IDPs who fled attacks use drug imported illegally from India to cope with post-traumatic stress and challenges in camps.

Maiduguri, Nigeria – Aliyu Yusuf hadn’t heard of Tramadol until he arrived at an IDP (internally displaced persons) camp in 2016, having escaped an attack by Boko Haram on Gwoza, his hometown near the border with Cameroon.

One morning in the camp in Madinatu, where some 5,000 IDPs live on the outskirts of Maiduguri, there was no food to eat. A man he had made friends with offered him the drug to ease the pain of hunger.

A few tablets later, he felt relieved. It was the start of his Tramadol addiction.

“I feel very empty without Tramadol,” said Yusuf.

“It is the only thing that makes me tough and takes away all my pain away.”

Yusuf is one of dozens of IDPs in Madinatu who is addicted to Tramadol.

While it is mainly used as pain relief medicine, when taken at higher doses, it can produce the same high as heroin.

Tramadol binds to opioid receptors in the brain and spinal cord, leading to a sense of euphoria.

Like Yusuf, most of the people on the drug in Madinatu told Al Jazeera that they were introduced to it in the IDP camp.

Many said they experienced post-traumatic stress following Boko Haram attacks and cited the challenges of living in an IDP camp as reasons for their dependence.

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“Nothing matters to me any more whenever I take [Tramadol],” said 23-year-old Shettima, whose two brothers were killed in a Boko Haram attack in Bama town in 2015. “When fear comes, Tramadol takes it away.”

In 2015 when the camp was first erected, Tramadol was relatively unknown.

But when people managed to escape from Boko Haram captivity, where they were exposed to the drug by fighters, Tramadol made its way to the IDP community.

“They (dealers) gave the impression that it was a magic drug that will make whoever takes it very happy,” said Hauwa Salihu who has lived in Madinatu since escaping from Damboa town in 2015 when Boko Haram attacked. “People began to rush it since then.”

We've established a number of cases of bullying, intimidation and even sexual advances involving more than a dozen IDPs in Madinatu and Bulumkutu who regularly abuse Tramadol. Jibrin Bukkar, counsellor and social worker

Among the former Boko Haram captives who introduced Tramadol to IDPs in Madinatu is 19-year-old Adamu Musa, who spent months in a Boko Haram camp after being abducted, along with about a dozen others, from their home in Gwoza.

During his time in captivity, Musa said he joined fighters on forced missions to attack communities and abduct young men his age. His captors made sure everyone took high doses of Tramadol before embarking on any mission. He became addicted in the process and when he arrived in Madinatu after escaping, he introduced the drug to some in the camp.

“I wanted to help them forget about what they’ve been through,” he said. “Tramadol helps you feel like you’re on top of the world.”

Drug abuse in IDP camps in northeastern Nigeria is not restricted to Madinatu.

The National Drug Law Enforcement Agency (NDLEA), which last year arrested 19 IDPs for using and selling drugs in the Bakkasi and Mogolis IDP camps in Maiduguri, the Borno state capital, said drug use affects several IDPs and that “none of the camps in the state capital is free from the nefarious drug activities.”

Tramadol continues to be the most common drug used in IDP camps. Aid workers say they have witnessed aggression as a side effect among users in Madinatu and nearby the Bulumkutu IDP camp.

“We’ve established a number of cases of bullying, intimidation and even sexual advances involving more than a dozen IDPs in Madinatu and Bulumkutu who regularly abuse Tramadol,” said Jibrin Bukkar, a counsellor and social worker at Caprecon Development And Peace Initiative, an organisation assisting victims of drug abuse and human trafficking in IDP camps.

“Excessive use of the drug can sometimes lead to symptoms like agitation, nervousness, tension, and changes in mood which can trigger aggression.”

Yes it keeps me calm most of the time, but it has taken away everything I have. I spent all my money buying Tramadol. Maryam, Tramadol user

In Bulumkutu, where hundreds live in a crowded camp, 36-year-old Maryam has signs of depression following months of Tramadol abuse.

She was introduced to the drug after becoming frustrated in the camp, where IDPs often struggled to get enough food.

“Yes it keeps me calm most of the time, but it has taken away everything I have,” said Maryam, who is attempting to come off the drug following counselling. “I spent all my money buying Tramadol.”

The drug can easily be bought from local pharmacies for as little as 30 cents for a strip of 10 tablets, mostly in dosages as high as 225mg – more than two times what is legally allowed in some other countries.

Tramadol users also benefit from loose international regulation of production and distribution of the opioid, which has flooded Nigeria from South Asia, particularly India.

The United Nations said in December that almost 90 percent of all the pharmaceutical opioids (predominantly Tramadol) seized globally were seized in West, Central, and North Africa.

Cracking down

Nigerian authorities have cracked down on illegal importation; late last year, almost 600 million tablets were seized at the country’s biggest port.

But Nigeria’s porous borders have allowed for the drug to be smuggled from neighbouring countries including Benin, a country the US Department of State said was the world’s second largest destination for Indian Tramadol in 2016 after the US itself.

“The number of IDPs who abuse Tramadol keeps growing by the day and many of these persons get the drug from the black market,” said Yusuf Mohammed, a senior official at the Borno Community Coalition, an association of NGOs in Borno State supporting vulnerable IDPs – including victims of drug abuse, human trafficking, violence and exploitation.

“It appears black marketers, who may be working with Tramadol smugglers, have found a huge market with IDPs.”

In general, Nigeria’s problems with drug abuse is alarming.

Around 14.3 million people, or 15 percent of the country’s adult population, which is more than twice the global average of 5.3 percent, used a “considerable level” of psychoactive substances over the past year, according to an EU-funded survey on drug use and health.

A quarter of that number (about 4.6 million people) used opioids, including Tramadol, “for non-medical purposes.”

While efforts to reduce drug dependence in IDP camps are gathering pace, campaigners demand action on smuggling and the sale of opioids.

“Pharmacies have to insist on prescription before Tramadol is sold, and security at our borders has to be stronger,” said Bukkar. “If these actions are not effectively implemented, we will not get complete success in our campaign.”