Opioid of the people: the moral economy of tramadol in Lagos

Gernot Klantschnig, Inioluwa Dele-Adedeji

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

This article provides an in-depth examination of the illicit tramadol market in Lagos. It draws on interviews with tramadol regulators and traders to explore the moral narratives that state and market actors adopt to legitimise their work. Using a moral economy lens, we show how these narratives are linked to wider power struggles in the pharmaceutical market and between regulatory agencies. The article argues that the ambiguous moral nature of tramadol is critical for an understanding of a drug that is officially despised and yet so widely used and traded.

In recent years there has been growing concern in international policy circles about the abuse of opioids. The major opioid of concern in West Africa has been tramadol - a synthetic analgesic drug used to treat moderate to severe pain. The happenstance of an opioid crisis in North America has triggered an increased focus on the tramadol economy in West Africa, but without much of an emphasis on empirical evidence, which has made it easy to conflate the particularly different contexts into a singular global crisis narrative. International commentators and reports have commonly discussed opioids on these two continents as part of a single global crisis or portrayed tramadol use in West Africa as the ‘forgotten’ opioid crisis. The UNODC’s flagship World Drug Report of 2020 is a case in point. While it acknowledges the differences between opioid use in the two regions, especially the exceptionally large number of overdose deaths from fentanyl in North America which is clearly not the case with tramadol in West Africa, the report still discusses these two regions as part of one single opioid crisis.

There are indeed stark differences between opioid use in the two regions. Klein, Padwardhan and Loglo have shown that not only the type and strength of opioids differ – fentanyl being much more potent than tramadol – but also the social setting of use. Above all, it is tramadol’s role as a cheap pain medicine, especially in the healthcare sector that sets it apart from North American patterns of use. The medical use of tramadol is also widespread because alternative and affordable painkillers are often unavailable in West Africa. Health officials have been aware of this difference and have promoted a more nuanced view of medical tramadol use, in contrast to law enforcers who have often lumped tramadol together with illegal drugs such as heroin and cocaine.

But it is not the medical use of tramadol that has created most concern. Commentators have lamented tramadol’s widespread non-medical abuse by ‘addicted’ urban youth as well as its links to insecurity and terrorist activities by Boko Haram. In Nigeria, these concerns came to a climax in a media and state-triggered moral panic about the abuse of tramadol and the related drug codeine in 2018. As a result, new restrictions were imposed and enforced by agencies such as the National Drug Law Enforcement Agency (NDLEA). However, they have not had their intended effects. While tramadol should only be available via prescription and in low dosages today, it continues to be sold freely in pharmacies, open markets and in the street. Coupled with state attempts to prevent its unregulated importation, restrictions have re-shaped the trade and consumption of tramadol, above all tramadol’s price has risen. But despite these policies and the wider moral concern about tramadol, the drug is still widely used and sold.

This article is interested in the gap between these official concerns and the realities of the tramadol market, which can tell us not only about the (limited) powers of the state but also about the strategies that state and market actors take to legitimise their work – work that is often legally ambiguous. These strategies are also often linked to power struggles in the pharmaceutical market and between regulatory agencies. Conceptually, we explore the tramadol economy as a ‘moral economy’ in the sense used by James Scott, as we see how regulators and market insiders have rationalised their actions and interests, in both moral as well as economic terms. Using a moral economy lens helps us, first, to humanise a stigmatised set of actors and their work and, second, to see market actors not solely as economic agents concerned with the maximisation of profit but also as actors concerned with the just nature of their economic interactions. Hence, we aim to shed light on the moral landscape of tramadol, as we contrast prevailing policy views on tramadol and its control with counter-narratives that exist among market insiders and regulators.

To understand these moral debates, the article draws on interviews with tramadol regulators and traders in Lagos – a difficult to access group in the current anti-tramadol climate – which provide a unique insider perspective on the trade and its control. The article’s intended contribution is thus twofold. Empirically, it challenges some of the misrepresentations of tramadol markets in West Africa, which are referred to in policy circles but are rarely explored in in-depth research. Based on insider views, we are also able to provide a better understanding of discussions on the legitimacy of drug use and drug selling in Lagos, one of Africa’s most flourishing drug markets. Theoretically, we combine work on the moral dimensions of economic activities with the concept of ‘quasilegality’, which helps to expose the illusory quality of rigid binaries of legal-illegal or moral-immoral in the context of a local drug economy. In practice, we do this at an opportune moment, when tramadol and its control are at a critical juncture in West African and global policy debates. The aim is to provide an in-depth and contextualised understanding of the tramadol trade that has been missing from policy and academic debates to date, as they have either focussed on the situation in North America and global tramadol policy or have only recently attempted to sketch the extent of tramadol’s use in West Africa. While we know that tramadol is the second most widely used drug in West Africa after cannabis today, little is still known about why and how tramadol is used so widely and even less so about its trade and suppliers, who are often just stigmatised as (organised) criminals in policy discourse.

In the following, the article, first, provides a short history of tramadol before presenting prevailing policy views of the tramadol crisis. It then contrasts these views with counter-narratives in the Lagos tramadol market, which range from tramadol being seen as an essential pain medicine, a source of pleasure, as well as an important livelihood for traders. Finally, we explore the ‘quasilegal’ status of tramadol, which is openly acknowledged by market insiders, as well as regulators. The paper concludes by arguing that this quasilegality and the related moral ambiguity of tramadol is critical for an understanding of a drug that is officially despised and yet so widely used and traded.
Original languageEnglish
JournalPolitique Africaine
Publication statusAccepted/In press - 7 Jul 2021

Structured keywords

  • SPS Centre for the Study of Poverty and Social Justice

Fingerprint

Dive into the research topics of 'Opioid of the people: the moral economy of tramadol in Lagos'. Together they form a unique fingerprint.

Cite this