CAIRO — The first time Karim el-Bakry took tramadol, he threw up. “I thought: ok, this isn’t nice. My friends lied when they told me it was fun,” he said, as he pitched his three-wheeled taxi along the uneven dirt alleyways of the capital’s impoverished Imbaba district.
The second time, coaxed on by his fellow drivers, was a little better—“I felt the buzz,” he said. It was after the third try, however—again taken at his colleagues’ behest—that he felt he might finally have hit upon a means of whiling away the long, boring hours at the wheel.
Now, well and truly hooked and reliant on four or five doses a day, Bakry is full of regret. But even while navigating the pitfalls of addiction, he says that drug use still seems like one of the few ways to dull the pain of the country’s weak economy and trying political circumstances.
“Food, gas, everything is so expensive. People are exhausted and take things like tramadol just to keep going,” he said, his words barely traceable amid the rumble of electronic ‘Shaabi’ music blaring from the speaker system mounted on the back of his tuk-tuk.
Complete statistics on drug use in Egypt are hard to come by, but with stories like Bakry’s a dime a dozen, there’s plenty of evidence to suggest tramadol has emerged as one of the few beneficiaries of the past four years of flux.
From relative obscurity as recently as 2010, the opiate-like painkiller has surged ahead of heroin and is second only to cannabis (hashish and marijuana) in its popularity among Egypt’s almost 90 million people, according to health officials.
There’s no mystery either as to why the drug, a strong but relatively crude medication that delivers a slightly unusual high, has developed such a large recreational following instead of more refined products. At roughly 30 to 40 Egyptians pounds ($3.8 to $5.1) for a strip of 12, or as little as two to three pounds per pill in very poor parts of Cairo, it’s within reach for all but the most cash-trapped of the young male manual workers who form the core of its constituency.
Government officials have cast doubt, of course, on the notion that tramadol usage has soared as a direct consequence of Egypt’s troubles.
“People have been using opiates here for thousands of years,” said Hisham Ramy, who heads the Ministry of Health’s drug addiction unit. “They are just trying to rationalize it now by saying life is hard.” Officials at the United Nations Office on Drugs and Crime (UNODC) also say that Egypt’s anti-narcotics administration was one of the few government organs not adversely affected by successive regime changes.
But with ever-increasing numbers of university graduates forced to take on manual labor due to a lack of skilled jobs, and others required to up their workload to make ends meet amid high inflation, tramadol’s fortunes appear to be intimately wrapped up with those of the country at large.
Whatever the reason, the drug which many regard as more religiously permissible than alcohol or cannabis, can result in a whole host of unpleasant side effects, including liver damage, epilepsy and psychosis.
It’s even more addictive than heroin and is believed to be largely responsible for the sizeable hike in admissions to Egypt’s 15 specialist psychiatric hospitals since the revolution: 445,000 patients were referred for treatment in the public system last year, up from 386,000 in 2013, according to figures obtained by the private Al-Masry Al-Youm newspaper; 70 percent of admissions to the addiction wing of Cairo’s massive Qasr el-Aini hospital were linked to tramadol in 2014 alone.
Egypt certainly isn’t the only country on the African continent reeling from tramadol’s emergence—last September, tiny Benin seized a single shipment of 160 tons. But this phenomenon has struck Egypt’s ailing health network hard at a time when the government is has trouble increasing public spending.
“There is certainly a gap between the treatment and the number of people who need to be treated,” said Ramy, who admits some doctors are still getting to grips with the drug, which was first labeled a controlled substance in 2011.
Residents of Imbaba and other poorly serviced neighborhoods where tramadol has left a particularly notable imprint know this all too well.
“My son was sent home from the local clinic because they didn’t have enough medicine,” said Om Mahmoud, a neighbor of Bakry’s, whose youngest child began dabbling with tramadol to sustain himself through long days working as a waiter and taxi driver. “They just told him he needed to rest and eat well.” A year later, he’s wracked with hallucinations and paranoid fits.
But problematically for officials seeking to stymie its consumption, tramadol’s fan base extends way beyond those seeking to boost their energy levels.
“Many people have the idea that it’s good for your sexual health,” said Mohamed El-Kholey, a doctor who until recently worked at a Cairo drug rehabilitation clinic. Some use it as a means of delaying premature ejaculation—it dulls your sensory receptors, though there’s also some evidence that extensive use can lead to impotence. While others appear to favor it as a means of overcoming the pain or awkwardness of sex in a country in which at least 80 percent of women are thought to have undergone female genital mutilation.
Understanding the complications of dealing with a now deeply embedded habit, international drug officials have praised some of Egypt’s work in combating the drug’s expansion. “They see now how it’s spread, and so they are going after the sellers,” said Faisal Hegazy, a program officer at UNODC, which estimated there were at least five billion pills circulating around Egypt in 2012. “They know it’s popular, so they are campaigning to raise awareness.”
But despite most pharmacies’ refusal to stock domestically produced 50 mg tramadol pills for fears of drug abuse, stronger 200 mg pills, which dominate the recreational market, are still seeping over the borders in large quantities.
Ninety percent of illicit tramadol in Egypt is produced in India, according to Hegazy, and most of it is concealed in containers along with legal imports before making its way through major harbor facilities in Alexandria, Port Said and Ain Sukhna.
The army is devoting much more attention to cutting off cross-border contraband from Libya than in previous years, but with a frontier over 1000 kilometers long, a fair bit is still getting through. “They have only six million people in Libya, so the demand is much smaller, and when they receive a big shipment, they send some of it to us,” Hegazy said.
The upshot is that drug dealers say it’s never been easier to shore up their tramadol stocks. “It’s like the waves of the ocean. There’s that much of it,” said a supplier who goes by the name Maga, and who operates in the dingy Boulaq neighborhood, just steps from the Nile.
Sparked in part by this ready availability, tramadol has also begun to spread into more affluent areas of Cairo, a development that drug dealers do not welcome.
“It’s not good when [those] people buy tramadol, because it means they won’t buy more expensive things,” Maga said, laughing. “But with the economy and everything, this seems to be what Egyptians want right now.”