TRAMADOL …a disturbing development

The recent reportage on unlawful tramadol use among Ghanaian youth is a disturbing development. The situation is becoming frightening as young women and children join the bandwagon, and without a swift governmental response to hold the situation, the country could soon be engulfed by a public health crisis.

Moreover, the consequences of such an iffy situation could be dire. Tramadol is an opioid pain medication used to treat moderate to severe pain and is believed to be substantially addictive. Opioids – heroin-like substances – are the main ingredient used in the production of tramadol, and they act as receptors to produce morphine-like effects. They are drugs prescribed only by Medical Doctors for some specific categories of patients. Self-medication of such drugs can lead to overdose and potential death.

It is particularly a worrying situation because the abuse is rampant in underprivileged communities where there is less awareness about rational drug-use, drug-abuse and their implications. Many of these communities are already being torn apart by socio-economic difficulties, and tramadol-abuse further exacerbates their predicament. There is therefore an urgent need to prevent the illicit use of tramadol – and also put in place measures for the treatment of those already addicted to the drug.

Substance and dru- abuse have a long history. In 1877, one Ella Henderson died at age 33 after she had abused morphine for several years according to an American newspaper publication titled ‘A Beautiful Opium Eater’. Ella was from a middle-class family, and she was an intelligent and educated woman. She took to drugs after her father who was a hotel proprietor died.

Unable to manage the pain over the father’s death, Ella increased her daily intake of morphine to the point that she became a complete junky. Her addiction and subsequent death was a shock to many at the time, especially since she hailed from a well-to-do family. There are similar stories of substance abuse all over the world.

Not much has changed in the last 100 or so years regarding the menace of substance abuse. The colossal blip in markets and governments have made it possible for the illicit drug trade to persist and thrive. Often people who get hooked on drugs do so because of their vulnerabilities. They are unable to manage life’s changing moments and turn to drugs as extenuation measure.

Many of the young Ghanaians neck-deep in tramadol abuse are either emotionally stressed, economic destitute(s), or social and peer-pressured – and many also are chasing personal bliss. Moreover, they are poor so they are unable to access rehab care; and society seems to have neglected them, too. They are therefore left on their own – and unable to engineer any way out, they continue to abuse drugs the more.

These factors, justified or not, are leading our youth into early graves. It is a crisis that, ultimately, will create a colony of junkies and desperados shortly. Such a development will undoubtedly hurt the Ghanaian economy – either through high healthcare cost, increased crime, or low productivity – and ensure many dependents on welfare in the medium- to long-term. This requires urgent redress, as the consequence of ‘no action’ will be debilitatingly catastrophic.

The urgent need for a solution must be the responsibility of all Ghanaians. Fortunately, the flashpoints are known. In a recent GH One TV series dubbed ‘State of Affairs’, and also an extensive documentary by Redone Karim Dini Osman, many addicts came out in public to talk about their addiction and their readiness to seek support to cure such addiction.

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Old Fadama in Accra and Alabar in Kumasi are the epicentres of tramadol abuse. In such instances, targetted intervention is helpful as the identified epidemic areas are known. The responsible agencies must initiate an emergency programme that seeks to curtail tramadol supply through the black-market and all other outlets. Such outlets must be identified and crushed. I know the swag of black-market makes it difficult to identify, but with appropriate policing tact, and support from residents of these epidemic areas, the problem will be resolvable.

The abusers need care to remedy their addiction. The appropriate governmental agencies must collect such people, especially the children and women, put them into rehab or correctional centres and offer them proper support to cure their addiction.

They could also be supported with apprenticeship training, so they can be appropriately integrated into society to prevent them from going back to their old life. This Emergency strategy is an immediate solution to managing the situation presently. But, going into the future, there is need for a more thorough policy approach to controlling substance and drug abuse in the country.

The Ghana National Drug Policy (GNDP) of 2004 provides the basis for a long-term solution to tramadol and other substance abuse in the country. The GNDP has many objectives; the most critical of them is to “promote the rational use of drugs by prescribers, dispensers and consumers”.

Another important objective of the policy is to “to improve the system of supply and management of drugs by rationalising the procurement systems and improving the distribution and management systems at all levels of healthcare delivery”. I have particularly picked on these two objectives because they present the basis for a policy solution to the drug menace in the country.

At the core of any drug policy is the notion of rationality in the use of drugs. It requires adequate training for all persons in the drug administering chain – users, hospital staff and pharmacy attendants. In many developing countries, rational use of drugs is still a significant challenge due to inadequate controls in drug administration and also because of the capitalist profiteering opportunities inherent in the drug business.

It is not uncommon to find unauthorised and untrained prescribers dispensing medicine to innocent customers in many countries, including Ghana. Despite this, only a small fraction of people who abuse drugs do so unknowingly. A more significant fraction of abusers, however, often do so intentionally. Moreover, they have full knowledge of the potential ramifications of such actions. For these two categories of drug abusers, public information dissemination on the proper use of drugs presents an opportunity for them to change – especially for those who abuse drugs unknowingly.

Often, private chemical outlets are the primary conduit for dispensing illegal drugs to unauthorised people – though, occasionally, some governmental drug management agencies are complicit in the illicit trade. Without adequate systems to train practitioners in prescribing and dispensing drugs – both at the government and private drug dealers side – not much will be achieved on rational drug use. It also requires robust systems and routine checking of practitioners on compliance. Regulation, monitoring, education and enforcement are vital to ensuring rational drug use.

Given the grave capacity and logistical constraints in the delivery of rational drug use in Ghana, we have tried to typographically illustrate and demonstrate the potential weak links in the GNDP that are not helpful in the fight against drug abuse. We identified weakness in “drug education and campaigns” and “supply chain monitoring” as a particularly severe weaknesses which require attention from policymakers if we are to make any gains in the substance-abuse fight.

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The GNDP requires the National Drug Information Centre (NDIC), through the Ministry of Health, to collaborate with other stakeholders to facilitate the collection, compilation, processing, presentation and dissemination of information regarding appropriate drug use. Specifically, government is tasked under GNDP to “undertake comprehensive and sustainable information, education, and communication (IEC) programmes to educate the general public on the rational use of drugs”. Regarding self-medication, the policy prescribes that citizens be given access to sufficient unbiased information on all forms of medication. I observe that this responsibility is not performed to any appreciable level yet.

To curb the drug abuse menace, the Health Ministry necessarily needs to embark on aggressive drug information campaigns that alert citizens to drug abuse effects. New media platforms present an excellent opportunity for the Ministry of Health to effectively convey its messages across to the broader population.

Voice and text messaging of tips on drug use can also be sent to the public to deter them from abusing drugs.  At the same time, the MoH can engage the services of the Information Services Department (ISD) and National Commission for Civic Education (NCCE) to carry out ‘safer drug use campaigns’ in the remotest parts of the country where mobile usage penetration is less.

On the supply of drugs through the black-market, it remains a difficult task for all the relevant agencies – especially with the coming into force of the ECOWAS fiat on free movement of people across the region. That notwithstanding, with frequent monitoring of drug supply sources (domestic and external supply) and distribution as well as retail outlets, the situation could be improved – especially that China and India are the primary producers and suppliers of tramadol for the Ghanaian market.

The difficulty with monitoring supply channels must not cause the respective agencies to jettison their responsibilities and duties to the state. The Food and Drugs Authority, along with the Pharmaceutical Society of Ghana and Narcotics Control Board, must all support in ridding the ecosystem of illegal and black-market syndicates and smugglers. The police and other law enforcing agencies are essential in monitoring and incarcerating perpetrators of these crimes.

Ghana’s drug management architecture is comprehensive enough to be able to manage all kinds of crises, including the tramadol menace. Apart from the GNDP, there are legislative instruments on medicines which give legal bases to the respective agencies working in this space. Also, the regulatory authorities of Food and Drugs and the Pharmacy Council are adequately equipped to be able to contribute their quota in addressing this situation.

What is required now is the commitment, will and desire to “nip the bud” for good! The country cannot afford to wait any longer, as the situation is increasingly getting out of hand. The repercussions of no action or delayed action might be catastrophic for many aspects of Ghanaian society. The need to act is now, and the Ministry of Health must show firm leadership in that regard.

e-mail Kyeremeh@gmail.com

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