Thoughts From Afar
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Checks indicate that majority of the illicit supplies (strengths of tramadol higher than 100mg) are trafficked into our country through porous land borders and originates mainly from the port city of Cotonou in Benin

Tom Robbins in Even Cowgirls Get the Blues argues, “I believe in political solutions to political problems. But man's primary problems aren't political; they're philosophical. Until humans can solve their philosophical problems, they're condemned to solve their political problems over and over and over again. It's a cruel, repetitious bore.”

It is often said all humans are political animals and I make no effort to exclude myself. However, over time I have come to the realisation that devolving politics from many problems that confront our country gives a better paradigm with options that would have been discounted if political lenses were in place. I have been asked numerous times what the solutions to the pandemic abuse of the synthetic opioid analgesic tramadol are. Often, I have given answers in a skirmished manner. Today, I seek to move the conversation in this direction being clearly aware that we are nowhere near end game.

Having said that, it will be naïve if this advocacy were to continue without a clear sense of direction about what needs to be achieved, by whom and how. It will also be laughable on the basis of the evidence available if we assumed that the institutions of state constitutionally mandated to police our medicines supply chain and pharmacy practice had the capabilities to bring this spiraling menace under control. I take this view because of the international dimensions that are associated with the tramadol trail and supply chain.

Checks indicate that majority of the illicit supplies (strengths of tramadol higher than 100mg) are trafficked into our country through porous land borders and originates mainly from the port city of Cotonou in Benin. According to documents obtained from the United Nations Office of Drug and Crime shipments of tramadol from India to West Africa increased by 560% in just a year from 157 shipments to 882 between 2012 and 2013. At that point, the Twenty-fourth Meeting of Heads of National Drug Law Enforcement Agencies, Africa predicted that "Misuse of tramadol has created a situation of dependency and may become a public health problem in the years to come." Sadly, that statement was not followed up with forwarding planning to contain the situation leading to their prediction becoming reality. There is, therefore, a need for ECOWAS to look seriously at sub-regional cooperation to strengthen surveillance at the Cotonou port especially and other similar ports in the sub-region.

As a country, we have for long discussed the need to tighten our land borders and often kicked the necessity into the long grass. Clearly, the current situation makes it imperative that government takes this seriously. I am not oblivious to the logistical complications this may present but also believe, where there is a will, there is a way.

That our police officers are still not able to identify the illegal strengths of tramadol is an issue that needs to be urgently addressed. I am aware the Food and Drugs Authority (FDA) has been holding training programmes to help correct this but even with that the cascading down the chain of command seems to be bottlenecked. Hence the real men who go on raids and confront hardened criminals are none so wiser even if they find any medication on their person. The time has come for a proactive approach, requiring all hands and brains hence these frontline men need to be retooled to understand this new reality.

I cannot proffer solutions without indicating the need for intelligence gathering to try and map out the intra-country supply chain and kingpins. Many have indicated that most of the illicit supply is through foreign drug peddlers who parade our cities, towns and villages with impunity. Much as this may be true, we need to understand where their main source is and truncate that. Such detailed investigation can only be done using our national intelligence apparatus i.e. The BNI and National Security. We must not forget that anything that targets a large section of our youth is a matter that borders on human security with significant impact on our personal security. Thus making this priority for our intelligence apparatus must be on the cards.

We need to also start a discussion about the classification of tramadol and where regulatory control sits. Currently, by law, it is not even classified as a controlled drug, though the FDA has named it on its list of controlled substances. In my view, the current situation makes this position untenable. We need to establish whether there is a role for the Narcotics Control Board especially for the illicit strengths and if so what that should be.  Also though the law allows the imposition of a custodial sentence of up to ten years for the trafficking of illicit tramadol, indications are that many who are arrested do not even have their day in court. This is a real problem and indicative of a society not keen on winning this war. Our jails cannot be places mainly for cassava thieves and petty criminals, especially when there is credible evidence that their crime is fuelled by illicit drug use.

The country cannot continue to bury its head in the sand without facing up and having an honest conversation with our youth about the ills of our society and especially illicit drug use. For far too long we have walked on eggshells and not discussed these. Sadly, in this era of social media and smartphones, grapevine information that heather to spread by word of mouth has become the mainstay of youth gossip. Without a well thought out plan that amongst other things targets our secondary schools, churches and mosques as well as strategize to put information onto social media in an appealing way; any advocacy will be destined to fail. We must come of age and confront twenty-first-century problems with solutions that are a step ahead of the crime. We must always be mindful not to let things happen to us but be proactive and go and happen to things.

Finally, that as a country we lack a comprehensive drug rehabilitation policy is a grave dereliction of responsibility and a failure in our duty of care. The tramadol pandemic has brought this to the fore and presents us with an opportunity to right this wrong. It also justifies a case to be made for a system of drug treatment centres across the country. Any thought that we can rid this country of illicit tramadol without dealing with the problem of addiction through rehabilitation is not only shallow but a demonstration of a lack of understanding of addiction and mental health. It will also make it possible for evil minds with an eye for terrorism and mass crime to find the critical mass which till date has been none existent and hit us where it hurts most. The country must recognise that “drug dependence is a complex, multifactorial health disorder characterized by a chronic and relapsing nature with social causes and consequences that can be prevented and treated.” It is clear that we can only win this war if there is collaboration across institutions of state, civil society groups and with cross political party engagement. I believe this can be achieved and this isn't about me being utopian it's more about me being a passionate realist.