The pill is sold in small packs of ten tablets, looks like a common painkiller and can be easily found at street kiosks and informal pharmacies across West Africa.
Behind these pills, however, lies one of the most concerning health crises currently unfolding in the region, as revealed by an investigation by AFP News Agency.
Millions of tablets containing tapentadol, a powerful synthetic opioid produced mainly in India, are blamed for fuelling a new wave of addiction in countries such as Nigeria, Sierra Leone and Ghana.
Millions of tapentadol tablets from India are helping drive a deadly opioid epidemic ravaging the region, with officials and researchers telling AFP that they are also being added to the "zombie drug" kush.
— AFP News Agency (@AFP) May 14, 2026
The cheap pills are so strong that no regulatory authority in the world… pic.twitter.com/rGdJuwWkjK
Linked to the 'zombie drug'
According to the AFP investigation, these pills are now also being used in the production of so‑called kush, a drug described as a “zombie drug” due to the extreme physical and psychological collapse it causes in users.
Experts warn the situation is evolving into a major humanitarian crisis. In Freetown, the capital of Sierra Leone, authorities report daily collection of bodies from streets, markets and slums.
The head of mental health at the country’s Ministry of Social Welfare, Ansu Konneh, told AFP that more than 400 people were found dead in just three months in the capital alone.
Tapentadol is often crushed and mixed with kush, creating a highly addictive substance that is spreading rapidly across West Africa. The crisis has become so severe that both Liberia and Sierra Leone have declared national states of emergency due to kush.
A dangerous substance called Xylazine is quietly entering drug markets — and it’s raising serious global concern.
— Vajiram & Ravi (@VajiramRavi) April 9, 2026
Originally a veterinary sedative, it was never meant for humans.#Xylazine #ZombieDrug #DrugAwareness #PublicHealth #CurrentAffairs #UPSC #HealthCrisis #DrugAbuse pic.twitter.com/s1JMEfcscN
How India became an export hub
AFP visited improvised rehabilitation centres where addicts are kept chained for months in attempts to recover. Authorities estimate that about 90% of those admitted to limited official treatment centres have used kush mixed with tapentadol or other strong opioids.
India is the world’s largest producer of generic medicines but has in recent years drawn international concern over the uncontrolled export of powerful opioids to African countries.
The government announced a “zero tolerance” policy in 2025 against illegal trade in such substances, following reports that combinations of tapentadol and muscle relaxants were causing serious addiction issues in Ghana.
However, according to AFP, exports of pure tapentadol continue.
Customs data shows shipments worth millions of dollars are sent monthly from India to West Africa. Many of these products contain concentrations so high that India itself does not normally allow them to be sold without special authorisation.
In some cases, shipments were declared as “harmless medicines for human use”.
The investigation linked seized tablets in African countries to specific Indian pharmaceutical companies through production licence numbers found on packaging.
Taken to endure hardship
Although now used as a drug, many people in West Africa initially take it to cope with physically demanding work.
Motorcycle taxi drivers, market workers, porters and miners use tapentadol as an 'endurance booster.' "It gives me the strength to work day and night,” one motorcycle taxi driver in Sierra Leone told AFP. “Without it, I can’t survive.”
Experts say that in areas of extreme poverty, the pills are even used as a substitute for food, as they suppress appetite and allow people to keep working without eating.
In Nigeria, opioids are now the second most commonly used substance after cannabis. Authorities seized more than two billion high‑strength pills in 2023 and 2024 alone.
According to the country’s anti‑drug agency, criminal groups, kidnapping gangs and Boko Haram militants are also using the pills.
Tapentadol is often sold on the street as tramadol, although experts say it is two to three times stronger and far more dangerous. Many products are marketed under brand names such as 'TramaKing,' 'Super Royal 200' or 'Tamol‑X,' giving the impression they are legitimate medicines.
“Consumers in West Africa are far more vulnerable because there is insufficient state control,” explains anthropologist Axel Klein. Analysts say weak oversight and limited regulation allow some companies to export products considered problematic or dangerous.
Even children involved
Authorities are particularly concerned that use has now spread to school students. According to Konneh, primary school pupils and university students break the pills into smaller pieces and mix them with energy drinks.
Because tapentadol is presented as a 'medicine,' many users do not recognise the danger. “Even people seeking help tell us ‘I stopped kush, now I only take tapentadol pills,’” says Konneh. “They do not see this as a health problem.”
Experts warn that the opioid crisis in West Africa is increasingly resembling the epidemic that affected the United States in past decades, with the difference that healthcare systems and control mechanisms in many African countries are even weaker.
