Opioid addiction in West Africa
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In 2023, drug seizures by authorities in Africa accounted for half of the global seizures of pharmaceutical opioids, particularly tramadol.[1] There is a high rate of tramadol use and addiction in Ghana, Togo, Nigeria and Benin.[2] In West Africa, opiates are especially popular amongst the young, especially young men, and amongst people doing physical labour and in working class occupations.[2][3][4]
Nigeria
In 2024, opioids were the leading cause of fatal drug overdose in Nigeria.[5] In 2024, opioids such as tramadol and codeine were widely available in Nigeria.[4] Other opiates available include pentazocine and morphine.[4] Opiate use is widespread, in both urban and rural areas.[4] In some communities, opioid use is normalised, and seen as a non-stigmatised way to address personal stress.[4]
In 2024, there were few treatment centres available.[4] Law enforcement action has focused upon the criminalisation of drug use, rather than interdicting supply of the drugs.[4]
In response, the Nigerian government has tasked the National Drug Law Enforcement Agency (NDLEA) with tackling the opiate issue.[5] Drugs are seized, and users are arrested.[5] A public awareness campaign about the dangers of drugs is in effect.[5] Open drug markets have been banned, where street stalls and shops previously sold medications without any regulation.[5] Local codeine production and sale without prescription has been banned.[5]
Ghana
In 2021, it was estimated that between 24.9% and 77.6% of Ghanaian youth recreationally used tramadol.[2] More men than women used the drug, and especially males in the informal job sector.[2]
In Ghana’s media, young people’s use of tramadol has been framed in moral terms, rather than a health issue.[2] Structural factors in Ghanaian society that may influence the uptake of Tramadol use, include poor working conditions, anxiety and uncertainty of employment.[2]
There are recreational users of tramadol in Ghana’s middle class.[2] There is a more daily “functional use” amongst those engaged in harder physical work.[2] There are higher rates of tramadol use amongst the unemployed.[2]
Cited reasons for using tramadol, including boosting mood, stress relief, physical endurance at work, and as a sexual enhancer.[6] Some tramadol users reported being coerced into taking up the drug by their employers, so they could work harder, and for longer hours.[6]
Liberia
"Kush" is a synthetic drug sold in Liberia in pellet form, for 100 Liberian dollars per pellet in 2023, the equivalent of 50 US cents.[7] It is the same “Kush” as found in Sierra Leone.[7] In 2024, Kush tested in Sierra Leone and Guinea-Bissau contained cannabis, mixed with nitazene derivatives, tramadol and formaldehyde.[8] In Sierra Leone in 2024, 83% of the Kush samples contained nitazenes, which are powerful synthetic opiates.[8] In Guinea in 2024, 55% of the samples contained nitazenes.[8]
Ivory Coast
In 2025, tapentadol is an opioid available in Ivory Coast.[9] In Ivory Coast, it is cheap and widely available.[9] In 2025, a BBC world news investigation found that the tapentadol in Ivory Coast was being sourced from pharmaceutical manufacturers in India.[9]
A combination brand sold in Ivory Coast, is “Tramaking”.[3] It is manufactured in India, and contains tapentadol and carisoprodol.[3] Carisoprodol is a muscle relaxant.[3] The two drugs combined, the opiate and the muscle relaxant, can cause convulsions and death.[3] Locally, it is sometimes referred to as “apple”, or “225”.[3]
In 2023, a song promoted a local brand of tramadol, named “kadhafi”.[3] Aimed at young people, the song’s lyrics repeated the phrase "I want to get high on kadhafi”.[3] Kadhafi cost between 200 and 500 CFA francs, between €0.30 and €0.76 euros, per tablet.[3] In July 2023, the Ivorian police launched an anti-drug campaign in response.[3] In one raid alone, 927 kg of tablets were seized.[3]
Sierra Leone
“Kush” is a synthetic drug prevalent in Sierra Leone, containing synthetic opioids in the form of Nitazenes, and/or synthetic cannabinoids.[10] Chemicals are ordered from China and then mixed in labs in Sierra Leone’s capital Freetown.[10] The resulting liquid is sprayed onto plant material, to be smoked and sold as kush.[10]
The synthetic opioids and cannabinoids in the drugs are highly addictive.[10] Kush’s prevalence has fuelled police corruption in Sierra Leone.[10] ‘Cartels’ are the local name for kush smoking bars.[10]
Experimentation with new recipes to increase the high associated with Kush, has increased the rate of overdoses.[10] Kush is a depressant.[11] The high it provides the user is short lasting.[11] Addiction symptoms range from sores, to psychosis.[11] Kush can cause liver, kidney and respiratory problems.[11] A 2025 report found that nearly half of Sierra Leone’s Kush contained opioids up to 25 times stronger than fentanyl.[11]
In 2024, the government of Sierra Leone declared that the use of Kush was a public health emergency, and introduced legal, health, and prevention measures.[11]
Women in Sierra Leone under the influence of Kush, have been vulnerable to rape.[11] Women have been impregnated while high on Kush, and don’t know the men responsible.[11]
More men use Kush than women.[11] Women addicts in Sierra Leone have been reluctant to seek treatment, due to social stigma.[11]
References
- ↑ Sharkah, Madlyn (19 April 2024). "Tackling Substance Abuse: WHO Supports Efforts to Combat the Kush Epidemic in Sierra Leone". World Health Organisation. Retrieved 24 April 2025.
- 1 2 3 4 5 6 7 8 9 Alhassan, Jacob (December 2022). ""Here in Ghana hard work don't deserve money": The uncertainty and precarity of youth who use tramadol". SSM - Qualitative Research in Health. Retrieved 27 April 2025.
- 1 2 3 4 5 6 7 8 9 10 11 Jeannin, Marine (September 22, 2023). "In Côte d'Ivoire, the hunt for 'gaddafi,' the latest hype drug for young people". Le Monde. Retrieved 28 April 2025.
- 1 2 3 4 5 6 7 Alare, Kehinde; Muili, Abdulbasit (October 19, 2024). "The opioid crisis in Nigeria: a call for public health and policy interventions". The Lancet. 404 (10462). Retrieved 27 April 2025.
- 1 2 3 4 5 6 Oladapo, Rasaq; Oladapo, Mariam. "Combating opioid misuse in Nigeria: A comprehensive strategy for public health and social stability". Society for the Study of Addiction. Retrieved 27 April 2025.
- 1 2 Peprah, Prince; Agyemang-Duah, Williams; Appiah-Brempong, Emmanuel; Gyimah Akwasi, Adjei; Kwame Morgan, Anthony (23 July 2020). ""With tramadol, I ride like a Jaguar": a qualitative study of motivations for non-medical purpose tramadol use among commercial vehicle operators in Kumasi, Ghana". Substance Abuse Treatment, Prevention, and Policy. Retrieved 27 April 2025.
- 1 2 Kane, Coumba (November 24, 2023). "Liberia's youth shattered by another war: Drugs". LeMonde. Retrieved 24 April 2025.
- 1 2 3 "Report: Highly potent opioids now show up in drug users in Africa". Voice of America News. Associated Press. June 15, 2024. Retrieved 24 April 2025.
- 1 2 3 Wong, Vicky (23 February 2025). "India bans two opioids behind crisis in West Africa". BBC World Service. Retrieved 28 April 2025.
- 1 2 3 4 5 6 7 McMakin, Wilson (February 26, 2025). "The main ingredients in Sierra Leone's kush are synthetic opioids and cannabinoids, report finds". Associated Press. Retrieved 24 April 2025.
- 1 2 3 4 5 6 7 8 9 10 Kelly, Caitlin (April 5, 2025). "Sierra Leone declared an emergency over a powerful synthetic drug but women were left behind". Associated Press. Retrieved 24 April 2025.