Dear Kamran,
It is great to have your perspective as a staff member of the United Nations Office on Drugs and Crime. Welcome and thank you. In one of your recent messages you say:
"as opposed to North America where their earlier opioid crisis was driven by unethical marketing and overprescription of opioids for minor pain management, the mechanism misuse of opioids in other regions is quite different. In countries in West Africa for instance the misuse is driven by unregulated health care system, and misuse of tramadol, which in most instances is meant for misuse and trafficked into the countries (higher dosage of 250 mg or so than the approved max dosage of 100 mg in a tablet)"
Indeed we had a few messages earlier about the tramadol crisis in Nigeria and the use of cocktails known as 'colos'.
In the Nigeria Medical Journal I read:
'tramadol emerged as the most frequently misused opioid, commonly obtained without a prescription and used to manage work-related fatigue, untreated pain, or emotional distress. Sustained misuse has been associated with dependence, seizures, and a range of neuropsychiatric symptoms. Codeine misuse largely occurs through diversion of cough preparations and is reported predominantly among adolescents and young adults, particularly in academic settings, where it is consumed for its euphoric and anxiolytic effects. Morphine misuse appears less prevalent and is typically confined to diversion from medical settings, featuring mainly in hospital-based case series of opioid poisoning.' https://nigerianmedjournal.org/index.php/nmj/article/view/824/1199
I also read that tramadol has been used by students to enable them to study longer. [It reminds me when I was a medical student I once took caffeine tablets to study overnight before an exam - not recommended!] I had not been aware of the above motivations to take tramadol (or other opioid drugs). In my naivety I had assumed that people used it to 'get high' or to escape from emotional distress. It seems especially dangerous that young people could be using tramadol to try to enhance their performance, presumably unaware of the serious risks.
I would be interested to learn more about the motivations for 'experimenting' with and using different opioids in different countries. Perhaps this motivational abstract could be more clearly recognised and embedded in health education and awareness among young people?
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org