Opioid addiction in West Africa

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, and 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]