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In an article appearing in the Diplomat, researcher Natalie Tecimer brings attention to a less recognized, but still dangerous illicit opioid threat coming into the United States from India: tramadol.

According to Tecimer, tramadol is given as a pain medication in India, but it has a high potential for abuse, and in some countries, tramadol deaths outnumber deaths from heroin.  It is also completely unregulated in India, and is not on the World Health Organization (WHO) list of scheduled drugs or controlled substance list, which would force countries to regulate it.

Tecimer also notes, “In the past year, U.S. law enforcement officials estimate that one billion tramadol tablets have been seized leaving India by U.S. and its international partners in counternarcotics, and actual exports could be exponentially greater. Southeast Asian countries, which also do not regulate tramadol, are frequently used as transit countries, with tramadol repackaged in creative ways.”

Tecimer spoke to the Drug Enforcement Administration (DEA) Attaché for South Asia, the India Country Office who explained that “Libya has emerged as a significant hub for tramadol trafficking” and “the vast majority of these tramadol shipments originated from India via commercial shipping containers.”

Tramadol has also been linked to funding efforts for terrorist organizations such as the Islamic State and Boko Haram. Tecimer cites 37 million tramadol pills worth $75 million that were seized in Italy enroute to Libya. They had been purchased by ISIS for profitable resale.

Tramadol has appeared in the United States in both imported pill form and made into counterfeit drugs.  In 2012, The FDA warned that fake Adderall was being offered for sale in the United States, but that the pills were actually the banned opioid, tramadol.  In 2017, in an Illinois case, a resident of Champlain was charged with illegally importing tramadol and using an imported encapsulating machine to produce pills from it. In New Hampshire, a couple conspired with a partner in India to smuggle over 100,000 tramadol pills into the United States.

Illicit tramadol has also been found in Arizona, Louisiana, and Georgia.