Just Say No – by Pedro L. Gonzalez

I’ve had a severely deviated septum for years. A boxing injury forced me to relocate my nose to a different zip code on my face. I used my hands and a mirror to help me move it back into place as best I could and never thought about it again because it didn’t bother me that much. A persistent, mild blockage. That’s about it. But then it occurred to me that the reason I can’t remember the last time I felt refreshed after a night’s sleep was probably because of my nose. Sure enough, a doctor told me I’d been living with what was essentially one functioning nostril. “The surgery is going to be more complicated than usual,” he said, wondering why I’d been living this way for so long. The answer is that I’m one of many men who would rather cleaning a dirty toilet than going to the doctor. I suppose that, and our career choices, help explain why we have higher mortality rates than women.

As I write this, I have two giant nose splints stuck in my nose. I imagine removing them would feel a lot like the tracking bug scene from “Total Recall.”

The hospital sent me home with a bag of gauze, ointment, nasal spray, and painkillers. I didn’t plan on using the latter, as I generally avoid them altogether for personal reasons. I once had major femoral surgery and decided not to take any medications after waking up, so I wouldn’t be popping pills after a septoplasty. But my wife looked at what they sent me home with and was surprised by what she found in the little amber bottle: tramadol, a powerful opioid that’s over-prescribed in the United States and causing havoc worldwide.

Tramadol was first invented in 1962 by the pharmaceutical company Grünenthal. The same company also synthesized thalidomide, which was sold as a sedative under the name Contergan. The drug became a popular treatment for morning sickness. However, women who took it during pregnancy began giving birth to babies who suffered from terrible deformities. Tens of thousands of children were born with shortened arms and legs, underdeveloped external ears, and much worse. Some called it thalidomide scandal the “greatest man-made medical disaster ever.”

Tramadol was introduced in 1977, but it did not become available until the 1990s. A Journal Sentinel/MedPage Today research would later discover that the U.S. Food and Drug Administration had failed to consider key evidence indicating that tramadol was just as ripe for abuse as its alternatives, contributing to the agency’s initial recommendation that tramadol not be placed under the Controlled Substance Act.

Nevertheless, tramadol has long been marketed as a “safer” opioid because it carries a lower risk of addiction while being effective at reducing pain. However, a Mayo Clinic study found that patients taking tramadol were at higher risk of long-term use than patients taking alternatives. Another study published in The BMJ made similar findings.

“What we know now is that there really is no safe opioid, and tramadol is not a safe alternative,” said Cornelius Thielsthe lead author of the BMJ study. “Tramadol has essentially a similar risk of long-term dependence or long-term opioid use compared to other opioids.”

Thiels added that part of the problem is that tramadol is so often prescribed after surgery, even when it is inappropriate. I think that is what happened in my case.

The drug is so potent that several sports federations have drastically restricted or even banned it completely. The World Anti-Doping Agency banned tramadol this year.

Tramadol was linked to the death of a young rugby player named Archi Brucewho was found dead in a hotel room with twice the “toxic” amount of the drug in his system. A BBC investigation found that the painkiller was actually deeply rooted in the sport, with players regularly washing the pills down with beer after matches to numb the pain of potential injuries. Others took it because it gave them peace of mind or “made them feel normal”. The Union Cycliste Internationale banned the opioid after players discovered it was a great way to suppress pain during a match and gain an edge.

Islamists came to the same conclusions during their ‘field tests’.

Boko Haram fighters in Africa have made the drug a staple in their arsenal. “Everyone took it before they left the camp. Even if there was nothing else in the camp, there was always Tramadol,” said Adamu Musaa former child soldier. “When we took Tramadol, nothing else mattered except what we were sent to do,” he added. “Because it made us very high and very brutal, it was impossible to go on a mission without taking it.”

Tramadol is actually fueling abuse and instability from India to Africa to the Middle East. Mexican cartels have apparently gotten into the export business, since the stuff can be bought without a prescription south of the border. Earlier this year, U.S. federal agents seized boxes of 159 pounds of tramadol at the World Trade Bridge.

There’s something unsettling about the fact that the same drugs that are so easily shipped home, even though they may not be needed, are also contributing to chaos in regions around the world. Mexico has the cartels; America has the Sackler family and their pain empire that profited from the opioid epidemic and providers who overprescribe addictive painkillers. The difference is in the curtains.