Dr Agwe Samuel, Mental Health Specialist, South West Regional Delegation of Public Health, Buea.
We observe a lot of agitation these days among youth with claims that Tramadol is used alongside "Indian hem" or "banga" to muster courage and act without fear of the forces of Law and Order. What is it really?
Actually, Tramadol is not a new substance. It has been existing for as long as medicine. Tramadol has been in existence for more than a hundred years as pain killer medicine. The way we categorize pain killers is through the pain ladder. So the pain ladder has the first rung which is paracetamol. If you give paracetamol and it does not work then you move to ibuprofen which is the next after paracetamol. After you have given ibuprofen and you want to step up the ladder you go to Tramadol or tramadol-related products and if that doesn't work well for you then you go to betadine and morphines. The substances which I have just called are all pain killers that we use to treat pain.
Is Tramadol really prescribed in Hospitals?
Absolutely, it is a pain killer that we use quite regularly in the theatre. This means that if you go in for surgery or you are having severe arthritis or you are having a cancer the doctors actually prescribe you tramadol. The trouble is the type of tramadol you are talking about. There are many types and also many intentions why this one or that one is being taken. For instance, the Tramadol that is prescribed in the hospital has a lower dose and prescribed for a shorter time. It is pure and probably more expensive. Its availability is regulated. But the Tramadol that has come to plague our society is adulterated. It is taken in large quantities, unregulated large doses and for a very long period of time and for wrong motives.
Where is this Tramadol fabricated?
Anyway, before we go to where it is fabricated, let's try to find out why this young men and women are taking this Tramadol. We were having a screening of the population of the Buea Central prison recently. We are waiting for the results of the questionnaires we sent out. But from what people are talking to us, what parents are telling us now, the primary reason why this children are taking Tramadol now is to get high, energetic and courageous. The primary reasons why bike riders are taking this Tramadol is to get extra energy to ride their bikes for 12 hours without getting tired. But they fail to understand the other side of it. The way Tramadol works by making you get high is by squeezing your blood vessels and making much blood available to the heart rapidly. You do so to make energy readily available for your system to use. As such, you sometimes put so much blood into the chambers of the heart not giving the heart enough time to rest before receiving another dose of that blood. So, it chokes the blood up and you develop a cardiac arrest. The other impact of tramadol is that it goes to the brain and touches the neuro-transmitic substances of the brain. These chemicals regulate the way that we work. The information that is coordinated in our body is actually controlled by those chemicals in the brain particularly Dopamine and Cerothenine etc. Once you touch this neuro-transmiting substances of the brain you alter the way they work and once you do this it is only a matter of time before you begin to develop chaotic episodes and schizophrenia which means these children who are taking tramadol today to get high sexually, to drive their bikes for a whole day without getting tired, if we do nothing in four or five years' time they will actually become mentally unwell.
You mentioned that the Tramadol prescribed in hospital is different from the one taken in the streets; can one decipher it with the naked eye?
The adulterated Tramadol is littered everywhere with roadside vendors and in drug kiosks in Buea, Mutengene, Tiko, Limbe, Kumba Bamenda. With CFA 50 you can get a tablet, CFA 100 you have two with CFA 500 you get ten and so they go. They usually start with one tablet or two and then they come the next day because one or two tablets are no longer enough. They come the day after because of increased dependence for the drug. You started with two tablets you are now with four. We had a case in Muyuka where somebody actually swallowed 17 tablets because he wanted to "teach a girlfriend a lesson" by becoming sexually high. After it he went to the bath to have a shower and he collapsed and died. So the difference between medical Tramadol and the illicit Tramadol is that medical Tramadol is regulated in dose, frequency and duration. While the illicit Tramadol is completely based on someone's believe or wish to become high, to act irrationally and there is no regulation as to how much they take in terms of dose and duration.
Medically, how is Tramadol taken? By injection or just tablets?
There is injectable Tramadol and there is the oral one. Most people start taking the tablet form but eventually they get to the injectable form as they develop more dependence. Which means they cannot do without the Tramadol. If they don't take it they start sweating and trembling becoming delusional and excited. They cannot resist taking it.
How can its use and access be controlled in the South West, Region?
The exact source of medical Tramadol is the pharmacies. The pharmacies have the licenses to import this medication regulated by the Ministry of Health. We don't yet know the exact source of the ones on the street. It is unfortunate that we are still looking through the various options but one of the options that has come up quite frequently is that it is illegally imported into the country through the borders. People who go out to buy this drug certainly hide from the law enforcement officers or actually participate with the officers to bring them into the country. This is a question for another day. We should know that illegal Tramadol is not coming from the pharmacies. It is coming from across the borders from other countries. For me, the first approach is public health. Let us sensitize the public about the health consequences of adulterated Tramadol.
Has the Sensitization begun?
It has already begun, I am offering a lot of talks on radio and television and I think that we should continue to do that at all levels. I mean even in social groups, homes, njangi houses, in churches anywhere that we have social groups. Parents should come together and talk about this Tramadol. If parents start talking about it then they will see to it that even their children at home have some form of regulation. The other thing that we can use to reduce the spread of Tramadol is the law enforcement officers. Let a legislation be passed on Tramadol criminalizing it. There should be no difference between someone who is caught with adulterated Tramadol and someone who is caught with marijuana or cocaine. Therefore let us use this period as a grace period to go out there and tell those who are consuming and those who are supplying that Tramadol is a problem to our society and we don't want to destroy our future generation.