Painkillers Causing Pain

For the longest time, young men and women in Ethiopia have dealt with substances such as khat, cigarettes and alcohol. Widely consumed and considered as part of the culture in some parts of the country, khat used to be the primary point of concern as far as substance abuse is concerned. In recent years, the list of substances being abused by teenage boys and girls seems to be getting longer. As this concerning list gets longer, EBR’s Bamlak Fekadu looks into the consumption of opioids and its impact on the youth.

57-year-old retired former air force pilot Atnafu B. Maryam is a father of two, who sustained injuries during the 1999–2000 Eritrean – Ethiopian war. The heat was so extreme that several bullets still remain in his body, causing using him to experience excruciating pain during the colder months. He frequently chooses to take stronger painkillers, such as opioid medications, to manage the pain.

Atnafu used these drugs to temporarily relieve his pain, but it wasn’t long before he began to notice that his younger son Kaleb, 26, who frequently used the opiate Tramadol, had developed an addiction to it.   He remembers the occasion when he met the owner of a pharmacy in his neighborhood. “This pharmacist asked about my health with great concern.” Atnafu shares “It was unusual. Then he warned me about my consumption of Tramadol and the damage it could do to me and cautioned me not to send Kaleb without prescriptions.”

To clear his confusion, he sat with the pharmacist to understand more about the impact it could have on his health. “It was alarming to learn that kids are using opiates like Tramadol for purposes other than for medical use, and to realize that my son is one of them,” Atnafu told EBR.

After taking the advice, Atnafu began to notice his son’s physical and emotional changes, which were preceded by itching, tiredness, and a mood swing. Kaleb had been using      Tramadol for three years. He started using Pethidine, a Tramadol substitute, but his body had adjusted to the medication. Kaleb developed the habit of using opioids to alleviate a migraine that was triggered by sadness of being kicked out of college. He is said to have started to get better recently, following an open dialogue and placing him in a rehabilitation program.

On November 1, 2022, the Ethiopian Food and Drug Authority (EFDA), which oversees 23 private hospitals, 1,169 drug stores and pharmacies, and 63 specialty health centers operating in the capital, made an unusual announcement enacting strict control ordering      pharmacies in Ethiopia to refrain from selling Tramadol. The warning was issued by the A     uthority in response to mounting complaints of painkiller addiction and rising drug use among high school students, which it claimed was putting many lives at risk.

The Authority issued an order mandating stringent control of the drug and forbidding sales to anyone unless they have a special prescription from a licensed doctor. The medication will be subject to strict regulation, as its use can lead to fatigue, lack of appetite, severe headaches, sweating, mental instability, and sleep disruptions.

In response to the findings of a study done by the authority, the EFDA removed Tramadol from the list of over-the-counter (OTC) drugs four years ago. The study found that Tramadol misuse had increased to worrying levels, with an eight percent prevalence rate in the 13–19 age range in and around Addis Ababa. Eight of 100 pupils in this age bracket from 218 secondary schools, in the capital, may have fallen into this trap.

Tramadol was an OTC drug available at neighborhood pharmacies, available for sell without even a prescription. It gained popularity among high school students because of its accessibility and comparatively inexpensive cost when compared to other addictive drugs. One kilogram of cannabis, often known as marijuana, might be sold for ETB 3,500, compared to up to ETB 2,800 for one gram of cocaine. A strip of Tramadol, containing 10 capsules, costs not more than ETB 30.

According to the Authority, the number of youths who use Tramadol without a doctor’s prescription has been increasing in recent years, leading to addiction. Many young people      purchase Tramadol without prescriptions, and some typically use excessive dosages.

Simeon Hailay is one of several high school kids who, tragically, spent two years ensnared by addiction. Simeon attended a public high school in Lemikura District, a neighborhood on the outskirts of Addis Abeba’s northeast. While he was a grade 11 student, Simeon momentarily stopped going to class as a result of his severe addiction to several substances, including cigarettes, khat, marijuana, alcohol, opioids, and cough syrup.

As a result of the psychedelic drugs, he later began to encounter visual illusions. Simeon described having “fuzzy moving visuals that made me feel nervous.” His addiction caused him to become socially isolated, further worsening his mental health.

“Tramadol strips are sometimes combined with cough syrup, like I used to do with dry gin.” Simeon told EBR. “My parents took me away for a month to a monastery in Debre Birhan, which is around 120 kilometers from the city.”   He asserted that he experienced stress and sadness as a result. A relative who works at St. Paul’s Hospital Millennium Medical College recommended putting him in the New Life Rehabilitation Center at the hospital located on Sheh Ojele Street, founded by Sister Yirgedu Habtu.   After close to three consecutive months of therapy, he is clean from all of his addiction and plans to resume his education.  “I have a plan to create awareness about substance abuse, addiction, mental health, and the significance of rehabilitation centers to the community,” he told EBR.

The government-owned Ethiopian Pharmaceutical Supply Agency, which was founded in 1947, is the largest pharmaceutical purchaser in the nation, buys medicines and medical supplies and disperses them via its 19 locations to hospitals and medical facilities all over the nation. In order to service more than 5,000 healthcare facilities, it imported medical supplies and equipment worth ETB17 billion last year. 90Pct of the medications imported into the nation are a result of its import bill.

The agency imports nearly 1,000 different medications, including Tramadol. The agency distributes the medicine to its branches depending on the quantity of patients and the demand from the medical facilities. EFDA’s experts are working to raise awareness of the problem among high school students and teachers, about how it might damage children’s health.

From 2022 to 2030, the market for opioids is projected to increase at a compound annual growth rate (CAGR) of 1.2Pct reaching a value of USD22.66 billion. The introduction of novel opioid drugs for the treatment of patients with chronic pain and rising approval rates are the two main factors anticipated to fuel market expansion. For instance, Trevena, Inc.     ‘s Olinvyk (oliceridine) injectable, designed for the treatment of individuals with severe pain, received FDA approval in August 2020. It costs about USD194 for a supply of 10 ml      of the opioid   agonist olinvyk, which is given intravenously to patients. Although it puts users at risk for addiction, abuse, and misuse, no one is immune to the risk of addiction, although it can happen to patients.

According to the World Health Organization (WHO), opioids have analgesic and sedative effects and are commonly used for the management of pain. Opioid medicines such as methadone and buprenorphine are used for maintenance treatment of opioid dependence and cause euphoria after intake, which is one of the main reasons they are taken for non-medical reasons.

As of the WHO’s study worldwide, about 275 million people (or 5.5 percent of the global population aged 15–64 years) used drugs at least once in 2019. Among them, about 62 million people used opioids. About 36.3 million people suffered from drug use disorders in 2019.

Most people who became dependent on opioids used illicitly cultivated and manufactured heroin, but the proportion of those using prescription opioids is growing. Worldwide, about 500 000 deaths are attributable to drug use. More than 70 Pct of these deaths are related to opioids, with more than 30 percent of those deaths caused by overdose. According to WHO estimates, approximately 115 000 people died of opioid overdoses in 2017. Opioid overdoses that do not lead to death are several times more common than fatal overdoses.

Forbes Business Magazine pegs the market size of the addiction treatment sector at up to USD35 billion. Bridge Market Research has conducted analysis on this market size and growth rate for the drug addiction treatment sector by type (opioid addiction, benzodiazepine addiction, barbiturate addiction, and others) for the forecast years of 2023–2030. During the aforementioned projection period, drug addiction therapy market is expected to register a 7.3Pct growth rate. The market had a gross value of USD15.5 billion in 2022, this figure is expected to reach USD30.8 billion by 2030.

The WHO’s special initiative for mental health highlighted that nearly four out of five people with mental illnesses, including substance use disorders and neurological disorders, do not receive good quality and affordable mental health care globally. According to Netsuh Workafes, a public health expert with over 10 years of experience, although substance use is a known public health issue and a pressing one in Ethiopia, its true scope and severity have not been adequately investigated.

According to Netsuh’s assessment, the widespread abuse of drugs and narcotics by children has reached a concerning level, yet parents and schools are not aware of the problem.

Ethiopia is a member of the International Narcotics Commission Board , established in 1968 as the independent monitoring body for implementing the UN international drug control conventions. The board inspects, monitors, and gives permission to member countries if they import narcotic drugs beyond the acceptable amount.

The authority said that they will make serious monitoring and follow-ups on pharmacies and others that have been selling the drug arbitrarily. All regional health inspectors strictly implement the legal and administrative steps in violating the directive.

“People with mental illness are at an increased risk of experiencing human rights violations, stigma, and discrimination like Simeon faced,” Netsuh said, urging stakeholders and the Ministry of Health to address mental health issues with contextually designed and effective stigma reduction, alongside organizing mental health care facilities.. EBR

11th Year • March 2023 • No. 115

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