A pill for work and play

THE little pills of Tramadol are ubiquitous in Egypt. Taxi drivers take them to stay awake on the road. Men use them to improve their sexual prowess. Petty officials readily accept them as a bribe. And wedding guests even receive them as token gifts. Tramadol has become Egypt’s favourite recreational drug, supplanting heroin and cannabis.

An opioid prescribed as a painkiller, Tramadol has a reputation for improving alertness and male sexual stamina—qualities much sought after in a country where people often have several jobs to make ends meet and where few women find it easy to experience orgasm because of widespread female genital mutilation. “It just makes you feel relaxed. Even if there are two men fighting to the death beside you, you wouldn’t care,” explains Taha, a bank teller, as he buys pills from a pharmacist willing to turn a blind eye. He says the drugs help him at work.

Until recently, Tramadol was selling for one or two Egyptian pounds a pill ($0.15-$0.3). It offers an affordable buzz in a country where average household income is less than $4,000 a year. “There is no social stigma attached to Tramadol,” says Hisham Mamdouh, who heads a Cairo rehabilitation centre. At least 40% of those attending his clinic are addicted to the pills. Among them is Ibrahim, a socially awkward 17-year-old schoolboy. As a child, he took just half a tablet. “I found myself feeling unusually outgoing and positive,” he says. Ten years on, he was ingesting a whole sheet of ten tablets a day and even then the effects quickly wore off. The symptoms of overuse include dizziness, shivers (many suffer these), headaches, difficulty sleeping, nausea and seizures.

The growth of Tramadol use accelerated after the uprising of 2011 that swept away the former dictator, Hosni Mubarak. In part the reason lies in the weakening of state controls. Drugs flooded in from India and China in little-inspected containers, says Ehab El-Kharrat, a doctor who heads the Freedom, Drugs and HIV Programme, a local NGO that runs the clinic. He says more funding is needed for rehabilitation and public-health education—largely absent in Egypt.

Egypt is a transit point for pharmaceuticals shipped to nearby countries. Customs inspections under President Abdel-Fattah al-Sisi have recently been tightened. In 2013 the government seized 35m pills which, it said, had been smuggled in. Pharmacists caught dealing on the side in theory face long prison sentences. The price of Tramadol has risen sharply, at one point reaching $1-$3 a pill. “Since then we have seen a flood of people seeking help,” says Mr Kharrat.

Yet enforcement is poor. Court cases are thrown out because of shoddy police work. Officers are often in cahoots with the drug dealers, or are themselves drug-users. And even if the government succeeds in restricting the supply of Tramadol, there may be unintended consequences. If the pills become more expensive, users may switch to stronger heroin. Some worry that the worst of Egypt’s drug problem is yet to come.