youths, the drug is simply more than just a pain killer – it has become a ‘make me feel good’ sort of recreational drug that most youths repeatedly abuse in the process of satisfying their craving for a high. A walk through the streets of some bordering towns around the Federal Capital Territory would tell you a more vivid story of how easy it is to abuse Tramadol. You hear young people speaking of their experiences on what it felt like when they were new to the drug.

One young fellow, who simply identified himself as Joe in a similar neighborhood in Lugbe Village, said he is does Tramadol on a regular has been doing it for two years now and that he is aware of the implications of abusing the drug but that he goes seriously ill whenever he attempts to stop.

From the increasing number of health complications to the surge in the population of persons in need of psychiatric care, it all points to the menace of drug abuse. Yet it appears very little is being done to control the influx of Tramadol to the country. As far as experts are concerned, the implications of abuse of drugs like Tramadol on Nigerian youths is devastating.

“Though tramadol is an analgesic used as pain reliever, the truth remains that it is being abuse and such abuses come with huge consequences,’’ said Dr Ambrose Onivefu Lawani, who doubles as a consultant psychiatrist with the Federal Neuro-Psychiatric Hospital Uselu, Benin City and president, Association of Catholic Medical Practitioners of Nigeria, Archdiocese of Benin. He explained that what happens is that most of the time, the people seem to increase their dosage. ‘‘You know it comes in different dosage form and of course, for different kinds of pain. So people would not know how to regulate the dosage but if you use the drug with the supervision of a physician to a particular amount of dosage, the physician may need to reduce it due to the origin of the pain because pain is a symptom of an underlying problem. But with abuse, the person increases the dose and begins to get all the side effects.”

Lawani reiterated that: “Besides the effect Tramadol may pose on its users, more worrisome is the fact that it is a gateway to the abuse of other drugs. So what is supposed to be done is for people to be taught better ways of pain management and there are people who are experts in that. What actually needs to happen is this, government needs to make sure people who are the first point of call in health matters like primary healthcare workers, are educated. Also, we need to make sure that some medications are not available over the counter.’’

Speaking further, he commended the recent Nigeria Medical Association policy that doctors have a stamp for their prescription. ‘‘It will alleviate a lot of these issues but again, people must be ethical because if they buy from somewhere else, the doctors are not the ones who are in charge of whatever places these drugs are sold. So we also expect that the Pharmaceutical Association of Nigeria, which I know are limited in what they can do, hold their own side such that they provide a nice synergy to addressing the issues of abuse.

“So fundamentally, abuse of drugs generally is a sign of a deeper problem. As I speak, you are also aware of the problem in the health sector – only the doctors are working. Can only one hand clap well? Can one hand wash and maintain the clean? Government needs to look inward and address these issues and make sure they give Nigeria a functional health system. In a situations where people just walk to the counter to self-medicate is a result of frustration and poverty. Our health insurance scheme is also still in the embryonic stage, the only people captured in it are the people working in the formal sector. The people working in the private sector are not captured. Most people who abuse Tramadol are the ones who go to the pharmacies to purchase it – the reason is that they cannot go to the hospitals because they will be asked to pay at least N500 for card or for consultation fee.’’

Speaking on how dangerous the side effects of Tramadol can be, Dr Lawani revealed that most of the time when Tramadol is taken in doses that are inappropriate, it can depress the respiratory centers and result in cardiac arrest which could also lead to sudden death. Again Tramadol makes the abuser a dependent, which is a form of illness because it is already something you do not have control over. That means the pain is not really there again but you continue to take it because you derive some pleasure of getting high and whenever the means is not there to buy it – you could go into some inappropriate behavior to get the money to maintain it.

Similarly, Dr Uchendu Ikedilichukwu Ubueye, a consultant neuropsychiatrist and executive director, Centre for Information and Prevention of Mental Health, proposed that the fight not only stop at banning Codeine but that other drugs like Tramadol and pentatusine, even Indian hemp, be addressed too. ‘‘I think it is high time governments at all levels really sat down to solve this menace because if this continues, in the next ten years, I assure you, we will not have a nation that we can be proud of,” he said.

Dr Lawani agrees that banning is not the right way to go about nipping the problem in the bud. ‘‘Remember codeine or Tramadol have their own therapeutic uses in the sense that, it is not illegal to have it in cough syrup such that when it is prescribed, doctors knows how to use it. But now that it is abused – banning it doesn’t really do anything more than forcing the market underground. Making drugs like this illegal does not stop their abuse but immediately forces the price up. It is an issue of demand and supply. It will continue to be there if you reduce the supply the price goes up, the people know where to get it.

Another question is what government is doing about the people who are already dependent on the drug? Because the people need to be rehabilitated and Rehabilitation is an expert service that needs psychosocial intervention to mitigate the phenomenon.

 

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