Sierra Leone, Togo, Ghana, Nigeria, and several other West African countries are facing an opioid crisis largely ignored by Indian authorities, the country from which these substances are exported to the African continent. Several investigations show that the Indian pharmaceutical industry has profited handsomely from exporting these illicit products.

A young man smokes "Kush," a synthetic drug, in a hideout in Freetown, Sierra Leone, on April 29, 2024 © Misper Apawu, AP

Once merely a transit zone for illicit drug trafficking linking Latin America to Europe, West Africa has become one of the world's leading consumers of opioid-based medications. Ghana, Sierra Leone, Senegal, Nigeria, and Côte d'Ivoire are now grappling with the devastating effects of soaring consumption of these powerful painkillers, causing thousands of deaths and severely straining already fragile healthcare systems.

Estimates suggest that nearly 30% of the population of West Africa administers tramadol and 11% codeine, making these prescription opioids among the most widely used substances in the region.

National state of emergency in the face of drug addiction

Another particularly dangerous opioid mixture is "Kush" . A synthetic drug, some formulas of which contain cannabinoids nine times more potent than THC, and others synthetic opioids such as nitazenes, which are much more potent than fentanyl.

The scale of this crisis is such that in 2024, the leaders of Sierra Leone and Liberia declared a national state of emergency in response to drug addiction. In Ghana, the Food and Drug Administration (FDA) reported an increase in the misuse of tapentadol, an opioid locally known as "Red".

As everywhere in the world, the causes of this phenomenon lie in poverty, unemployment, and the dysfunction of state institutions. A particularly vulnerable segment of youth then turns to drugs.

In Liberia, specialists also mention the high prevalence of psychological trauma linked to the civil war that ravaged the country in the 1990s.

Several investigations have shown that the products circulating in West Africa originate in India. The Asian country exported more than 1,400 batches of tapentadol, worth nearly $130 million, to various states in the region, including Ghana, Sierra Leone, Benin, Senegal, and Nigeria.

A lack of control in India

As the world's leading producer of generic drugs and self-proclaimed " pharmacy of the world ," India has repeatedly been accused of flooding West Africa with illicit opioids.

A BBC investigation published in February 2025 examined Aveo Pharmaceuticals, a Mumbai-based company that manufactured "Tafrodol," a highly addictive and dangerous mixture of tapentadol—an opioid painkiller—and carisoprodol, a muscle relaxant. This product is banned worldwide, including in India and Ghana, the main entry point for these shipments. Yet, it was exported in significant quantities by Aveo Pharmaceuticals by exploiting regulatory loopholes.

Following this investigation, Indian authorities eventually seized Aveo's stocks and suspended production of the drug. However, a new investigation published in April 2026 shows that the export of these opioids, particularly tapentadol, has not stopped. In this investigation, the NGO Bellingcat and the independent Indian media outlet Newslaundry even reveal that this trafficking is on the rise.

Indian companies are reported to have sold over 320 million tablets to West Africa. The value of these exports increased from approximately $27 million between 2020 and 2022 to nearly $130 million between 2023 and 2025.

The investigation reveals that more than 80% of these exports were sent to Sierra Leone and Ghana, two countries with strategic ports, allowing these substances to then be transported to neighboring countries, concealed in shipments or parcels.

The exported tablets contained doses of 200 milligrams or more—concentrations prohibited in India. The Indian FDA also states that it has not issued any import authorizations for tapentadol, regardless of the dosage.

For Dinesh Thakur, an Indian whistleblower and co-author of "Truth Pill: The Myth of Drug Regulation in India" (2022), the problem lies mainly in regulatory gaps and a lack of coordination between states.

“How can a manufacturer produce and export these opioids without any real regulatory oversight?” he asks. The problem is that India’s drug regulator only intervenes if the product is sold on the Indian market, which isn’t the case for most of these opioids. As for those classified in India as prescription drugs, authorization from the Indian Bureau of Narcotics is theoretically required, but “the actual effectiveness of this control remains unclear.”

Indian companies that are getting rich

Since 2023, more than 60 Indian suppliers have allegedly profited from tapentadol exports to West Africa, reveals an in-depth investigation by the independent media outlet Newslaundry . However, only two companies have been authorized by the Indian FDA to manufacture tapentadol for export.

The investigation also cites the names of three companies - Syncom Formulations, Puizer Pharmaceuticals and Twin Impex - which allegedly dominate the market.

Nelson Aghogho Evaborhene, a Nigerian doctoral student at Roskilde University in Denmark, explains that only strengthened cooperation between India and West African countries will be able to stem this crisis. "We need more effective transnational policies, better border control, stricter regulations, and greater accountability from all actors involved," he recommends.

For Dinesh Thakur, importing countries must strengthen their own verification mechanisms.

West African borders that are difficult to control

Nelson Aghogho Evaborhene indicates that the explosion in opioid consumption dates back about ten years and that the flows are extremely difficult to contain. "Border controls are supposed to prevent these products from entering, but they are regularly circumvented," he explains. "In West Africa, borders are often very porous. Sometimes it can simply be a bridge or a poorly guarded fence."

He nevertheless believes that the Nigerian National Agency for Food and Drug Control has made great efforts to stem the problem, but that it needs support from customs and neighboring countries.

Another difficulty is the lack of reliable systems for collecting data on drug use. "Many people addicted to these substances do not go to the hospital, and some health facilities still do not have digital [data collection] systems. It is therefore very difficult to accurately assess the extent of the phenomenon," he laments.