Tramadol, a drug used to treat pain in the Dominican Republic, has triggered alarms for the devastating side-effects it can cause.

A report from the AP agency, dated in India, warns that the picture is becoming increasingly alarming: Trucks full of pills are confiscated; children who take the pills after having found them in the pockets of dead terrorists.

The world was told that the medicine was safer than oxycontin, Vicodin and the Fentanyl, which have caused so much damage. But now they are at the epicenter of what the United Nations calls “the other opioid crisis,” an epidemic that does not generate as many headlines as the medicines flagged in the United States but is having devastating effects on the most vulnerable countries on the planet.

The abuse of tramadol opioid covers continents, from India to Africa and the Middle East, creating an international collapse that experts attribute to gaps in narcotics regulations and to poor assessments of drug risks.

It was said that this man-made opioid could relieve pain without danger of addiction or attendant abuse. Unlike other opioids, tramadol is over-the-counter and not subject to international controls for more dangerous drugs.

But the abuse is so severe today that some nations are calling for the intervention of international authorities.

Grunenthal, the company that originally produced the drug, wants things to remain as they are. It says that international regulations hinder access to medicines in countries with disorganized health systems and that adding tramadol to the list of restricted substances will deprive patients of that drug.

“It is a great public health dilemma,” said Gilles Forte, secretary of the World Health Organization committee that recommends what substances should be regulated. Tramadol is available in combat zones and in poor nations because it is not regulated. And it is widely used for the same reasons. “It is very difficult to find the right balance,” said Forte. Tramadol is not as lethal as other pain relievers, but many governments have realized that it still carries risks and they’re trying to control its sale. Punjab, a state in northern India, has just joined that battle. There are pills everywhere. It is sold in pharmacies and imitations abound in the street.

Tramadol is similar to an opioid and becomes addictive after a time of use. ARCHIVE

This year the authorities confiscated hundreds of thousands of pills, banned most of the sales in pharmacies and closed centers of fake tablet production, which made the price of ten pills rise from 35 cents to $ 14. The government opened a network of care centers, afraid that those who became addicted start using heroin in the desperation caused by its absence. Quantities of people sought help to deal with intense withdrawal symptoms. For some, tramadol is as vital as food.

“If you don’t eat, you feel hungry. The same thing happens to you with this,” explained Deepak Arora, a welder in a 30-year-old mechanical shop who consumed 15 pills a day and stole from his family to buy them. “You are like a dead man.”

Jeffrey Bawa, an official with the United Nations Office on Drugs and Crime, realized what was happening in 2016.

Police began finding pills in the terrorists, who traffic them to finance their activities, according to Bawa.

The majority came from India, which has a booming pharmaceutical industry driven by cheap generic drugs. Laboratories produce imitations and distribute them worldwide, in doses that far exceed the allowed limits.

Authorities said in 2017 that they had confiscated a shipment of tramadol valued at $ 75 million that was destined for the Islamic State organization. They also intercepted 600,000 pills for Boko Haram. Another 3 million were found in a van in Niger, in boxes that had the UN logo as a deception. The agency warned that tramadol was having “destabilizing effects in the region.”

Grunenthal makes strength so that tramadol is not regulated. The company financed several studies according to which its regulation would prevent fighting pain and sent people to the WHO to present the thesis that the tablet is less risky than other opioids.

Regulation and pain
India regulated tramadol in 2018. Regulators said that domestic exports and abuse declined. But they also recognized that it is virtually impossible to contain illegal abuse and exports in a country with a huge pharmaceutical industry it is still easy to find tramadol.

Free sale
Standing at the entrance of his house, Jyoti Rani pointed to several homes in his Kapurthala neighborhood where he said the medicine was sold.