KABUL (Pajhwok): Pajhwok findings show that in last five years in addition to nearly 111 million addictive tablets, tramadol tablets were also imported both legally and illegally amid increase in prices.
According to the findings, tramadol tablets are highly addictive and taking it without a doctor’s advice is illegal, but the tablets are sold in some pharmacies without a doctor’s prescription.
According to doctors, Tramadol tablet is used to treat severe and moderate pain, but it is highly addictive because opium is used in its composition.
The use of Tramadol is similar to opium due to its psychological and physical effects, so it is illegal to use these tablets without a doctor’s prescription.
10 times increase in Tramadol imports to Afghanistan
The National Authority for Regulation of Medicines and Health Products said tramadol tablets were determined before allowed to be imported based on previous years’ and demand.
The level of legal imports of tramadol tablets to Afghanistan has increaserd in recent years.
According to the authority, more than 110,700,000 tramadol tablets have legally been imported to Afghanistan until the first five months of 2020 since 2016.
According to documents of the authority, in 2017 a total of 4,200,000 tramadol had been imported, in 2017, 17,500,000, in 2019 35,500,000, in first five months of 2020 15,500,000 tramadol were imported to the country.
However, the director of a section in National Authority for Regulation of Medicine, who did not want to be named, told Pajhwok Afghan News that figures for the remaining months of 2020 had not been compiled yet.
Considering these figures for last five years and first five months of 2020, tramadol imports would double until the end of this year.
Legal importers: Millions of tramadol tablets smuggled each year
Licensed importers are concerned about illegal imports of tramadol, which they say, is a serious blow to their trade.
Haji Niaz Ahmad Sarwari, head of the HaroonPharma Pharmaceuticals, hit out at the smuggling of medicine into the country, saying some people were importing illicit drugs, evading duties and taxes, especially tramadol tablets.
He added: “We have repeatedly told the Ministry of Public Health’s department of medicine that the smuggling of medicines, especially tramadol tablets, is our biggest concern, but it did not receive any attention.”
He called the smuggling of drugs into the country illegal and said illegal import of medicine was big blow to the companies they had invested in.
H asked the MoPH to stop the illegal import of medicines, especially tramadol tablets and not allow anyone to import or export medicines from and to Afghanistan without paying duty and taxes.
Sarwari grumbled, Pakistan produced tramadol tablets under the name of Iran, India and China are illegally exported to Afghanistan.
According to this investor, drug smugglers are selling tramadol on Balochis on Iran border in Nimroz and Farah provinces and then Balochis export it to Iran.
He attributed the lower price of tramadol in Afghanistan to lack of addicts in the country as compared to Iran , which is why tramadol tablets are smuggled to Iran.
He did not give exact details of the purchase or sale of Tramadol tablet, but said there was no fixed price as the prices fluctuated from time to time.
He added that the smuggling of tramadol tablets affected the business of those who had a legal license for the drug.
This is because those who illegally import tramadol tablets offer the tablets at lower rate due to non-payment of customs duty and sell these drugs below the set price in the market.
Meanwhile, the director of a pharmaceutical importing company, who did not want to be named, told Pajhwok that pharmaceutical companies, especially those legally importing tramadol tablets, were particularly concerned about the supply of drugs, especially tramadol.
He also blamed drug trafficking on companies that legally import drugs and called on the authorities to stop the smuggling of drugs, especially tramadol tablets.
He added that companies that legally import tramadol tablets pay taxes, customs duties, etc., but companies that illegally (smuggle) tramadol and other drugs are exempted from taxes and customs duties.
According to him companies that illegally import and sell tramadol drugs freely and illegally at pharmacies, serving a severe blow the business of licensed companies.
Negative consequences of Tramadol without prescription
Pajhwok findings show Tramadol pills are sold without prescription at many drug stores and people can easily find them.
A drug store owner in Taimani area of Kabul, who wished to go unnamed, told Pajhwok that he sometimes sold medicines without prescription due to people’s urgency.
“Most of our customers are youths who are addicted to this tablet,” he said, adding that children aged between 12 and 15 years ask for Tramadol tablets.
He did not clarify the price of the tablet but said the price of the medicine had increased after a ban on its sale by the Ministry of Public Health.
A pharmacist in Khair Khana area of Kabul, said that Tramadol existed in many drug stores and most of people purchased it without a prescription.
In response to a question whether they sell the drug without a prescription, he said, “Yes, we sell it to trustable people.”
“If I do not sell it, other pharmacists will, so do not make myself in trouble with people,” he said in response to another question.
When asked why he sells banned medicines, he said, “If you check medical wholesalers in Hotel Parwan, there are tones of this medicine, all drug stores sell it.”
“A few days ago, two girls came and asked me about Tramadol tablets, I did not gave it to them, later they came with another woman who probably was their mother and showed me a pack of the medicine and told me that they can find it anywhere,” he said.
He said no wholesaler would provide a formal bill of the drug for selling it to drug stores.
Many drug companies are full of these tablets, but they are allowed to operate normally as they pay a high amount of money in taxes, he added.
Dr. Baz Mohammad Shirzad said Tramadol was a strong pain killer which used for severe and moderate pains.
This drug is used for pains that others can’t ease,” he added, saying that a longer take of the drug can be addictive.
Nausea, vomiting, constipation, lightheadedness, dizziness, drowsiness, or headache may occur as side effects of the medicine.
Tramadol takers say they are addicted to the medicine.
A number of youths said they are addicted to Tramadol and they used it as intoxication.
Mujtaba, a youth said that he first used Tramadol for easing the pain of his kidneys but stopping the drug could lead to an increase of the pain.
He said, “I do not feel relaxed until I use this drug, I think I am addicted to it.”
He added that after continued use of the drug, now he encountered body shaking and stuttering.
Another person who wished to go unnamed said he first used the drug during some parties but now he was addicted to it.
“Despite the price of the tablet has increased three times high, but I still take them,” the person said.
Tramadol price increased three times.
A pharmacist in Khair Khana area of Kabul said that the price of a pack of Tramadol was increased from 250 afghanis to 1,000 afghanis after the Ministry of Public Health’s banned the drug.
Mohammad Yousuf, a drug store owner in Taimani area of Kabul also said that the price of the drug had increased.
He said that the price of a pack of the tablets increased from 250 afghanis to 700 afs and up to 1,000 afghanis.
“Wholesalers give more money (to MoPH) and that is the reason they are not fined or impose ban on the drug,” he added.
Both pharmacists criticized MoPH over dual standards and said that the ministry should nationally ban the medicine or permit it to all drug stores.
National Medicine and Health Products Authority (NMHPA):
NMHPA says Tramadol is not under restrictions in India until 2018 and companies smuggled the drug to Afghanistan.
After 2018, Indian and Iran stopped drug companies from producing the medicine based on the countries narcotics’ control agencies and confirmation by International Narcotics Control Board, the source said.
However, the organization says some companies after the ban had requested import of the medicine based on requirements.
NMHPA said the drug’s imports were based on permission of the government, donor organizations and private companies based on requirements at home.
“Based on the Counternarcotics Law, importing companies of Tramadol are allowed in consideration of some rules and control,” the source added.
Niamatullah Nawruzian, an official of NMHPA, said that Tramadol was in the list of normal medicine in Afghanistan but it should be given to patients based on prescription.
“That was the reason all drug stores in the country are informed no to sell the drug without a prescription,” he said, adding a number of drug stores that sold the drug without prescription had recently been closed in Kabul.
About smuggling of the drug, he said Tramadol was in the list of control drug in INCB, the manufacturing companies could not sell the drug without the certificate of counternarcotics agencies.
He said the drug could not be illegally imported to Afghanistan based on the companies’ obligation to comply with INCB rules.
However, NMHPA did not respond to questions regarding annual needs of Afghanistan for the drug, the amount of illegal trafficking of the drug to the country and detention of people involved in the illegal business.