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This paper aims to explore the role of tramadol in pain management and the impact of regulatory measures on supply and medical access in Ghana and other African countries.

The study adopted an exploratory design and qualitative methods to explore the perspectives of different actors, including officials of regulatory agencies, law enforcement agents, health-care providers and non-medical tramadol users. Data were collected through individual and group interviews, and transcripts were subjected to thematic analysis.

Findings show that tramadol fills a critical gap in treating pain across Ghana in areas with an acute shortage of opioid analgesics due to scheduling-related barriers. This was partly due to porous borders allowing for an influx of tramadol into the countries. The study further found that most tramadol purchases in Ghana and other West African countries were made from market traders rather than from health-care settings and were mainly generic medicines categorised as “substandard/spurious/falsely-labelled/falsified/counterfeit medical products” within the World Health Organization standards.

Although the findings are instructive, there were some limitations worth noting. The study encountered several limitations, especially with the non-medical users, because the environment is highly criminalised, People who use drugs were unwilling to avail themselves for fear of law enforcement officers’ harassment. Obtaining ethical clearance had its own bureaucracy – challenges that delayed the study time frame.

Placing tramadol under the list of internationally controlled substances would create barriers to access to effective pain medications, particularly by the poor, and encourage victimisation of users by law enforcement authorities.

The study is based on empirical research on tramadol use and regulation in African countries, contributing to knowledge in an under-researched subject area on the continent. The comparative approach further adds value to the research.

As in other parts of the world, the ‘war on drugs’ in West Africa has led to significant focus on criminal justice, compromising public health and human rights without reducing the scale of drug trafficking, production and use. West Africa is not only a transit zone, local production and consumption continue to rise unabated. The Economic Community of West African States has described drug issues as the enemy of the state and the rule of law, and has called on members States to fight the ‘scourge’.

The failure of the current policies has been vividly documented by the West Africa Commission on Drugs through its 2014 report titled ‘‘Not Just in Transit: Drugs, the State and Society in West Africa’’.

In response, civil society organisations and activists have contributed to raising awareness of the harm being caused by the current repressive drug policies in West Africa and engaged their respective national governments in evidence-based drug policy reform.

These engagements culminated in regional consultations that gave birth to the West African Common Position for the 2016 United Nations General Assembly Special Session (UNGASS) with a call for harm reduction and an evidence based drug policy for the region. Unfortunately, the UNGASS outcome was not as revolutionary as expected by the West African progressive voices, who have therefore continued to engage their governments to make the 2019 High Level Ministerial segment a turning point in the global drug debate.