Tramadol and Prescription Opioids

Tramadol is a synthetic opioid painkiller that is legally prescribed for moderate to severe pain. Across Africa, including in Kenya, it is increasingly misused outside of medical use. People take it in doses far higher than prescribed to achieve euphoric or stimulant effects.

Other prescription opioids misused in Kenya include codeine (found in cough syrups), pethidine, and morphine. Benzhexol (Artane), an anticholinergic medicine, is also misused. Nation Africa reported benzhexol as the most commonly misused prescription drug at 44.1% of cases surveyed, with tramadol and Rohypnol (flunitrazepam) also significant.

Tramadol is Africa's fastest-growing drug problem according to UNODC data. Africa accounted for more than half of all global pharmaceutical opioid seizures between 2016 and 2020, largely driven by the tramadol crisis.

Students and people doing physically demanding work use tramadol for perceived energy, focus, and endurance, particularly before exams or during long working days.

The perception that tramadol is "just medicine" and therefore safer than street drugs lowers the psychological barrier to misuse. It is available cheaply and without a prescription from many informal pharmacies.

People using it for genuine pain may escalate to dependence over time as tolerance develops and higher doses are needed for the same effect.

Tramadol is significantly addictive when misused at high doses. Physical dependence develops faster than many users expect, and the withdrawal is similar to heroin withdrawal.

The seizure risk at high doses makes tramadol particularly dangerous compared to other opioids. Seizures can occur with no warning, including in people who have used it regularly without problems.

Students at secondary school and university level use tramadol for perceived cognitive and physical enhancement. A Nation Africa investigation documented widespread use before exams.

Transport workers and day labourers use it for sustained energy during long working hours. Use is documented across the Coast, Nairobi, and Northern Kenya.

People managing chronic pain who escalate to dependence on legally prescribed tramadol are a less visible but significant affected group.

Prescription drug misuse is documented in 12 of 18 sampled Kenyan counties. Benzhexol (Artane) is the most commonly misused prescription drug at 44.1% of cases, followed by flunitrazepam (Rohypnol) at 14.7%, and tramadol.

Kenya, alongside Nigeria, Tanzania, and Egypt, is among the most affected African countries by the tramadol crisis (UNODC data). Seizures of illicit tramadol shipments at Kenyan ports have been documented repeatedly.

The Kenya Pharmacy and Poisons Board has increased enforcement against pharmacies dispensing tramadol without prescription, but the black market remains significant.