Exposing an Indian pharma agency fuelling West Africa’s opioid disaster

An Indian pharmaceutical firm is manufacturing unlicensed, extremely addictive opioids and exporting them illegally to West Africa the place they’re driving a serious public well being disaster in nations together with Ghana, Nigeria, and Cote D’Ivoire, a BBC Eye investigation has revealed.

Aveo Prescription drugs, based mostly in Mumbai, makes a spread of capsules that go underneath totally different model names and are packaged to appear to be reputable medicines. However all include the identical dangerous mixture of components: tapentadol, a robust opioid, and carisoprodol, a muscle relaxant so addictive it is banned in Europe.

This mix of medication just isn’t licensed to be used wherever on the planet and may trigger respiratory difficulties and seizures. An overdose can kill. Regardless of the dangers, these opioids are common as avenue medication in lots of West African nations, as a result of they’re so low cost and broadly out there.

The BBC World Service discovered packets of them, branded with the Aveo emblem, on the market on the streets of Ghanaian, Nigerian, and Ivoirian cities and cities.

Having traced the medication again to Aveo’s manufacturing facility in India, the BBC despatched an undercover operative contained in the manufacturing facility, posing as an African businessman trying to provide opioids to Nigeria. Utilizing a hidden digital camera, the BBC filmed one in all Aveo’s administrators, Vinod Sharma, displaying off the identical harmful merchandise the BBC discovered on the market throughout West Africa.

Within the secretly recorded footage, the operative tells Sharma that his plan is to promote the capsules to youngsters in Nigeria “who all love this product”. Sharma would not flinch. “OK,” he replies, earlier than explaining that if customers take two or three capsules without delay, they’ll “calm down” and agrees they’ll get “excessive”. In the direction of the tip of the assembly, Sharma says: “That is very dangerous for the well being,” including “these days, that is enterprise.”

It’s a enterprise that’s damaging the well being and destroying the potential of thousands and thousands of younger folks throughout West Africa.

Within the metropolis of Tamale, in northern Ghana, so many younger persons are taking unlawful opioids that one of many metropolis’s chiefs, Alhassan Maham, has created a voluntary activity power of about 100 native residents whose mission is to raid drug sellers and take these capsules off the streets.

“The medication devour the sanity of those that abuse them,” says Maham, “like a hearth burns when kerosene is poured on it.” One addict in Tamale put it much more merely. The medication, he mentioned, have “wasted our lives”.

The BBC workforce adopted the duty power as they jumped on to motorbikes and, following a tip off a few drug deal, launched a raid in one in all Tamale’s poorest neighbourhoods. On the way in which they handed a younger man slumped in a stupor who, in accordance with locals, had taken these medication.

When the vendor was caught, he was carrying a plastic bag crammed with inexperienced capsules labelled Tafrodol. The packets have been stamped with the distinctive emblem of Aveo Prescription drugs.

It is not simply in Tamale that Aveo’s capsules are inflicting distress. The BBC discovered related merchandise, made by Aveo, have been seized by police elsewhere in Ghana.

We additionally discovered proof that Aveo’s capsules are on the market on the streets of Nigeria and Cote D’Ivoire, the place youngsters dissolve them in an alcoholic power drink to extend the excessive.

Publicly-available export information present that Aveo Prescription drugs, together with a sister firm referred to as Westfin Worldwide, is delivery thousands and thousands of those tablets to Ghana and different West African nations.

Nigeria, with a inhabitants of 225 million folks, offers the most important marketplace for these capsules. It has been estimated that about 4 million Nigerians abuse some type of opioid, in accordance with Nigeria’s Nationwide Bureau of Statistics.

The Chairman of Nigeria’s Drug and Legislation Enforcement Company (NDLEA), Brig Gen Mohammed Buba Marwa, informed the BBC, opioids are “devastating our youths, our households, it is in each group in Nigeria”.

In 2018, following a BBC Africa Eye investigation into the sale of opioids as avenue medication, Nigerian authorities tried to get a grip on a broadly abused opioid painkiller referred to as tramadol.

The federal government banned the sale of tramadol with out prescription, imposed strict limits on the utmost dose, and cracked down on imports of unlawful capsules. On the identical time, Indian authorities tightened export laws on tramadol.

Not lengthy after this crackdown, Aveo Prescription drugs started to export a brand new tablet based mostly on tapentadol, an excellent stronger opioid, combined with the muscle-relaxant carisoprodol.

West African officers are warning that opioid exporters seem like utilizing these new mixture capsules as an alternative to tramadol and to evade the crackdown.

Within the Aveo manufacturing facility there have been cartons of the mixture medication stacked on prime of one another, virtually ceiling-high. On his desk, Vinod Sharma laid out packet after packet of the tapentadol-carisoprodol cocktail capsules that the corporate markets underneath a spread of names together with Tafrodol, the most well-liked, in addition to TimaKing and Tremendous Royal-225.

He informed the BBC’s undercover workforce that “scientists” working in his manufacturing facility might mix totally different medication to “make a brand new product”.

Watch India’s Opioid Kings from BBC Eye Investigations on iPlayer or, if you’re outdoors the UK, watch on YouTube.

Aveo’s new product is much more harmful than the tramadol it has changed. In response to Dr Lekhansh Shukla, assistant professor on the Nationwide Institute of Psychological Well being and Neuro Sciences in Bengaluru, India, tapentadol “offers the results of an opioid” together with very deep sleep.

“It could possibly be deep sufficient that individuals do not breathe, and that results in drug overdose,” he defined. “And together with that, you’re giving one other agent, carisoprodol, which additionally offers very deep sleep, rest. It appears like a really harmful mixture.”

Carisoprodol has been banned in Europe as a result of it’s addictive. It’s authorised to be used within the US however just for brief intervals of as much as three weeks. Withdrawal signs embrace nervousness, insomnia, and hallucinations.

When combined with tapentadol the withdrawal is even “extra extreme” in comparison with common opioids, mentioned Dr Shukla. “It is a pretty painful expertise.”

He mentioned he knew of no scientific trials on the efficacy of this mixture. In contrast to tramadol, which is authorized to be used in restricted doses, the tapentadol-carisoprodol cocktail “doesn’t sound like a rational mixture”, he mentioned. “This isn’t one thing that’s licensed for use in our nation.”

In India, pharmaceutical corporations can not legally manufacture and export unlicensed medication except these medication meet the requirements of the importing nation. Aveo ships Tafrodol and related merchandise to Ghana, the place this mixture of tapentadol and carisoprodol is, in accordance with Ghana’s nationwide Drug Enforcement Company, unlicensed and unlawful. By delivery Tafrodol to Ghana, Aveo is breaking Indian legislation.

We put these allegations to Vinod Sharma and Aveo Prescription drugs. They didn’t reply.

The Indian medication regulator, the CDSCO, informed us the Indian authorities recognises its duty in direction of international public well being and is dedicated to making sure India has a accountable and robust pharmaceutical regulatory system.

It added that exports from India to different nations are intently monitored and that just lately tightened regulation is strictly enforced. It additionally referred to as importing nations to assist India’s efforts by guaranteeing that they had equally robust regulatory programs.

The CDSCO said it has taken up the matter with different nations, together with these in West Africa, and is dedicated to working with them to forestall wrongdoing. The regulator mentioned it’ll take fast motion towards any pharmaceutical agency concerned in malpractice.

Aveo just isn’t the one Indian firm making and exporting unlicensed opioids. Publicly out there export information recommend different pharma corporations manufacture related merchandise, and medicines with totally different branding are broadly out there throughout West Africa.

These producers are damaging the fame of India’s fast-growing pharmaceutical trade, which makes high-quality generic medicines upon which thousands and thousands of individuals worldwide rely and manufactures vaccines which have saved thousands and thousands of lives. The trade’s exports are price not less than $28bn (£22bn) a yr.

Talking about his assembly with Sharma, the BBC’s undercover operative, whose identification should stay hid for his security, says: “Nigerian journalists have been reporting on this opioid disaster for greater than 20 years however lastly, I used to be nose to nose… with one of many males on the root of Africa’s opioid disaster, one of many males who truly makes this product and ships it into our nations by the container load. He knew the hurt it was doing however he did not appear to care… describing it merely as enterprise.”

Again in Tamale, Ghana, the BBC workforce adopted the native activity power on one last raid that turned up much more of Aveo’s Tafrodol. That night they gathered in a neighborhood park to burn the medication that they had seized.

“We’re burning it in an open glare for everyone to see,” mentioned Zickay, one of many leaders, because the packets have been doused in petrol and set ablaze, “so it sends a sign to the sellers and the suppliers: in the event that they get you, they’re going to burn your medication”.

However even because the flames destroyed a number of hundred packets of Tafrodol, the “sellers and suppliers” on the prime of this chain, hundreds of miles away in India, have been churning out thousands and thousands extra – and getting wealthy on the income of distress.