For more than a decade, a sizable chunk of West Africa – including Ghana, Sierra Leone, Senegal, Nigeria and Ivory coast – has been gripped by an opioid-abuse epidemic that has devastated families, killed thousands and strained an already overburdened healthcare system. Once primarily a transit zone for the trade of illicit drugs that linked Latin America to Europe, West Africa has become one of the primary consumers of these painkillers.
Broadly, about 30% of West Africa’s population has been found to use tramadol and codeine, making these prescription opioids among the most widely abused substances in the region. Another notoriously dangerous opioid mix is ‘Kush’ – a synthetic drug which commonly contains cannabinoids and synthetic opioids like nitazenes, which can at times be even more powerful than fentanyl. The state of drug abuse has been so devastating that in 2024 leaders of both Sierra Leone and Liberia, in an unprecedented decision, declared national emergencies over drug use. Ghana’s Food and Drugs Authority also said last year that the abuse of the opioid tapentadol, known on the street as “Red”, was on the rise.
The root of addiction in these countries is no different than anywhere else: poverty, unemployment and weak governance have created a vulnerable youth who turn to substance abuse during trying times.
Illicit pills have been in circulation outside formal markets in several countries in the region since the surge in drug use began about a decade ago. But unlike the crisis in the US, where Purdue Pharma’s now infamous OxyContin pills were manufactured and distributed, several investigations have revealed that the crisis plaguing West Africa has its roots in India.
India has exported more than 1,400 consignments of tapentadol, worth almost USD $130 million, to several countries in the region, including Ghana, Sierra Leone, Benin, Senegal and Nigeria.
Porous borders and lax regulation
India, the world’s largest producer of generic medicines and self-styled “pharmacy of the world”, has been in the spotlight several times for flooding West Africa with illicit opioids.
A BBC investigation released in February last year took a deep look at one Indian company, Aveo Pharmaceuticals, based in Mumbai, which manufactured a drug they called “Tafrodol” – a particularly addictive and deadly combination of tapentadol, an opioid painkiller, and carisoprodol, a muscle relaxant. It isn’t legal anywhere in the world, including India or Ghana (the main point of shipment deliveries). Yet it was exported in vast quantities by Aveo Pharmaceuticals using regulatory loopholes.
In response to the investigation, Indian authorities seized Aveo’s stock and halted production. The disruption in the supply chain was expected to reduce the export of opioids by Indian pharmaceutical companies.
But new investigation published by investigative agency Bellingcat and independent Indian news platform Newslaundry revealed that, in fact, exports of other opioids like tapentadol have sharply increased.
Indian companies shipped more than 320 million tapentadol pills to West Africa. The value of tapentadol sent to the region has risen from about $27 million between 2020 to 2022 to almost $130 million from 2023 to 2025.
More than 80 percent of the total value of the potent drug was exported to Sierra Leone or Ghana. Both countries have sizable ports and sit in the middle of a wider trafficking route where these illicit substances – which are often hidden in cargo or courier parcels – can be transported to neighbouring regions.
The drugs were in high-strength 200mg doses or more – an amount that isn’t even approved in India. Ghana’s Food and Drugs Authority (FDA) categorically stated that they had not issued any permits for the import of tapentadol in any strength to any country in the neighbouring region.
The trade suggests serious gaps in export oversight, enforcement and cross-border drug controls.
Dinesh Thakur, public health activist and co-author of “Truth Pill: The Myth of Drug Regulation in India”, says the problem lies in regulatory gaps and a lack of transparency between countries.
“There are two aspects to this issue. First, in the country of manufacture, how does a manufacturer make and export these opioids without any regulatory oversight? Current law in India is that if a particular formulation is not sold in the Indian market, the Indian regulator, CDSCO, has no role in its manufacture and export,” he says. “For opioids especially, which fall under Schedule H (prescription only), approval from the Narcotics Bureau is necessary for export; however, how well this process functions is anyone’s guess.” Thakur adds that on the other side, the importing country will also have to execute their own rules to check for specific batches of drugs.
Nelson Aghogho Evaborhene, a Nigerian PhD fellow at Roskilde University, Denmark, says the spike in opioid use began about a decade ago and its circulation has been challenging to control.
“There are supposed to be border controls to look at drugs that are coming into the country. But most times we see is that this can be bypassed and products can be smuggled through different routes. In like West Africa, the borders are very porous – sometimes it’s just a bridge or a fence. They’re not really manned.”
Evaborhene says Nigeria’s National Agency for Food and Drug Administration and Control has tried hard to curb the problem, but it needs the support of customs and neighbouring countries.
He also says that many countries in the region lack robust systems to collect comprehensive data on drug use patterns: “Countries are trying to document but it’s not done at the scale it needs to be. A lot of people will not come to the hospitals and some primary, even secondary healthcare spaces have not transitioned to electronic systems. So it is difficult.”
‘The pharmaceutical giant of the world’
More than 60 Indian suppliers have made a tidy profit exporting tapentadol to West Africa since 2023. Out of those, three companies – Syncom Formulations, Puizer Pharmaceuticals and Twin Impex – have dominated the market.
According to a detailed investigation into India’s West African opioid economy, only two firms were granted approval to manufacture tapentadol for export but neither was in the 60 exporters released. This marks a serious lapse in India’s regulatory structure.
“Raw materials and API manufacture is China’s forte. But to convert those into formulation (pills) requires skills in medicinal and process chemistry which are largely available in India,” says Thakur, adding that as far as he is aware, India’s pharmaceutical industry has not taken appropriate responsibility and action on the matter.
Evaborhene says that the reckless import puts vulnerable communities most at risk, especially in countries facing socioeconomic hardship: “Sierra Leone is an important case. It’s a relatively small country of less than 10 million people and everybody’s cramped in Freetown, so whatever is going on there, it easily spread.”
India ranks third globally by production volume (pills and units) for generics, supplying roughly 20% of global generics and over 60% of vaccines by volume. The country excels in affordable, high-volume generics, but lags behind in high-value branded drugs and research and development. These investigations into the opioid exports and previous scandals have brought the quality and legality of some of those medicines, particularly exports to Africa, into question.
Evaborhene says that both India and West African nations have to come together to curb the opioid use. “We need to adopt better transnational policies and joint strategies to manage the issues. That could mean better border control, since the trafficking has a particular route, better regulations and more accountability.”
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