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