Thoughts from the void: Cannabis and Sudan

'The bulk of tramadol seized in the period 2014– 2018 was seized in West and Central Africa (notably in Nigeria, Benin, Côte d’Ivoire and the Niger), followed by North Africa (notably Egypt, Morocco and the Sudan) and the Near and Middle East (notably Jordan and the United Arab Emirates). In some instances, countries in Western and Central Europe (notably Malta and Greece) have been used as transit countries for tramadol destined for North Africa (Egypt and Libya), although some of the tramadol seized in Europe (in particular Sweden) was also intended for the local market. For the first time ever, significant seizures of tramadol were reported in South Asia (India) in 2018, accounting for 21 per cent of the global total that year, which reflects the fact tramadol was put under the control of the Narcotic Drugs and Psychotropic Substances Act of India in April 2018.

As the full-scale scheduling of tramadol in India took place in 2018,218 and India had been the main source for (illegal) tramadol shipments, the decline in seizures outside India in 2018 may have been the result of a disrupted market. By contrast, and probably as a result of the control in India, seizures of tramadol in that country increased greatly in 2018, and thus in South Asia as a whole (more than 1,000-fold compared with a year earlier).' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'In the Sudan, while population-based estimates of the extent of substance use are not available, research suggests that the drug scene has rapidly changed, especially with the increasing non-medical use of pharmaceutical drugs among young people, including tramadol, benzodiazepines, cough syrups and antihistamines, trihexyphenidyl, anticonvulsants and neuropathic pain agents such as pregabalin and gabapentin.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The manufacture of counterfeit “captagon” tablets, that is, amphetamine tablets mixed with caffeine, in the Near and Middle East is more widespread than the manufacture of amphetamine in South Asia or in East and South-East Asia. Indications received from other countries in the subregion pointed to the existence of clandestine laboratories manufacturing “captagon” tablets in the period 2014–2018, in particular in the Syrian Arab Republic and Lebanon, intended partly for domestic consumption and partly for the more lucrative markets of Saudi Arabia and the Gulf States, as well as the Sudan and Libya. In addition, Iran (Islamic Republic of) and Jordan have been identified by other countries in the subregion as possible countries of origin of amphetamine shipments. Jordan reported that all of the amphetamine found on its market originated in either the Syrian Arab Republic or Lebanon.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'The trafficking and availability of tramadol for its non-medical use is a public health concern, but limited distribution of tramadol for medical use would also pose a public health concern, in particular in Africa, where there is a chronic shortage of pain medications. There are no data on the availability and use of tramadol for medical purposes, but data on internationally controlled substances clearly highlight the gaps in the accessibility of pain medications. The general lack of access to opioid-related pain medications under international control is a specific problem for developing countries, which is even more pronounced in countries in West and Central Africa than in other parts of the world.

Against this background of a de facto non-availability of internationally controlled opioids for pain medication for large sections of the population in West and Central Africa, tramadol – even though it is under national control in some West African countries – is in fact a widely available opioid in those countries, used for both medical purposes (including outside prescription) and for non-medical purposes' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'From what is known, it is possible to identify common threats and different dynamics in the two opioid crises, in Africa and in North America: • The ease of manufacturing, easy accessibility and low-cost production make the illicit markets for tramadol and fentanyls substantially more profitable for traffickers than are other opioids such as heroin. • The large-scale manufacture of tramadol and fentanyls for the illicit market started in a context of an absence of international regulations on tramadol and many fentanyl analogues or their precursors. • The interchangeability (or substitution) of fentanyl and tramadol within the pharmaceutical and illicit drug markets makes it more difficult to address their misuse. Their non-medical use is also seen in the context of self-medication, and thus carries less stigma or is countered by lesser legal sanctions than is the case with other controlled drugs.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'In West, Central and North Africa and the Middle East, tramadol – a pharmaceutical opioid not under international control – has emerged as a major opioid of concern. The drug, in addition to being diverted from the legal market, is mainly trafficked into those subregions in dosages higher than what is prescribed for pain management, with an increasing number of people with tramadol use disorder entering treatment.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The non-medical use of pharmaceutical opioids is not a new phenomenon. It has been observed for decades as part of the polydrug use pattern among high-risk or regular opioid users. What characterizes the most recent opioid crisis is the emergence of non-medical use of pharmaceutical opioids as the main phenomenon, leading to alarming rates of dependence and overdose deaths at the national level. The subregions most affected by this crisis are North America and West, Central and North Africa, where different opioids and different dynamics are driving the threat. In North America, the introduction of fentanyl and its analogues (fentanyls) in the drug market has resulted in a syndemic of use of opioids characterized by an unprecedented increase in opioid overdose deaths' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Medicines for pain relief are unequally distributed across regions. More than 90 per cent of all pharmaceutical opioids available for medical consumption were in high-income countries in 2018. Some 50 per cent were in North America, 40 per cent in Europe, and a further 2 per cent in Oceania. Those countries are home to about 12 per cent of the global population. Low- and middleincome countries, which are home to 88 per cent of the global population, are estimated to consume less than 10 per cent of pharmaceutical opioids.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'In West, Central and North Africa, the opioid crisis is fuelled by tramadol; in North America, by fentanyls. Although those subregions have little in common in terms of economics, demographics or general patterns of drug use, both are struggling with an opioid crisis fuelled by substances that are easy to access and cheap to produce.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'With the exception of Nigeria, where 4.6 million people were estimated to have used opioids – mainly tramadol – in 2017, population-level prevalence estimates of the use of opioids are not available for countries in West, Central and North Africa. However, many countries in those subregions report high levels of non-medical use of tramadol. For example, in Egypt, 2.5 per cent of male and 1.4 per cent of female students aged 15–17 had misused tramadol in the past year. Students in that country also reported the use, to a lesser degree, of heroin or opium/morphine in 2016. Furthermore, data on the provision of treatment suggest that the prevalence of the non-medical use of opioids is quite high in Egypt. Tramadol tablets available in some parts of Africa are reportedly intended for the illicit market and may be of a dosage higher than usually prescribed for medical purposes.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'In line with the dominance of the opium production in Afghanistan, quantities of heroin and morphine seized related to Afghan opiate production accounted for some 84 per cent of the global total in 2018, a slight decrease from 88 per cent in 2017, the year of the bumper harvest in the country. Most of the heroin found in Europe, Central Asia/ Transcaucasia and Africa is derived from opium of Afghan origin, accounting for 100 per cent of all mentions in the responses to the annual report questionnaire by countries in Central Asia/Transcaucasia, 96 per cent in Europe and 87 per cent in Africa over the period 2014–2018.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

Afghanistan and Mexico source the heroin and morphine. Mexico, Thailand, Myanmar and China source the methamphetamine. The Middle East and Eastern Europe sources the amphetamine. The US consumes heroin, cocaine and methamphetamine. Europe consumes heroin, morphine, methamphetamine and amphetamine. Asia consumes heroin, morphine and methamphetamine. Australia consumes methamphetamine. The Middle East consumes heroin and amphetamine. West Asia consumes heroin and methamphetamine. All countries grow and consume cannabis. Opioids, methamphetamine and amphetamines kill the most in terms of drug deaths, cannabis kills none. Who are the leading opponents to cannabis legalization and leading enforcers of global anti-cannabis policy? The countries involved the most in heroin, morphine, amphetamines and methamphetamine. They put on a mask of concern about harms from drugs, produce, sell and consume the most dangerous synthetic drugs and vehemently oppose cannabis legalization worldwide while clandestinely feeding their habits and protecting their sources. They use arms and armies to protect and promote their synthetic drug habits, and drug money to fund and wage a war on cannabis everywhere, pushing man and planet ever closer to death on massive scales and away from the safe, healing cannabis herb...
Jul 10, 2020, 1:14 PM

Cannabis and Opioids
https://ravingkoshy.blogspot.com/2019/04/cannabis-and-opioids.html

Cannabis and Harm Reduction
https://ravingkoshy.blogspot.com/2019/04/cannabis-and-harm-reduction.html