Countries across West Africa, including Sierra Leone, Togo, Ghana, Nigeria, and several others, are facing a growing but often overlooked opioid crisis that is damaging communities, overwhelming families, and placing additional pressure on already fragile healthcare systems. Unlike narcotics produced in clandestine laboratories, many of the drugs fueling this epidemic are legally manufactured pharmaceuticals imported in enormous quantities from India’s pharmaceutical sector.
For more than a decade, large parts of West Africa—including Ghana, Sierra Leone, Senegal, Nigeria, and Côte d’Ivoire—have experienced a widespread opioid abuse epidemic that has devastated households, contributed to thousands of deaths, and stretched healthcare resources to their limits. Historically known as a transit corridor for illicit drugs moving between Latin America and Europe, the region has increasingly become a major consumer market for opioid-based painkillers.
Recent estimates suggest that approximately 30 percent of West Africa’s population has used tramadol or codeine, making these prescription opioids among the most frequently abused substances in the region. Another particularly dangerous drug mixture known as “Kush” has also gained prominence. This synthetic substance commonly contains cannabinoids alongside powerful synthetic opioids such as nitazenes, which in some cases can be even more potent than fentanyl.
The scale of the crisis has become so severe that in 2024 the governments of both Sierra Leone and Liberia took the unprecedented step of declaring national emergencies related to drug abuse. Ghana’s Food and Drugs Authority also reported last year that the misuse of tapentadol—widely known on the streets as “Red”—was increasing significantly.
The underlying causes of addiction in these countries are largely similar to those seen elsewhere. Poverty, high unemployment, limited economic opportunities, and weak governance structures have left many young people vulnerable to substance abuse during periods of hardship.
Illicit opioid pills have circulated outside formal pharmaceutical markets throughout the region since drug consumption began rising roughly a decade ago. However, unlike the opioid epidemic in the United States, where the crisis became closely associated with Purdue Pharma’s OxyContin, multiple investigations have indicated that the West African crisis is heavily linked to pharmaceutical exports originating in India.
India has exported more than 1,400 shipments of tapentadol valued at nearly USD $130 million to countries across the region, including Ghana, Sierra Leone, Benin, Senegal, and Nigeria.
Porous Borders and Weak Regulatory Controls
India, often described as the world’s largest producer of generic medicines and frequently referred to as the “pharmacy of the world,” has repeatedly faced scrutiny over allegations that pharmaceutical exports have contributed to the opioid crisis in West Africa.
A BBC investigation published in February of last year focused on Mumbai-based Aveo Pharmaceuticals, which manufactured a drug marketed under the name “Tafrodol.” The product combined tapentadol, a powerful opioid painkiller, with carisoprodol, a muscle relaxant. Health experts regard the combination as particularly addictive and dangerous.
Notably, the drug was not approved for legal use anywhere in the world, including India and Ghana, one of the principal destinations for shipments. Despite this, investigators found that Aveo Pharmaceuticals exported large quantities of the product by taking advantage of regulatory loopholes.
Following the publication of the investigation, Indian authorities confiscated the company’s inventory and suspended production activities. At the time, many observers expected the disruption to reduce the flow of opioid exports from Indian pharmaceutical manufacturers.
However, a subsequent investigation conducted by the investigative organisation Bellingcat and the independent Indian media outlet Newslaundry revealed a different trend. While some products disappeared from the market, exports of other opioids—particularly tapentadol—had increased substantially.
According to the investigation, Indian pharmaceutical companies shipped more than 320 million tapentadol tablets to West African markets. The value of tapentadol exports to the region rose dramatically, increasing from approximately $27 million between 2020 and 2022 to nearly $130 million between 2023 and 2025.
More than 80 percent of the total value of these exports was directed toward Sierra Leone and Ghana. Both countries possess major seaports and occupy strategic positions along broader trafficking routes through which pharmaceutical opioids are frequently transported to neighbouring states, often concealed within cargo shipments or courier packages.
Many of the exported products contained high-strength doses of 200mg or more—strengths that are not approved for use within India itself. Ghana’s Food and Drugs Authority stated unequivocally that it had not authorised permits for the importation of tapentadol in any strength for distribution within Ghana or neighbouring countries.
The trade highlights significant weaknesses in export monitoring, regulatory enforcement, and regional cross-border drug control mechanisms.
According to Dinesh Thakur, public health activist and co-author of Truth Pill: The Myth of Drug Regulation in India, regulatory gaps and limited transparency between exporting and importing countries remain at the heart of the problem.
“There are two dimensions to this issue. First, in the manufacturing country, how can a company produce and export these opioids without effective regulatory oversight? Under current Indian law, if a specific formulation is not marketed domestically, the Central Drugs Standard Control Organisation (CDSCO) has limited involvement in overseeing its production and export,” he explains.
“For opioids, which fall under Schedule H and require prescriptions, export approvals should also involve the Narcotics Bureau. However, how effectively that system operates remains unclear.” Thakur further notes that importing countries must also enforce their own regulatory frameworks and carefully monitor incoming pharmaceutical shipments.
Nelson Aghogho Evaborhene, a Nigerian PhD researcher at Roskilde University in Denmark, says the rapid rise in opioid abuse began roughly a decade ago and has proven difficult to contain.
“In theory, border authorities should inspect pharmaceutical products entering the country. In practice, these controls can often be bypassed, allowing products to be smuggled through alternative routes. Across much of West Africa, borders are extremely porous. In some places they consist of little more than a bridge or a fence and are not consistently monitored,” he says.
Evaborhene acknowledges efforts by Nigeria’s National Agency for Food and Drug Administration and Control (NAFDAC) to address the issue but argues that stronger cooperation with customs authorities and neighbouring countries is essential.
He also points to another major challenge: the absence of robust data collection systems for monitoring drug abuse across much of the region.
“Many countries are attempting to document drug-use patterns, but the process is not occurring at the scale required. A significant number of people never seek treatment in hospitals, and many primary and even secondary healthcare facilities have not yet adopted comprehensive electronic record systems. As a result, obtaining reliable data remains difficult,” he explains.
The “Pharmacy of the World” Under Scrutiny
Since 2023, more than 60 Indian pharmaceutical suppliers have generated substantial revenues from exporting tapentadol to West African countries. Among them, three companies—Syncom Formulations, Puizer Pharmaceuticals, and Twin Impex—have emerged as dominant players in the market.
According to investigative reports examining India’s opioid export network into West Africa, only two manufacturers were officially authorised to produce tapentadol for export. Yet neither of those companies appeared among the more than 60 exporters identified in the investigation.
This discrepancy raises serious questions about the effectiveness of India’s pharmaceutical regulatory framework.
“China’s strength lies in the production of raw materials and active pharmaceutical ingredients (APIs). India’s strength lies in converting those ingredients into finished pharmaceutical products, which requires expertise in medicinal and process chemistry,” says Thakur.
“As far as I am aware, the Indian pharmaceutical industry has not yet taken sufficient responsibility or implemented adequate corrective measures regarding this issue.”
Evaborhene warns that the consequences of uncontrolled opioid imports are especially severe for vulnerable populations, particularly in countries facing economic hardship and social instability.
“Sierra Leone is a particularly important example. It is a relatively small country with a population of fewer than 10 million people, and much of the population is concentrated around Freetown. In such an environment, social and public health challenges can spread very quickly,” he explains.
India remains one of the world’s largest pharmaceutical producers, ranking third globally by production volume. The country supplies approximately 20 percent of the world’s generic medicines and more than 60 percent of global vaccine volumes. Its pharmaceutical industry has built a reputation for producing affordable medicines at scale, although it remains less dominant in high-value branded pharmaceuticals and advanced research and development.
However, investigations into opioid exports, along with previous controversies involving pharmaceutical products, have raised broader concerns regarding the quality, oversight, and legality of certain medicines exported to African markets.
According to Evaborhene, addressing the opioid crisis will require coordinated action from both India and West African governments.
“We need stronger transnational policies and coordinated strategies to tackle the problem effectively. That includes improved border controls along known trafficking routes, stronger regulatory systems, and greater accountability from all stakeholders involved,” he says.