KAPURTHALA, India (AP) — Reports rolled in with escalating urgency — pills seized by the truckload, pills swallowed by schoolchildren, pills in the pockets of dead terrorists.
These pills, the world has been told, are safer than OxyContin, Vicodin and fentanyl, which have wreaked so much devastation. But now they are the root of what the United Nations named "the other opioid crisis" — an epidemic featured in fewer headlines than the American one, as it rages through the planet’s most vulnerable countries.
Mass abuse of the opioid tramadol spans continents, from India to Africa to the Middle East, creating international havoc some experts blame on a loophole in narcotics regulation and a miscalculation of the drug's danger. The manmade opioid was touted as a way to relieve pain with little risk of abuse. Unlike other opioids, tramadol flowed freely around the world, unburdened by international controls that track most dangerous drugs.
But abuse is now so rampant that some countries are asking international authorities to intervene.
Grunenthal, the German company that originally made the drug, is campaigning for the status quo, claiming that it's largely illicit counterfeit pills causing problems. International regulations make narcotics difficult to get in countries with disorganized health systems, the company says, and adding tramadol to the list would deprive suffering patients access to any opioid at all.
"This is a huge public health dilemma," said Dr. Gilles Forte, the secretary of the World Health Organization's committee that recommends how drugs should be regulated. Tramadol is available in war zones and impoverished nations because it is unregulated. It is widely abused for the same reason. "It's a really very complicated balance to strike," Forte said.
Tramadol has not been as deadly as other opioids, and is not killing with the ferocity of America's struggle with the drugs. Still, governments from the United States to Egypt to Ukraine have realized the drug's dangers are greater than was believed and have tried to rein in the tramadol trade.
The north Indian state of Punjab, the center of India's opioid epidemic, was the latest to crack down. The pills were everywhere, as legitimate medication sold in pharmacies, and as illicit counterfeits hawked by street vendors.
This year authorities seized hundreds of thousands of tablets, banned most pharmacy sales and shut down pill factories, pushing the price up fortyfold, from 35 cents for a 10-pack to $14. The government opened a network of treatment centers, fearing those who had become addicted would resort to heroin out of desperation. Hordes of people rushed in, seeking help in managing excruciating withdrawal.
For some, tramadol had become as essential as food.
"Like if you don't eat, you start to feel hungry. Similar is the case with not taking it," said auto shop welder Deepak Arora, a gaunt 30-year-old who took 15 tablets day, so much he had to steal from his family to pay for pills. "You are like a dead person."
Worldwide Effects
Jeffery Bawa, an officer with the United Nations Office on Drugs and Crime, realized what was happening in 2016, when he traveled to Mali in western Africa, one of the world's poorest countries, gripped by civil war and terrorism. They asked people for their most pressing concerns. Most did not say hunger or violence. They said tramadol.