More than 320 million tapentadol pills have left Indian pharmaceutical factories for West Africa since January 2023. The shipments are worth nearly $130 million. Not a single destination country has approved the drug for use.

Customs records reviewed by AFP, Bellingcat, and Newslaundry show more than 1,400 consignments of the high-strength synthetic opioid flowing to Nigeria, Sierra Leone, and Ghana, with millions of dollars’ worth shipped every month — often labelled “Harmless Medicines for Human Consumption.” More than 60 Indian suppliers have taken part. Three companies — Syncom Formulations, Puizer Pharmaceuticals, and Twin Impex — dominate the market.

Health officials in Sierra Leone say tapentadol is being ground into kush, a synthetic cocktail notorious for reducing users to a vacant, shambling state. Liberia and Sierra Leone both declared national emergencies over the drug in 2024. More than 400 corpses were collected from the streets of Freetown in a three-month period, according to Ansu Konneh, director of mental health at Sierra Leone’s social welfare ministry. Ninety percent of patients admitted to the country’s few rehab centres had smoked kush laced with tapentadol or other powerful opioids.

Doses approved nowhere

More than half the pills shipped were in strengths of 200mg or higher, according to Bellingcat’s analysis of trade data. Nearly three-quarters of exports since India’s crackdown have been 225mg and 250mg tablets.

Andrew Somogyi, professor of pharmacology at the University of Adelaide, told AFP he was not aware of any country that had approved 225mg tapentadol tablets. He questioned “why a country would want that strength except to bypass regulatory and commercial restrictions.”

India’s own drug regulator, the Central Drugs Standard Control Organisation, said it had “no record” of issuing export clearances for 225mg and 250mg tapentadol. Only two companies have been granted authorisation to manufacture the drug for export since 2019 — and neither appeared among the 60-plus firms actually shipping it to West Africa.

A crackdown that didn’t crack down

New Delhi declared “zero tolerance” on illegal opioid exports in February 2025, banning tablets that combined tapentadol with the muscle relaxant carisoprodol after a BBC investigation exposed the damage in Ghana. The ban targeted a specific combination. Pure tapentadol tablets continued largely unaffected.

Syncom Formulations, the largest tapentadol exporter to West Africa by value, shipped consignments worth nearly $15 million after the ban, many declared as harmless medicines.

Ghana’s Food and Drugs Authority told investigators it had “never issued any permit for the manufacture or importation of tapentadol of any strength.” Nigeria’s drug agency said the drug was “unauthorised and illegal.” Sierra Leone’s health minister Austin Demby confirmed only 50mg tramadol administered in clinical settings was legal.

Yet the value of tapentadol exports to the region surged from roughly $27 million between 2020 and 2022 to almost $130 million between 2023 and 2025, according to export data from trade provider 52wmb.

Not addiction — survival

Most users in West Africa do not take tapentadol for pleasure. Motorbike taxi riders, market porters, and gold miners use the pills to endure punishing physical labour. “It energises my body to ride day and night,” motorbike taxi rider Abubakar Sesay told AFP in Freetown. “Without it, I can’t survive.” A single tablet costs less than a meal in the poor suburbs of Abuja, according to Boluwatife Owoyemi of YouthRISE Nigeria.

Medical anthropologist Axel Klein of the Global Initiative Against Transnational Organized Crime said users in the region are “much more naive than in other parts of the world,” with little government enforcement to protect them. The pills are made to look like medicine, which masks the danger.

Vanda Felbab-Brown, a senior fellow at the Brookings Institution, said Indian companies previously exported vast quantities of tramadol at potencies far beyond safe levels, then pivoted to tapentadol after controls tightened. “Africa is a market that provides opportunities at a low end,” she told AFP.

The Indian Drug Manufacturers’ Association said a legitimate manufacturer “who has followed the procedures cannot be held responsible for what happens later in the supply chain.” India’s drug regulator did not respond to detailed follow-up queries.

Now even children are caught in the trade. Konneh said young pupils in Sierra Leone are splitting tapentadol pills into pieces and mixing them with energy drinks. Addicts tell rehab workers they have stopped taking kush and switched to tapentadol alone. “They don’t see that to be a problem to their health.”

Sources