Frictions in drug control: prescription opioids, prohibition and consumption cultures in Africa


Frictions in drug control: prescription opioids, prohibition and consumption cultures in Africa

2 December 2023
Ediomo-Ubong Nelson
Emeka Dumbili


There has been a growing concern about the misuse of pharmaceutical opioids in Africa, with some commentators describing it as part of a “global opioid crisis” (e.g. Kurth et al., 2018), ignoring the socio-historical peculiarities and contextually distinct materializations of these public health crises. Scholars have challenged this broad-brush approach through critical commentaries and original research (Klein et al., 2020; Klantschnig and Dele-Adedeji, 2021). Others have argued that conflating these distinct crises “blocks the path to rational regulatory reforms and public health strategies that could constructively address each crisis on its own terms” (Pettus and Radbruch, 2023, p. 2). A notable outcome of the global crisis narrative, according to Klantschnig and Dele-Adedeji (2021), and crucially for the purpose of this Special Issue, is the increased focus on the tramadol economy in Africa. The narrative has stirred political interests and enforcement-based responses across the continent and among international drug control agencies, who view the crisis as a “drugs” problem that should be addressed with law enforcement and bureaucratic controls (Klein et al., 2020). However, the wider social and structural drivers of opioids consumption on the continent are neglected, and the potential impacts of restrictive controls on health care remain poorly understood. This Special Issue aims to fill these knowledge gaps.

Articles summary

Tinasti and Outleb analyse opioid regulation in Morocco, showing how recent restrictive regulations are influenced by international frameworks and how they affect access to opioid analgesics for pain management and palliative care, as well as opioid agonist therapy. Ane-Loglo examines tramadol regulation in Ghana and six other African countries, showing how they impact the medical use of tramadol. Although tramadol is essential for managing pain in these countries, existing regulatory frameworks hinder access to these medicines. Onyima documents how street-involved young men in a south-eastern Nigerian city obtain opioids from street drug dealers and pharmacies and consume them by sniffing, popping and mixing tramadol with other drugs. These practices emerged in response to the threat of formal control. Nwafor and colleagues show how manual labourers in two south-eastern Nigerian cities consume tramadol to improve energy for work, pain relief and sexual performance. These consumption practices are contextualized by difficult working conditions and low access to pain management. Nelson and colleagues show how strict measures imposed by the Nigerian state on opioid supply due to public concerns about non-medical use among youth did not mitigate this practice. Instead, it constrains access to opioids for medical purposes and fuel police corruption. Dele-Adedeji and colleagues show how social relationships facilitate the illegal tramadol market in Nigeria, enabling market actors to resolve frictions between illegality and the social acceptability of tramadol. Last, but not the least, Otu and colleagues describe how domestic and international politics shape opioid control in Nigeria, reproducing punitive approaches that hinder access to opioids for medical purposes.