Fricciones en la fiscalización de drogas: opiáceos con receta, prohibición y culturas de consumo en África
Nelson y Dumbili presentan un número especial de "Drogas, hábitos y política social", el cual arroja luz sobre los factores sociales y estructurales que impulsan el consumo de opiáceos en el continente, y las repercusiones de las políticas restrictivas. Más información, en inglés, está disponible abajo.
Introduction
There has been a growing concern about the misuse of pharmaceutical opioids in Africa, with some commentators describing it as part of a “global opioid crisis” (e.g. Kurth et al., 2018), ignoring the socio-historical peculiarities and contextually distinct materializations of these public health crises. Scholars have challenged this broad-brush approach through critical commentaries and original research (Klein et al., 2020; Klantschnig and Dele-Adedeji, 2021). Others have argued that conflating these distinct crises “blocks the path to rational regulatory reforms and public health strategies that could constructively address each crisis on its own terms” (Pettus and Radbruch, 2023, p. 2). A notable outcome of the global crisis narrative, according to Klantschnig and Dele-Adedeji (2021), and crucially for the purpose of this Special Issue, is the increased focus on the tramadol economy in Africa. The narrative has stirred political interests and enforcement-based responses across the continent and among international drug control agencies, who view the crisis as a “drugs” problem that should be addressed with law enforcement and bureaucratic controls (Klein et al., 2020). However, the wider social and structural drivers of opioids consumption on the continent are neglected, and the potential impacts of restrictive controls on health care remain poorly understood. This Special Issue aims to fill these knowledge gaps.
Articles summary
Tinasti and Outleb analyse opioid regulation in Morocco, showing how recent restrictive regulations are influenced by international frameworks and how they affect access to opioid analgesics for pain management and palliative care, as well as opioid agonist therapy. Ane-Loglo examines tramadol regulation in Ghana and six other African countries, showing how they impact the medical use of tramadol. Although tramadol is essential for managing pain in these countries, existing regulatory frameworks hinder access to these medicines. Onyima documents how street-involved young men in a south-eastern Nigerian city obtain opioids from street drug dealers and pharmacies and consume them by sniffing, popping and mixing tramadol with other drugs. These practices emerged in response to the threat of formal control. Nwafor and colleagues show how manual labourers in two south-eastern Nigerian cities consume tramadol to improve energy for work, pain relief and sexual performance. These consumption practices are contextualized by difficult working conditions and low access to pain management. Nelson and colleagues show how strict measures imposed by the Nigerian state on opioid supply due to public concerns about non-medical use among youth did not mitigate this practice. Instead, it constrains access to opioids for medical purposes and fuel police corruption. Dele-Adedeji and colleagues show how social relationships facilitate the illegal tramadol market in Nigeria, enabling market actors to resolve frictions between illegality and the social acceptability of tramadol. Last, but not the least, Otu and colleagues describe how domestic and international politics shape opioid control in Nigeria, reproducing punitive approaches that hinder access to opioids for medical purposes.
Articles
- An overview of legal and policy barriers to opioid analgesics access and opioid agonist therapy in Morocco
Khalid Tinasti, Lahcen Outaleb - Tramadol control measures and supply for health-care services: findings from Ghana and other West African countries
Maria-Goretti Ane - Prescription opioids, consumption cultures and “informal governing images” among “young street guys” in Nigeria
Blessing Nonye Onyima - “It worked for my friend”: non-medical use of tramadol among manual labourers in Anambra state, Nigeria
Chidozie Edwin Nwafor, Chukwuemeka Felix A. Okoye, Nelson I. Nwankwo, Paschal Chukwuma Ugwu - Tramadol regulation, illegal markets and consumption practices: exploring frictions of drug control in Nigeria
Ediomo-Ubong Nelson, Ogochukwu Winifred Odeigah, Emeka W. Dumbili - Resolving friction in the tramadol economy in Nigeria
Ini Dele-Adedeji, Lala Ireland, Gernot Klantschnig - Beyond evidence and reality: the politics, political economy and fallout of hawkish regulatory policy on prescription drugs in Nigeria
Smart E. Otu, Macpherson Uchenna Nnam, Mary Juachi Eteng, Ijeoma Mercy Amugo, Babatunde Michel Idowu - Drinking to cope and college grade point average
Morgan A. Douglass, Madison L. Colley, Alexander J. Tyskiewicz, Mark A. Prince - Ayahuasca ceremonies: set and setting features across Italy and Colombia
Federica Ambrosini, Laura Pariset, Roberta Biolcati - Family ties: examining family functioning and alcohol use among American Indian youth
Morgan A. Douglass, Meghan A. Crabtree, Linda R. Stanley, Randall C. Swaim, Mark A. Prince