Two-thirds of global drug deaths now come from opioids, according to a recent report by the UN. 53 million people worldwide use opioids today, coming second-place to cannabis, used by 188 million people globally.

A significant portion of opioid use is concentrated in West Africa. Codeine and tramadol, strong painkillers, are the main opioids used in the region, both recreationally and for mental alertness. In Nigeria, many workers use tramadol, because it allows them to work harder while ignoring pain and hunger.

“The market women use it here in Lagos. They use it to wake up very early and work long hours. They carry very heavy goods for hours when they use drugs,” a Nigerian businesswoman said.

“The men use it too. They can carry very heavy items like washing machines and fridges when they are on drugs, so they work as movers,” another retiree from Nigeria said.

Nigerian customs have intercepted many trucks bringing opioids into the country. In September 2018, The Nigerian Customs Service (NCS) intercepted a truck with concealed cartons of cough syrups with codeine, diazepam and tramadol injections and tablets.

Last month, the NCS intercepted containers of tramadol worth ₦5 billion ($14,000), in the capital, Lagos State. In July 2019, about ₦7 billion ($20,000) worth of tramadol was destroyed by the NCS. Almost 90% of the pharmaceutical opioids seized globally in 2016 were seized in Africa.

Why Opioids?

In West Africa, opioid usage is now a crisis. Opioids are cheap, widespread and highly accessible in many West African nations. Mainly manufactured in India and smuggled into West Africa, they offer mental release to a population living in poverty and facing mass unemployment, with no opportunities for social mobility.

West African nations top the world’s poorest nations list. In 2016, 79% of global suicide occurred in low- and middle-income countries. The rising rate of opioid abuse has directly led to an increase in mental health diseases in the region.

“In Kenya, Nigeria and South Africa triggers of mental illness such as unemployment and violent crime are at critically high levels. The mental health picture is far worse in poorer countries, especially those that have recently experienced civil wars and conflicts, including Liberia and Sierra Leone,” the UN explained.

Nigeria: Textbook Example

West Africa’s opioid crisis can be understood throughout Nigeria. 55% of youths in Nigeria are unemployed. A great cause of this unemployment is mass corruption within political institutions. Political elites have, for decades, stolen government funds for their personal pockets, refusing to invest in the country’s infrastructure and institutions.

Corruption among officials has led to very few prosecutions of drug dealers caught smuggling illegal opiates into the country. Although it is legal to buy tramadol from pharmacies in the country, many drug users opt for the illegal varieties which can go as high as 600mg, six times the recommended dosage for the synthetic opioid.

Nigeria has the fifteenth highest suicide rate in the world. Trauma caused by generational problems, such as poverty, economic and political instability, unemployment, lack of education, religious and tribal violence, along with a corrupt government, has led to 14% of the nation’s population abusing tramadol.

When taken in high doses, tramadol can produce the same high as heroin, giving users an euphoric experience. In Northern Nigeria, tramadol abuse is rampant among Boko Haram members, who take it before their violent attacks.

Mr Pierre Lapaque, the UNODC’s (United Nations Office on Drugs and Crime) Regional Representative in West and Central Africa confirmed in 2017 that: “Tramadol is regularly found in the pockets of suspects arrested for terrorism in the Sahel, or who have committed suicidal attacks. This raises the question of who provides the tablets to fighters from Boko Haram and Al Qaeda, including young boys and girls, preparing to commit suicide bombings”.

Many who have been internally displaced by Boko Haram also abuse tramadol for relief against PTSD as a result of their experiences, including loss of loved ones and being kidnapped to work as child soldiers.

In 2012, the Nigerian government banned over-the-counter codeine cough syrups after widespread abuse by the population. Tramadol, however, is a legitimate painkiller used in hospitals all over Nigeria. A nationwide ban of tramadol will cause patients dealing with pain to suffer, such as sickle cell anaemia patients.

The UNODC has pledged to “support governmental institutions in the region to strengthen the capacities of law enforcement and justice officials to fight illicit trafficking and terrorism.” Furthermore, it also promised to “deliver support on border control (land, aerial and maritime borders), and intelligence gathering and sharing.”

West Africa’s opioid problem, however, is a political one that wouldn’t benefit from simple government surveillance and crackdowns. Rather, West African governments must tackle youth, unemployment, civil unrest and war, and corruption. Once West Africa reaches social stability and financial mobility, mass demand for opioids will subside.

L'articolo West Africa’s Opioid Crisis: A Political Problem For Nigeria proviene da InsideOver.

There is little justice amid America’s spiralling opioid crisis. Drug companies get rich, addicts die. For the devastated families left behind, there’s scant hope of recourse, just an unending blame-game defined by a single question: who led their loved one down this brutal path? Tens-of-thousands wrestle with it every day; but now, mercifully, an answer – and a little compensation – may be coming their way. 

Late August saw a watershed court reckoning in Oklahoma – Johnson & Johnson (J&J), a multinational drugmaker, was ordered to pay $572m for its role in the opioid epidemic. The penalty fell far short of the $17bn prosecutors had demanded, but it has, at last, put on record at state-level Big Pharma’s culpability in the crisis. “[The drugs epidemic] has ravaged the state of Oklahoma,” said presiding judge Thad Balkman, “it must be abated immediately”.

Though J&J will doubtlessly appeal, the ruling marks a successful opening salvo from those seeking justice in the courts. Nearly 2,000 counties, cities, unions, hospitals and Native American tribes have filed lawsuits against drug companies. The breadth of the litigation speaks to the crisis’s scale – opioids have been linked to over 400,000 deaths since 1999, and will likely kill upwards of half a million over the next decade. 

The epidemic’s roots lie in the advertising campaigns of pharma firms a quarter-century ago. Aggressive marketing tactics put profits above patients, testimony in the Oklahoma case heard, with deliberate efforts to underplay the risk of painkiller addiction. Overpromotion to doctors “to influence their prescribing behaviour” was rife, with language like ‘pseudoaddiction’ used to assuage fears that patients may be dangerously hooked on pills. Close financial links to pain management advocacy groups were also commonplace, with large drugmakers effectively funding ‘undertreatment awareness’ campaigns.  

Of those in the firing line, Purdue Pharma is perhaps most widely blamed for the opioid crisis. Fiercely marketed as a safer pain treatment in the mid-‘90s, their OxyContin medication is regarded as a starting point of the epidemic. Mesmerised by growing sales, Purdue’s client base – pharmacies and hospitals – peddled more and more of the drug, helping the company’s owner, the Sackler family, amass their $13bn fortune. The firm’s legal clout is formidable, but Oklahoma’s landmark ruling has helped sketch Purdue’s plaintiffs a roadmap to victory, law experts say. 

“[The J&J verdict] is very reassuring to the many [parties] suing opioid makers… and it is, correspondingly, very disturbing for those who made and sold opioids to the American public,” said Stanford Law Professors Michelle Mello and Nora Freeman Engstrom. “[It shows that] judges and juries may be willing to pin blame not just on Purdue, the maker of OxyContin, but on others who played an arguably less central role in fuelling this public health crisis”.

Taking heed of the J&J decision, the Sacklers have reportedly backed a plan to resolve all outstanding lawsuits. The scheme would involve Purdue’s voluntary bankruptcy and payouts of up to $12bn. But not all are content with the proposals. The Sacklers’ personal $3bn contribution, a fraction of their total worth, is an insult to the families whose misery they account for, critics say. Opponents are also unhappy that at least half of the compensation is believed to be in the form of free drugs – including OxyContin – which will be valued at retail prices, minimising the settlement’s overall monetary worth.

It is also unclear how much of a forward focus the restorative action will have. Insiders suggest there’s no provision for new addiction treatment centres, painkiller alternatives, or offering Purdue’s own expensive anti-addiction drugs. Cash for these is unlikely to come through conventional channels – the stigma of addiction limits the political incentives for intervention – so must be sought in court, campaigners say.

“It is imperative that as we move forward, we make it a priority to get people access to high-quality, evidence-based treatment just as people with other chronic diseases receive,” said Gary Mendell, founder of Shatterproof, an addiction charity. “Equally important is the need to invest in educating the public around substance use disorders to end the stigma and discrimination that surrounds it”.

Education must spread beyond the public, into the hospitals and pharmacies where pain medication has been too readily dispensed. Federal initiatives to improve prescribing practice and retrain medical staff misled by pharma firms would be worthwhile. The Food and Drug Administration (FDA), the national body which approved OxyContin, must also face up to its role in the crisis. Even now the regulator seems to be complicit in the epidemic, with the chair of its opioid unit identifying the group’s “direct impact” on mortality rates.

That’s no doubt part of a wider issue: the commercial incentives woven into America’s health-care system. To tackle those would require unparalleled political impetus, which, regrettably, is unlikely to materialise anytime soon. For the time being, those left bereft by the opioid epidemic must put their faith in the courts. Legal action alone can’t abate the crisis, but it’s a good place to start. 

L'articolo Landmark Ruling Holds Big Pharma Accountable For US Opioid Crisis proviene da InsideOver.