OccupyGhana urges crackdown on Tradamol abuse

Pressure group OccupyGhana has admonished government to take immediate steps to curtail the abuse of Tramadol.

Tramadol is a narcotic-like pain reliever used to treat moderate to severe pain. Fatal side effects can occur if it is used with alcohol, or with other drugs that cause drowsiness or slow breathing.

There has been an increase in the purchase and abuse of Tramadol, which could lead to adverse consequences, hence a campaign by health groups, individuals and other civil society organisations for government to intervene.

In the Ashanti Region, 21 drug sellers have been referred to the Pharmacy Council for the necessary action to be taken against them for stocking and selling high doses of Tramadol.

This was after the Food and Drugs Authority (FDA) had undertaken a market surveillance at 84 shops comprising 50 over-the-counter chemical shops and 34 pharmacy shops within the region, Mrs Nora Narkie Terlabi, the Ashanti Regional head of the FDA told Adehye FM's Elisha Adarkwah.

At the over-the-counter chemical shops, she said 21 of them had stocked and sold Tramadol even though the regulation governing their operations does not permit them to sell controlled prescription medicines.

OccupyGhana said in a statement on Monday, 23 April 2018 that government must “urgently take steps to tackle the illegal trade in Tramadol. We recommend a three-pronged approach – medical, law enforcement; and prevention and rehabilitation”.

The pressure group is asking the Ministry of Health to appoint a group to research the extent of the problem.

“The group will train doctors to recognise signs of Tramadol addiction and take steps to treat these patients. Consideration could be given to setting up addiction treatment centres.

“We ask the Law Enforcement agencies to investigate how these drugs are coming in and to take steps to stop the large shipments from India and China. The Narcotics Control Board, FDA and Pharmacy Council should ensure that licensed chemical sellers do not sell Tramadol or that it is not sold over the counter.

“Tramadol should only be obtainable with a prescription from a licensed medical provider.



“We ask for programmes to educate the general public about the drug and its addictive potential. This should involve pharmacists, doctors, teachers, and pastors. Consideration should be given to programmes of rehabilitation,” the statement explained.

Below is the full statement:

Introduction

Tramadol is a synthetic opioid that is used to treat acute and chronic pain of moderate to severe intensity. It has one-tenth the potency of morphine. It is used worldwide, having originally been developed in 1962 by Grünenthal Gmbh and coming onto the market in 1977.

Tramadol has the potential to be dangerously addictive. However, although it has been reviewed several times by the WHO, it is not a regulated drug.

Thus, the International Narcotics Control Board (INCB), the independent intergovernmental control organ for the implementation of the United Nations drug conventions, has not seen it fit to regulate Tramadol.

It is considered a cheap opioid, used for managing pain. Being regulated would make it difficult for doctors in poor countries to obtain it for legitimate use.

Nevertheless, being an opioid, Tramadol has potential to cause dependence and addiction, through abuse or taking higher doses than recommended.



The Problem

Tramadol has recently become a cause of major addiction in Ghana and other developing nations in Africa and Asia. Without the oversight of the INCB, manufacturers in India and China have been able to flood the market with the drug.

There have been many reports lately about the scourge of Tramadol addiction. Until recently, however, many health workers were unaware of the scale of non-medical use and abuse of Tramadol. Patients addicted to Tramadol present with different symptoms from those addicted to the usual opioids like morphine or heroin. This has led to many doctors misdiagnosing the condition.

Porous borders allow the drug to be brought into the country undetected. Tramadol is a controlled substance in Ghana, meaning that those who trade in it, without medical prescription, do so illegally. The trade in Tramadol has links with organised crime.

The doses of Tramadol approved by the FDA for use in Ghana are 50mg and 100mg. The strengths illegally sold on the streets, popularly called TRAMOOR among the youth, tend to be much higher (200mg, 225mg, 250mg).

It has also been reported that Boko Haram and ISIS fighters ingest Tramadol before attacks to increase risk-taking behaviour and make death painless.

Teenagers and young adults are most at risk of abusing and becoming addicted to Tramadol. It is being used to enhance sexual prowess, increase athletic ability and allow prolonged physical labour. The abuse of the drug by some drivers could play a role in motor vehicle accidents. Ultimately, the addiction to the drug results in depression, an increase in risk-taking behaviour, seizures and even death.

Without exact numbers, it is difficult to estimate the extent of the problem, but it could easily be designated a public health problem.

Recommendations

OccupyGhana® is calling on the government to urgently take steps to tackle the illegal trade in Tramadol. We recommend a three-pronged approach - medical, law enforcement and prevention and rehabilitation.

We ask the Ministry of Health to appoint a group to research the extent of the problem. The group will train doctors to recognise signs of Tramadol addiction and take steps to treat these patients. Consideration could be given to setting up addiction treatment centres.

We ask the Law Enforcement agencies to investigate how these drugs are coming in and to take steps to stop the large shipments from India and China. The Narcotics Control Board, FDA and Pharmacy Council should ensure that licensed chemical sellers do not sell Tramadol or that it is not sold over the counter. Tramadol should only be obtainable with a prescription from a licensed medical provider.

We ask for programmes to educate the general public about the drug and its addictive potential. This should involve pharmacists, doctors, teachers, and pastors. Consideration should be given to programmes of rehabilitation.

Though not part of the three-pronged approach, another option to look at would be petitioning the International Narcotics Control Board (INCB) to add Tramadol to the list of opioids it controls. The cost of obtaining it for cancer and post-surgical patients will be a much lesser evil than the scourge of rampant Tramadol addiction.

Tramadol addiction presents a health problem of grave severity and it behoves the nation to get on top of it before it becomes an uncontrollable epidemic.

In service for God and Country.