The reports rolled in with escalating urgency: pills seized by the truckload, pills swallowed by schoolchildren, pills in the pockets of dead terrorists. These pills supposedly are safer than the OxyContins, the Vicodins, the fentanyls that have wreaked so much devastation. Now they are the root of what the United Nations calls “the other opioid crisis” as it rages through some of the most vulnerable countries, from India to Africa to the Middle East, the Associated Press reports. Some experts blame the spread on a loophole in narcotics regulation and a miscalculation of the drug’s danger. The synthetic opioid was touted as a way to relieve pain with little risk of abuse. Unlike other opioids, tramadol is unburdened by international controls that track most dangerous drugs. The lack of regulation has made tramadol available in war zones and impoverished nations. Abuse is now so rampant that some countries are asking international authorities to intervene.
While tramadol has not been as deadly as other opioids, governments from the U.S. to Egypt to Ukraine have begun to rein in the tramadol trade. the German company that originally made the drug, is pushing back against those efforts, arguing that it’s largely illicit counterfeit pills causing problems. International regulations make narcotics difficult to get in countries with disorganized health systems, the company says, claiming that adding tramadol to the list would deprive suffering patients access to any opioid at all. But Dr. Gilles Forte, of the World Health Organization’s committee that recommends drug regulations, calls it “a huge public health dilemma.”