Tramadol has been the drug of choice in Egypt for years, due to its affordability and availability. Before February 2015, a strip cost as little at LE15 to LE30.
According to *Mohamed Mahmoudy — a regular tramadol user — cab drivers would share tramadol as readily as cigarettes, and coffee shops would accept tramadol pills in lieu of tips.
But over the past two months, the government has been cracking down on tramadol. The drug is becoming more difficult to obtain, so prices have risen. A strip that used to cost LE30 now costs around LE100 to LE150, and users say the police are watching dealers.
Most pharmacies also no longer stock the drug, according to Ahmed Abdel Hakim, a doctor at the Imbaba Fever Hospital.
Nour Husseiny — a former tramadol user — says that before the crackdown everyone in his neighborhood took tramadol. He says he once saw a 10-year-old child take it. “Everyone in Egypt does it,” he says, “the poor, the cultured, women, children.”
Ghada Waly, the Minister of Social Solidarity and President of the Treatment and Management of Addiction Council, recently stated that 44 percent of the calls received by public addiction centers in the past two months were about tramadol addiction. She added that in those months they had received over 9000 calls.
According to Hossam Abdel Ghaffar, the spokesperson for the Health Ministry, “the estimated number of people addicted to tramadol in Egypt is 700,000, out of a population of 55,528,519 above the age of 15 years,” he told Mada Masr.
However, others, including Husseiny, argue the number is much higher. “I quit,” he says, “But all you need to do is walk down the street and you’ll see it being sold.”
Amr Ramadan*, a worker at a private addiction treatment hospital, agrees that there is a big market for tramadol. Partially, he explains, because it is rumored to improve sexual relations by helping the user to maintain an erection for a longer period of time. “There are many people who are not addicted to tramadol but use it to improve sexual performance,” he says, adding that drivers and vendors are also a major market for tramadol, because it ups energy levels, even though the drug is an opiate.
According to Mahmoudy, “Everybody was doing it. If I fix my car, the mechanic does not want tips, the coffee shop does not want tips, if I give them pills they’ll be happier. It started being part of street culture in Cairo. If you walk in the streets, people will be like, ‘Don’t you have something for me?’”
Mahmoudy recalls hearing a mechanic and a customer talking recently. The customer was laughingly complaining that nobody was getting any work done and the mechanic responded, “Sorry it takes a long time to get your car fixed, everybody isn’t working as hard because there is no tramadol.”
Mahmoudy says that, while it is still possible to get tramadol, the new prices are proving to be a significant barrier to the majority of the population. “It’s not like before, when if you asked anyone in the street, he could get it for you. It was like candy.”
Ramadan disagrees, he says that people who are addicted to tramadol will either continue to pay for it, no matter what the price, or will move onto a similar but less expensive drug with the same effects. “This is the idea of addiction,” he says.
Although Mahmoudy only uses tramadol now, he used to deal. He took part in the widespread black market of tramadol to make extra cash on the side. Pharmacy workers would sell tramadol boxes to dealers, he explains. The dealers would then sell them at a premium, and both the pharmacy worker and the dealer would get a cut of the profits.
Mahmoudy says he used to make a tidy profit from dealing tramadol, even though he only did it casually.
“A strip [of tramadol] is like LE4 and you can sell it for LE20, so you make at least LE15 for one strip. He [his friend from the pharmacy] would bring me a box, so we would make a lot of money. You don’t sell just one pill, you sell a lot of them. I would make a few thousand pounds a month and, for Egypt, that’s good,” he explains.
But now, due to the crackdown, dealers are being much more careful and, according to Mahmoudy, many are selling tramadol manufactured in Egyptian homes (although this trend began before the crackdown) rather than in factories. This kind, he says, is much worse than the normal tramadol, which at the very least follows pharmaceutical safety requirements.
There have been intermittent media reports on police raids on pharmacies illegally dealing tramadol. Recently, the state-owned Al-Ahram reported that the police confiscated 1183 tramadol pills from a pharmacist who was selling them on the black market.
Dealers are also being much more careful in who they sell tramadol to, only showing up if you are a trusted customer, as the police have been conducting several sting operations.
Mahmoudy reports that in order to buy tramadol now you have to go to “underground places where you can still buy a pill for LE15. You buy it from a window in a really dark alley. You can’t touch the window, because they electrified it.” He says there are also people watching from nearby, ready to signal if the police show up, and there are people with swords guarding the alley.
There’s a reason the dealers are so careful: the penalty for dealing tramadol can range between three and 20 years, depending on the amount sold.
Ramadan believes the current crackdown is a result of the cabinet reshuffle, which resulted in former Interior Minister Mohamed Ibrahim being replaced with current Interior Minister Major General Magdy Abdel Ghaffar. Ramadan believes that the crackdown against tramadol and drugs in general are part of Ghaffar’s efforts to assert himself in his new office.
But Ramadan also emphasized that these sorts of crackdowns against drugs are cyclical. “There are four to five campaigns a year,” he says.
The sudden lack of cheap tramadol on the streets is reflected in Egypt’s public hospitals. At the Imbaba Fever Hospital, Abdel Hakim says that, since the start of the crackdown, around 100 patients come in due to tramadol withdrawal a week. He says often they hide what they’re suffering from “They are ashamed to say they are taking tramadol, but they vomit, feel nausea and pain.”
Ramadan says he has also seen an uptick in patients seeking help for tramadol addiction, but that he thinks the more serious problems are often due to heroin or cocaine addiction.
Tramadol, he explains, can function as a gateway drug. Because people build up a fast tolerance to it, “the dose always gets higher and always leads to something more. You can’t just use it casually at parties or one night,” he says. According to Ramadan, tramadol addiction is a big problem for young people below 22 or 23 years of age, whereas older people tend to have problems with heroin.
Abdel Ghaffar says the main physical effects of tramadol withdrawal include: body aches, sleep disorders, gastro-intestinal disturbances and pain. However, he says the physical affects only last for a few days, compared to mood swings and lack of motivation, which often last for a comparatively longer period of time.
Abdel Hakim says that tramadol addicts are given gradually reduced dosages of analgesics to break the addiction.
Tramadol is currently on “schedule 1 and 2” according to Abdel Ghaffar, meaning that pharmacies can only give it out with a prescription. However, Abdel Hakim says tramadol is no longer available from pharmacies, only in hospitals, and that patients who genuinely need the drug to treat chronic pain are struggling to find it.
“Old ladies and old men who were taking tramadol legally, cannot find it anymore,” he explains.
Nevertheless, even tramadol users like Mahmoudy, think that the crackdown on tramadol is a good thing.
“In a way I think it [the crackdown] is good, because it’s not a way to live your life. People were hiding from their problems behind it, because it relieves your pain and your brain, so you don’t have to think about your issues. There aren’t many jobs, not much money, not many ways to survive. Now I think people will see how their lives really are,” he says.
*All names and identifying details of drug users and dealers in this article have been changed.