Ghana's patients who are suffering from acute pain, for instance after surgical procedures, or with chronic conditions, from low back pain, Osteoarthritis, or cancer, accident victims, people with terminal illness and many more may soon not be able to find anything to soothe their pain if Tramadol is scheduled internationally.
Some UN member states like Egypt are requesting the Expert Committee on Drug Dependence of the World Health Organisation to recommend adding Tramadol to the list of internationally controlled substances.
For patients in Ghana who suffer from serious conditions, be this neuropathic pain, osteoarthritis, or who are coming out of surgery, have been in accidents or even stung by a scorpion this is painful news. All they will be able to get from their doctors and pharmacies is paracetamol.
Owing to the widely reported use of Tramadol among recreational users, the government is thinking of introducing tougher controls on the dispensing of the drug.
But experience shows that once a medicine is internationally controlled it simply becomes no longer available. Some officials may argue that there is a system in place to make it available but the reality is that the system is not working. Morphine, for example, is an internationally controlled substance that is used for managing extreme pain.
Ghana imported 4kgs of morphine, that is 0.11 mg for every Ghanaian. The UK, by contrast, provided 22 grams for each citizen. As a member of the Pharmaceutical Council explains, the impediments to import and distribution are considered. So pharmacies and health care practitioners switch to other medications, even when these are less efficacious.
What does that mean for pain patients?
It means that getting prescriptions for a strong, effective medication will take longer, and finding a pharmacy that stocks it becomes harder. They are then more likely to buy these informally, from hawkers or on the market. But now the risk is that these medications are falsified and adulterated.
Moreover, the price will be much higher than what it is now. The most alarming prospect is that patients who buy Tramadol will be committing an offence and could be arrested. So the prospects are suffer your pain or run the risk of arrest. In either case, the price for being ill will be much higher.
Yet, these control measures impact only on the trade through legal channels, not the illegal ones. It would have little effect on the trade in powerful and falsified Tramadol tablets because that trade already is illegal. But one of the rarely considered consequences of such a decision would be to make it very difficult for genuine patients to access.
According to Reverend Dennis Sena of the Pharmaceutical Society of Ghana, people who do not live in close vicinity to a hospital will find their access to Tramadol much more difficult and are likely to resort to the black market or illegal sources for their supply.
This is critical because Tramadol is the only stage two medication with a good safety profile that is available for pain management. Without it, patients would have to resort to the far less potent paracetamol or Non-Steroid Anti-Inflammatory Drugs, with often severe side effects.
According to Dr. Yorke, Chairman of the Ghana Medical Association, the international control “will lead to scarcity outside of hospitals. There will be a lot of paperwork for pharmacies, prices will go up and doctors will simply resort to less effective medications.”
It is now evident that medications that are scheduled under the international drug conventions become very difficult to access for people in need. At the moment, for example, morphine and pethidine are only available at a few hospitals in Ghana, and only around 14% of people around the world who need palliative care currently receive it.
As a signatory to the international conventions, Ghana would become obligated to prohibit Tramadol at the national level. Increasing control will add to the barriers, as doctors are disinclined to prescribe and pharmacies see no incentives to stock. Patients will be left to suffer their pain or resort to the illicit market.
Speaking to Mr. Francis Torkornoo, Executive Secretary of Narcotics Control Board, in expressing his personal views, stated that international scheduling is the wrong approach to address the Tramadol issue in the country.
He proposed instead a more balanced way forward: “The Food and Drugs Authority should allocate quotas for local manufacturers and importers, designate one single point of entry for importation of Tramadol and increase funding for demand reduction strategies such as education and sensitization.”
Now, there are many entry points for falsified Tramadol and other counterfeit medications. Ghana borders are porous and law enforcement has other priorities.
It is time for a reassessment of our priorities. Falsified medicines, according to the World Health Organisation, are responsible for up to 100,000 deaths annually on the continent.
It is time for this issue to be taken seriously and control efforts be moved away from the ‘war on drugs’ approach to psychoactive drugs – while greater attention also needs to be given to providing support and treatment to people who use drugs, including licit and illicit Tramadol.
Civil society, however, recommends the following measures should be taken in addressing the Tramadol and other control medicines in the Country:
- Tighten national restrictions on trade in falsified medicines, combating international trade in falsified medicines; by tightening our porous borders
- Enforce the current/ existing laws on dispensing and stocking of prescription drugs only.
- Outreach education/ Sensitisation to affected communities especially the youth who are the most affected
- Traffickers of unauthorised doses or falsified medicines should be punished