In 2023, drug seizures by authorities in Africa accounted for half of the global seizures of pharmaceutical opioids, particularly tramadol. [1] There is a high rate of tramadol use and addiction in Ghana, Togo, Nigeria and Benin. [2] In West Africa, opiates are especially popular amongst the young, especially young men, and amongst people doing physical labour and in working class occupations. [2] [3] [4]
In 2024, opioids were the leading cause of fatal drug overdose in Nigeria. [5] In 2024, opioids such as tramadol and codeine were widely available in Nigeria. [4] Other opiates available include pentazocine and morphine. [4] Opiate use is widespread, in both urban and rural areas. [4] In some communities, opioid use is normalised, and seen as a non-stigmatised way to address personal stress. [4]
In 2024, there were few treatment centres available. [4] Law enforcement action has focused upon the criminalisation of drug use, rather than interdicting supply of the drugs. [4]
In response, the Nigerian government has tasked the National Drug Law Enforcement Agency (NDLEA) with tackling the opiate issue. [5] Drugs are seized, and users are arrested. [5] A public awareness campaign about the dangers of drugs is in effect. [5] Open drug markets have been banned, where street stalls and shops previously sold medications without any regulation. [5] Local codeine production and sale without prescription has been banned. [5]
In 2021, it was estimated that between 24.9% and 77.6% of Ghanian youth recreationally used tramadol. [2] More men than women used the drug, and especially males in the informal job sector. [2]
In Ghana’s media, young people’s use of tramadol has been framed in moral terms, rather than a health issue. [2] Structural factors in Ghanian society that may influence the uptake of Tramadol use, include poor working conditions, anxiety and uncertainty of employment. [2]
There are recreational users of tramadol in Ghana’s middle class. [2] There is a more daily “functional use” amongst those engaged in harder physical work. [2] There are higher rates of tramadol use amongst the unemployed. [2]
Cited reasons for using tramadol, including boosting mood, stress relief, physical endurance at work, and as a sexual enhancer. [6] Some tramadol users reported being coerced into taking up the drug by their employers, so they could work harder, and for longer hours. [6]
"Kush" is a synthetic drug sold in Liberia in pellet form, for 100 Liberian dollars per pellet in 2023, the equivalent of 50 US cents. [7] It is the same “Kush” as found in Sierra Leone. [7] In 2024, Kush tested in Sierra Leone and Guinea-Bissau contained cannabis, mixed with nitazene derivatives, tramadol and formaldehyde. [8] In Sierra Leone in 2024, 83% of the Kush samples contained nitazenes, which are powerful synthetic opiates. [8] In Guinea in 2024, 55% of the samples contained nitazenes. [8]
In 2025, tapentadol is an opioid available in Ivory Coast. [9] In Ivory Coast, it is cheap and widely available. [9] In 2025, a BBC world news investigation found that the tapentadol in Ivory Coast was being sourced from pharmaceutical manufacturers in India. [9]
A combination brand sold in Ivory Coast, is “Tramaking”. [3] It is manufactured in India, and contains tapentadol and carisoprodol. [3] Carisoprodol is a muscle relaxant. [3] The two drugs combined, the opiate and the muscle relaxant, can cause convulsions and death. [3] Locally, it is sometimes referred to as “apple”, or “225”. [3]
In 2023, a song promoted a local brand of tramadol, named “kadhafi”. [3] Aimed at young people, the song’s lyrics repeated the phrase "I want to get high on kadhafi”. [3] Kadhafi cost between 200 and 500 CFA francs, between €0.30 and €0.76 euros, per tablet. [3] In July 2023, the Ivorian police launched an anti-drug campaign in response. [3] In one raid alone, 927 kg of tablets were seized. [3]
“Kush” is a synthetic drug prevalent in Sierra Leone, containing synthetic opioids in the form of Nitazenes, and/or synthetic cannabinoids. [10] Chemicals are ordered from China and then mixed in labs in Sierra Leone’s capital Freetown. [10] The resulting liquid is sprayed onto plant material, to be smoked and sold as kush. [10]
The synthetic opioids and cannabinoids in the drugs are highly addictive. [10] Kush’s prevalence has fuelled police corruption in Sierra Leone. [10] ‘Cartels’ are the local name for kush smoking bars. [10]
Experimentation with new recipes to increase the high associated with Kush, has increased the rate of overdoses. [10] Kush is a depressant. [11] The high it provides the user is short lasting. [11] Addiction symptoms range from sores, to psychosis. [11] Kush can cause liver, kidney and respiratory problems. [11] A 2025 report found that nearly half of Sierra Leone’s Kush contained opioids up to 25 times stronger than fentanyl. [11]
In 2024, the government of Sierra Leone declared that the use of Kush was a public health emergency, and introduced legal, health, and prevention measures. [11]
Women in Sierra Leone under the influence of Kush, have been vulnerable to rape. [11] Women have been impregnated while high on Kush, and don’t know the men responsible. [11]
More men use Kush than women. [11] Women addicts in Sierra Leone have been reluctant to seek treatment, due to social stigma. [11]