Wonim Red? The Tramadol Misuse Menace in Ghana
The Red Epidemic Among the Youth of Ghana
"Wonim Red?" has been resonating across Ghanaian streets from Tamale to Accra, a terrifying reference to the startling increase in tramadol addiction among young people. This phenomenon—which, in local slang, means "Do you know red?"—reflects the colour of the tramadol pill and has come to represent the drug's terrible effects on society. The public health implications of the increasing misuse of tramadol among Ghanaian youth are dire. The tramadol epidemic has far-reaching implications on both individual health and community well-being.
A Ghanaian Musician, O’Kenneth, featured in Reggie’s song ‘Sa Me’, alluded to using red (tramadol pill) to escape the life troubles plaguing him in his verse of the song. The ‘streets’ (youth) then coined the phrase “wo nim red”, to wit, “do you know red” from it. This reflects the inappropriate coping mechanisms the youth adopt to cope with life stressors.
Tramadol misuse is a common way that Ghanaian youth cope with social marginalisation, poor economic conditions, and the protracted transition to adulthood (Alhassan, 2022). The name tramadol is now used as a catch-all to describe a whole range of opioids that are used as street drugs (BBC News Africa, 2025) including tapentadol and tafrodol. Tramadol was referred to as "tramol" a few years ago when the opioid problem in Ghana began to garner attention. This illustrates how names for certain substances of abuse have changed over time.
In 2019, drug use caused approximately 600,000 deaths worldwide. Nearly 80% of these deaths are caused by opioids, with opioid overdose accounting for approximately 25% (World Health Organization, 2023). Media reports in West African countries show a tramadol misuse crisis, with a sharp increase in use among young people (Alhassan, 2022). The use of "cheap and accessible" opioids by young people in Ghana and West Africa is on the rise (Cascais & Herrmann, 2019).
A Brief Overview of Opioids
Tramadol is a synthetic opioid used to treat moderate to severe pain that does not respond to non-opioid pain relievers (ANR Clinic, 2024). Non-opioid analgesics such as paracetamol (acetaminophen), aspirin, and non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen or naproxen, are used to treat mild to moderate pain.
The World Health Organisation defines "opioids" as substances derived from the poppy plant (Papaver somniferum), as well as semisynthetic and synthetic substances with comparable characteristics that can interact with the brain's opioid receptors.
Opioids are commonly used for the management of moderate to severe pain. Opioids can produce euphoria after ingestion, which is one of the primary reasons they are used for nonmedical purposes. Opioids include fentanyl, heroin, morphine, codeine, methadone, pethidine, tramadol, and other drugs of similar characteristics (World Health Organization, 2023).
How the Red Menace Developed in Ghana
According to (Cascais & Herrmann, 2019), Tramadol was first produced by the German pharmaceutical company Grünenthal and released to the market in 1977 under the brand name Tramal. When the original patent expired, Indian generic manufacturers began producing medications on a massive scale for the African market.
Tramadol is a legally prescribed medicine, not an illegal substance. It is therefore quite easy to be smuggled into Ghana from India, which is nicknamed the Pharmacy of the World. This resulted in the flooding of the West African countries like Ghana with unlicensed or unapproved higher doses or combinations of tramadol and other opioids. People started misusing tramadol after learning that greater dosages of the drug produced euphoric effects. Due to unapproved distribution and inadequate regulatory oversight, these unapproved combinations of opioids and larger doses of tramadol quickly entered the Ghanaian pharmaceutical industry.
Tramadol is frequently seen as a safe opioid with a low risk of abuse and addiction; thus, some people only realise they are dependent on it when they suffer unpleasant tramadol withdrawal symptoms while attempting to discontinue their medicine (ANR Clinic, 2024).
Side Effects of Red
Individual Health
The most typical side effects of tramadol are constipation, light-headedness, mouth dryness, sweating and feeling weariness. The rest of the side-effects are feeling queasy, throwing up, loss of appetite, itching and abdominal pain. Long-term and high-dose tramadol use may lead to addiction, dependency, seizures, hallucinations, disorientation, respiratory depression, and liver and kidney damage (Danso & Anto, 2021).
Community Well-being
The societal consequences of tramadol misuse are also catastrophic. Crime rates have skyrocketed, with many addicts turning to stealing and violence to support their habit. In addition, families are ripped apart as members battle addiction. Also, students who become addicted to tramadol perform poorly in school and drop out at a higher rate than others.
Causes of Tramadol Misuse
- The unrestricted availability of tramadol is a major contributor to the tramadol menace in Ghana. The medication can be bought readily from pharmacies, street sellers, and even online platforms, often without a prescription.
- Due to lax enforcement of drug laws, there is now an underground tramadol market that thrives on young people's curiosity and despair.
- Furthermore, the socioeconomic situation of Ghana has also had a key influence in tramadol misuse. The drug creates a vicious cycle of addiction and dependency by giving users a false sense of invincibility and a reprieve from the harsh realities of life.
The Way Forward
Tackling the tramadol menace in Ghana requires a holistic approach that involves individuals, the community and government.
Prevention
- Awareness campaigns on the negative effects of tramadol misuse
- Strict regulations on the sale and distribution of tramadol
- Enforcement of existing drug laws by conducting raids on illegal vendors and pharmacies that flout the rules
- Huge fines or penalties on individuals or organisations that engage in unauthorised distribution
- Incorporation of educational programs on substance use disorders into the school curricula at the basic school level
- Government providing jobs or opportunities for the youth to learn vocational skills e.g through the National Apprenticeship Program being rolled out by the current government
Treatment
The Government must as a matter of urgency set-up at least one community rehabilitation canters in each district in Ghana to provide treatment for those youth already addicted to tramadol and other substances of abuse. These facilities will offer medical care, psychological assistance, and social reintegration programs to help addicts recover and re-integrate with society.
Conclusion
The Food and Drugs Authority, which draws its mandate from the Public Health Act, 2012 (Act 851) must live up to its mandate by providing and enforcing standards for the manufacture, import, export, sale and distribution of tramadol in Ghana to safeguard public health and safety (Food and Drugs Authority, 2025). As Ghana continues to grapple with this tramadol misuse crisis, a collective effort by all is needed to ensure Ghana becomes a drug-free society. By: Dr. (Med.) Yennusom Maalug (MB ChB, MGCPS, MPH) - 0558488232 / yennusom27@gmail.com
References
Alhassan, J. A. K. (2022). Where is the pain? A qualitative analysis of Ghana’s opioid (tramadol) “crisis” and youth perspectives.
ANR Clinic. (2024, November 10). Tramadol Withdrawal Symptoms, Timeline & Treatment. ANR Clinic - Advanced Opioid Treatment Center.https://anrclinic.com/tramadol-withdrawal-detox/
BBC News Africa. (2025, February 20). India’s Opioid Kings - BBC Africa Eye Documentary. YouTube.https://www.youtube.com/watch?v=ji6tjiRjbok
Cascais, A., & Herrmann, C. (2019, June 26). Opioids in Africa: cheap and accessible. Deutsche Welle.https://www.dw.com/en/opioids-in-africa-cheap-and-accessible/a-49352237
Danso, M., & Anto, F. (2021). Factors Associated with Tramadol Abuse: A Cross-Sectional Study Among Commercial Drivers and Assistants in the Accra Metropolitan Area of Ghana. Drugs - Real World Outcomes, 8(3), 337–347.https://doi.org/10.1007/s40801-021-00247-6
Food and Drugs Authority. (2025). Welcome to Ghana Food And Drugs Authority | Home. FDA Ghana.https://fdaghana.gov.gh/
World Health Organization. (2023, August 29). Opioid overdose. World Health Organization.https://www.who.int/news-room/fact-sheets/detail/opioid-overdose