Key facts
- Type: Opioid · Prescription medicine misused
- Category: Opioid
- Legal status in Kenya: Prescription-only controlled medicine; illegal to sell without authorisation
- Addiction risk: High
- Source: Pharmacies, black market, online
NACADA Helpline: 1192 | If you or someone you know needs help with substance use, call the National Authority for the Campaign Against Alcohol and Drug Abuse. Free, confidential, available 24 hours.
Overview
What is Tramadol and Prescription Opioids?
Tramadol is a synthetic opioid painkiller that is legally prescribed for moderate to severe pain. Across Africa, including in Kenya, it is increasingly misused outside of medical use. People take it in doses far higher than prescribed to achieve euphoric or stimulant effects.
Other prescription opioids misused in Kenya include codeine (found in cough syrups), pethidine, and morphine. Benzhexol (Artane), an anticholinergic medicine, is also misused. Nation Africa reported benzhexol as the most commonly misused prescription drug at 44.1% of cases surveyed, with tramadol and Rohypnol (flunitrazepam) also significant.
Tramadol is Africa’s fastest-growing drug problem according to UNODC data. Africa accounted for more than half of all global pharmaceutical opioid seizures between 2016 and 2020, largely driven by the tramadol crisis.
What it does to the brain and body
How does it work?
Tramadol acts on opioid receptors in the brain, producing pain relief and, at higher doses, euphoria and stimulation. Unlike heroin or morphine, it also inhibits the reuptake of serotonin and noradrenaline, which can produce stimulant effects and contributes to its misuse for energy and focus. At very high doses, the opioid effect predominates and can suppress breathing.
Why people use it
What draws people to it?
Students and people doing physically demanding work use tramadol for perceived energy, focus, and endurance, particularly before exams or during long working days.
The perception that tramadol is “just medicine” and therefore safer than street drugs lowers the psychological barrier to misuse. It is available cheaply and without a prescription from many informal pharmacies.
People using it for genuine pain may escalate to dependence over time as tolerance develops and higher doses are needed for the same effect.
Short-term effects
What happens when someone uses it?
These effects can occur even with first-time or occasional use.
- Pain relief and relaxation at therapeutic doses
- Euphoria and a sense of energy at higher doses
- Nausea, dizziness, and dry mouth
- Seizures, even at doses not far above the therapeutic range
- Serotonin syndrome (agitation, high fever, muscle twitching) if combined with antidepressants
Long-term effects
What happens with regular or prolonged use?
These effects build gradually and many are not reversible once they develop.
- Physical dependence with painful withdrawal
- Seizure risk that increases with dose and duration of use
- Serotonin syndrome, which can be life-threatening
- Liver damage
- Declining cognitive function
- Gateway effect to harder opioids including heroin
Recognising a problem
Signs that use may have become a problem
These signs apply to the person using the substance and can also help family members or friends recognise when help is needed.
- Taking tramadol without a prescription or in doses higher than prescribed
- Obtaining tramadol from street vendors, informal pharmacies, or multiple doctors
- Using it specifically to stay awake, perform, or feel more confident
- Experiencing withdrawal symptoms (restlessness, sweating, nausea) when unable to get it
- Combining it with alcohol or other drugs
Addiction and dependence
How addictive is it?
High addiction risk
Tramadol is significantly addictive when misused at high doses. Physical dependence develops faster than many users expect, and the withdrawal is similar to heroin withdrawal.
The seizure risk at high doses makes tramadol particularly dangerous compared to other opioids. Seizures can occur with no warning, including in people who have used it regularly without problems.
Overdose and acute danger
When does it become immediately dangerous?
Seek emergency help immediately
if you see any of these signs in someone who has used this substance.
- Seizures with no warning, even in regular users
- Loss of consciousness and very slow or stopped breathing (especially in combination with alcohol)
- Extreme agitation, confusion, rapid heartbeat, and high temperature (serotonin syndrome)
- Any overdose involving prescription opioids requires emergency medical care immediately
Withdrawal
What happens when someone tries to stop?
Tramadol withdrawal combines typical opioid withdrawal (muscle aches, sweating, vomiting, diarrhoea, severe anxiety) with an additional serotonergic component including vivid nightmares, unusual perceptions, and agitation. Medical management of withdrawal is strongly recommended.
Who is most affected
Groups particularly at risk in Kenya
Students at secondary school and university level use tramadol for perceived cognitive and physical enhancement. A Nation Africa investigation documented widespread use before exams.
Transport workers and day labourers use it for sustained energy during long working hours. Use is documented across the Coast, Nairobi, and Northern Kenya.
People managing chronic pain who escalate to dependence on legally prescribed tramadol are a less visible but significant affected group.
In Kenya
What the data says about Kenya
Prescription drug misuse is documented in 12 of 18 sampled Kenyan counties. Benzhexol (Artane) is the most commonly misused prescription drug at 44.1% of cases, followed by flunitrazepam (Rohypnol) at 14.7%, and tramadol.
Kenya, alongside Nigeria, Tanzania, and Egypt, is among the most affected African countries by the tramadol crisis (UNODC data). Seizures of illicit tramadol shipments at Kenyan ports have been documented repeatedly.
The Kenya Pharmacy and Poisons Board has increased enforcement against pharmacies dispensing tramadol without prescription, but the black market remains significant.
Across East and Central Africa
How is it used in the wider region?
Names, availability, and prevalence vary by country. All data is drawn from government and academic sources.
| Country | Local name(s) | Context and notes |
|---|---|---|
| Nigeria | Tramal, Tramadol | Nigeria experienced severe tramadol crisis among youth. High-dose tramadol (250mg tablets) flooded markets. The government imposed strict restrictions in 2018. Still widely available. |
| Ghana | Tramadol | Northern Ghana has documented extremely high tramadol misuse among youth and labourers. Accounts for the majority of drug treatment admissions in northern hospitals. |
| Tanzania | Tramadol, Tramal | Significant misuse documented, particularly in Dar es Salaam and among long-distance truck drivers. |
| Ethiopia | Tramadol | Growing non-medical use documented, particularly in Addis Ababa. Studies report use among students before examinations. |
Getting help
Where to turn in Kenya
NACADA Helpline
Free, confidential counselling and referral to treatment centres near you. Available 24 hours a day. 1192
Mathari National Hospital
Kenya's main national psychiatric and substance use treatment facility in Nairobi. Inpatient and outpatient services. 020 2714148
County referral hospitals
Every county in Kenya has a mental health and substance use service. Ask at your nearest hospital or health centre.
Sources
References
- Nation Africa. (2023, January 25). High for three days: Kenya’s prescription drugs abuse craze.
- Boun, S. S., et al. (2024). Prevalence and health consequences of nonmedical use of tramadol in Africa. PLOS Global Public Health. doi:10.1371/journal.pgph.0002784
- UNODC. (2023). World Drug Report 2023. Vienna: UNODC.
- National Authority for the Campaign Against Alcohol and Drug Abuse (NACADA). (2022). National Survey on the Status of Drugs and Substance Use in Kenya 2022. Nairobi: NACADA.