OPIOID ABUSE (TRAMADOL & CODEINE)
GHANA’s SITUATION
OLIVIA AGYEKUMWAA BOATENG (MRS)
HEAD,TOBACCO AND SUBSTANCES OF ABUSE DEPARTMENT
MSC. CLINICAL PHARMACY
FOOD AND DRUGS AUTHORITY-GHANA
WORKING FOR YOUR SAFETY
LIST OF ABUSED DRUGS
Most abused medicines in Ghana are
• Prescription pain relievers eg codeine, morphine,
fentanyl, pethidine, tramadol etc.
• Misoprostol, mifepristone
• Benzodiazepines eg Diazepam, nitrazepam
• Phosphodiesterase 5 inhibitors (PDE5),
Reasons given for Abusing opioid drugs;
• Enhances sexual drive/prolong ejaculation
• Extra energy for manual workers
• Euphoria(tramadol can produce euphoria comparable
to heroin even at a single dose of 75mg***)
• Staying alert for long hours especially for commercial
vehicle drivers and their mate(s) & students
• Making them dazed and easily drift to deep restful
sleep
First Signs of an ‘Emerging’
tramadol Problem
Tramadol abuse in Ghana became an issue of interest
when:
• In 2013 seizures of tramadol intercepted at the ports
• In 2016, intelligence gathered across the country pointed
to scattered incidences of abuse of tramadol and codeine
containing cough syrups.
• As a rapid response measure, the FDA strategically
conducted a series of raids in 3 target regions (Northern,
Volta and Western) to substantiate reported cases.
• Alarming quantities of unregistered Tramadol strengths (e.g. 120mg, 225mg, 250mg) were uncovered in swoops.
Most affected populations
• Intensified nationwide public education at schools,
market places, beaches and transport terminals:
– confirmed increased use by market women
– routine abuse by commercial vehicle drivers
– novel use by students currently keep them
awake and alert to study for longer periods.
– performance and sexual enhancers by the youth
– Predominantly abused in slum areas
• Counterfeit /substandard/unregistered medicines
• Re-labelling /packaging and changing expiry dates
• Unauthorized distribution, sale & supply
• Adulteration of food supplements/herbal
medicines with allopathic drugs( PDE5 inhibitors)
51 herbal male vitality products were screened
and 6 product failed about 10% (2018- FDA lab
results)
PUBLIC HEALTH THREAT
Regulatory Interventions
Current trend of Public Health:- Tramadol abuse
• Findings necessitated the need for a regulatory
intervention to restrict Tramadol as a Controlled
Substance till date.
• Therefore, as a controlled drug, Tramadol can only
be accessed through authorisation, utilisation and
distribution records vetting and official inspections
by the FDA.
Codeine is already part of the scheduled drugs
under the single convention of narcotic drugs 1961
of which Ghana is a party to it.
ENFORCEMENT
• Collaborated with the police and other law
enforcement agencies to organize nationwide raids.
• November, 2017 raid: Sixteen (16) suspected
peddlers, aged14 -28 years old were arrested [15
from Niger, 1 from Ghana].
• Among the drugs that were being peddled were
tablets of Tramadol; strengths 120mg,200mg and
225mg.
Market Tramadol Raid November 2017
Seizures - Tramadol in 2017>500,000caps
Seizures - Tramadol in 2018REGION QUANTITIES 120mg, 225mg, 200mg
EASTERN 90 capsules
BRONG AHAFO 3293 capsules ,128 ampoules, 260 tablets
WESTERN 2,180 capsules
CENTRAL 1,630 capsules
UPPER WEST 750 capsules
ASHANTI 4,115 capsules
VOLTA REGION 14,700 tablets, 110,400 capsules
NORTHERN 10,280 capsules1,300 tablets
Total 132,738 capsules, 16,260 tablets 128 ampoules
Examples of Tramadol Abuse and Linkage to Serious Crime
• Police arrested 3 gentlemen and a
lady for allegedly snatching a taxi
cab from its driver by drugging him
• They were said to have put a drug
identified as D10 tromo pills into an
energy drink and offered it to the
driver.
Source: Ghanaweb
12 October 20174 Car Thieves Busted
Examples of Tramadol Abuse and Linkage to Serious Crime
• Scores of Passengers on board a VIP bus were in critical condition following a head-on collision with a Trailer Truck when the bus driver attempted to overtake the trailer.
• According to an eye witness “we found out that the driver had taken tramadol drug. Because we found quantities of tramadol on the driver’s side, they take the Tramadol to harden them to drive carelessly “
Source: kasapafmonline.com
Scores injured as VIP bus crashes into trailer at Teacher-Mante
1 December 2017
WORKING FOR YOUR SAFETY
Examples of Tramadol Abuse and Linkage to Serious Crime
Abuse of Hard Drugs Cause of Ahwiaa Youth Rowdy Conduct 6 February 2018
Examples of Tramadol Abuse and Linkage to Serious Crime
Smuggled controlled drugs
ENFORCEMENT ACTIONS• Strengthened the follow-up inspections to monitor the
distribution records of importers and manufacturers of
Tramadol and other controlled drugs.
• The Honorable Minister of Health has
banned codeine-based cough syrups according to an
Executive Instrument named as ‘Instructions for the
restriction of importation, manufacture and registration of
codeine-containing cough syrups instrument, 2018’.
Restricted control on tramadol according to the
Executive Instrument named as ‘Instructions for the
control of the importation, manufacture and sale of
tramadol and tramadol containing products instrument,
2018’.
CHALLENGES• Unauthorized point of entries of medicines & free movement
of people and goods within ECOWAS
• There is lack of data on the estimate of trafficking abuse of
opioid medicines in Ghana.
• Lack of data on the illicit trade in Tramadol or codeine in the
ECOWAS region.
• Lack of data on the extent of abuse of drugs and prescription
drugs.
• Inadequate logistics/funds to carry out activities as expected
e.g. research, monitoring, training etc.
• Inadequate functional rehabilitation facilities for addicted
persons.
Conclusion
• Regulation is dynamic hence effective
awareness creation, inter-agency &
international collaboration, safe legitimate
supply chain among other regulatory
interventions would help reverse any emerging
abuse whilst providing patients with effectivepain management.
THANK YOU