Across several countries in west Africa, powerful opioid tablets manufactured in India are becoming part of a worsening drug crisis that health officials say is destroying lives at an alarming speed.
Sold cheaply in roadside kiosks and local pharmacies, the pills look like ordinary painkillers. But authorities and researchers say they are fuelling addiction, overdose deaths and even being mixed into the notorious street drug known as kush.
The centre of concern is tapentadol, a strong synthetic opioid that experts say is significantly more dangerous than tramadol, another painkiller that has already caused widespread addiction problems in the region. Reports suggest millions of high-strength tapentadol tablets continue to reach countries such as Nigeria, Sierra Leone and Ghana despite growing international concern and India's promises to tighten regulation.
What is tapentadol and why are experts worried?
Tapentadol is an opioid painkiller designed to treat severe pain. However, the versions flooding west Africa are often extremely high strength tablets, including 225mg and 250mg doses.
Experts say such strengths are not approved for normal use in many parts of the world.
Professor Andrew Somogyi from the University of Adelaide said he was unaware of any country officially approving 225mg tapentadol tablets and questioned why such doses were being exported at all.
Researchers say the tablets are cheap, widely available and easy to misuse. In many west African communities, people use them not necessarily to get high, but to keep working through physically exhausting jobs.
Motorbike taxi riders, labourers, market porters and miners reportedly take the pills to suppress pain, stay awake and continue working long hours.
How tapentadol became linked to "kush"
Health authorities in Sierra Leone and Liberia say tapentadol is now being mixed into kush, a highly addictive street drug often described locally as a "zombie drug".
Kush has already become such a serious issue that both countries have declared national emergencies over its spread.
Ansu Konneh, director of mental health at Sierra Leone's social welfare ministry, described the trend as "very alarming".
According to officials, bodies are being collected daily from streets and slum areas in the capital Freetown. Over a three-month period alone, more than 400 corpses were reportedly recovered in the city.
Public health researcher Ronald Abu Bangura said drug users grind tapentadol tablets and mix them with kush.
Authorities say around 90 percent of people admitted to Sierra Leone's few official rehabilitation centres had consumed kush mixed with tapentadol or similar opioids.
India's role in the supply chain
India is the world's largest producer of generic medicines, and reports indicate several pharmaceutical companies continue exporting high-strength tapentadol tablets to west Africa.
After international criticism over opioid exports, Central Drugs Standard Control Organisation announced a "zero tolerance" crackdown in February 2025. India also banned exports of tablets combining tapentadol with the muscle relaxant carisoprodol.
However, researchers say the biggest trade has always involved pure tapentadol tablets.
Shipment records reportedly show millions of dollars worth of tablets continuing to move from India into west African countries every month.
Some consignments were allegedly labelled as "Harmless Medicines for Human Consumption".
Companies named in seizure investigations
Reports linked several Indian pharmaceutical companies to tapentadol consignments seized in west Africa.
Tablets confiscated in Sierra Leone reportedly carried licence numbers connected to Gujarat Pharmaceuticals, based in Godhra.
Another Gujarat-based company, Merit Organics, was reportedly linked to tablets seized in Guinea.
Authorities in Senegal reportedly seized 250mg tapentadol tablets associated with Madhya Pradesh-based McW Healthcare.
Another company, PRG Pharma, allegedly shipped products after India's export crackdown while labelling them as harmless medicines.
Reports also identified Syncom Formulations as one of the biggest exporters of tapentadol to west Africa by value.
What Indian companies and regulators are saying
The Indian Drug Manufacturers' Association defended the industry, arguing that legal manufacturers cannot control what happens to medicines after export.
Its representatives said preventing misuse was a "shared responsibility".
India's drug regulator, CDSCO, reportedly stated that it had "no record" of approving exports of 225mg and 250mg tapentadol consignments.
Meanwhile, Gujarat Pharmaceuticals said its exports were conducted legally and claimed importers had provided authorisation letters.
One company representative reportedly said manufacturers shifted from tramadol to tapentadol because tapentadol is easier to export as it is not officially classified as a narcotic in India.
West African countries say the drugs are illegal
Authorities in several African countries insist the imported tapentadol products are illegal.
Ghana said it has never approved tapentadol imports of any strength.
Nigeria's National Agency for Food and Drug Administration and Control stated that tapentadol is neither registered nor authorised in the country.
Sierra Leone's health ministry said only limited medical use of low-strength tramadol is legal within recognised healthcare facilities.
Despite this, officials say use of tapentadol among young people is rapidly increasing, including among schoolchildren and university students.
Why the drugs continue spreading
Experts say poverty, unemployment and weak regulation are helping the opioid trade grow.
Medical anthropologist Axel Klein said the pills are often used as "performance enhancers" to help people survive physically demanding work.
In poor neighbourhoods, a tablet can cost less than a meal.
Some users reportedly rely on the pills to suppress hunger until they can afford food.
Authorities in Nigeria say criminal groups including kidnappers, armed gangs and extremist organisations also use the drugs.
Nigeria's NDLEA anti-drug agency reportedly seized two billion high-strength opioid pills during 2023 and 2024 alone.
A growing humanitarian crisis
The impact is becoming visible across communities in west Africa.
In Sierra Leone, informal rehabilitation homes are reportedly chaining addicts during detox because of a lack of proper treatment facilities.
Many users suffer severe mental and physical health problems.
Officials say some children are now crushing tapentadol tablets and mixing them with energy drinks.
Mental health chief Ansu Konneh warned that many addicts do not even realise tapentadol itself is dangerous because it is sold in medicine-style packaging.
According to him, some users believe they are safe simply because they have stopped using kush while continuing to consume opioid tablets.
"That is the tragedy," he said.