The Other, Other Opioid Crisis: Tramadol in West Africa

Editor’s Note: Today’s post comes from contributing editor Dr. David A. Guba, Jr., of Bard Early College in Baltimore. 

For the past twenty years, a steady rise in opioid addiction and overdose rates across the U.S. has led to a “public health emergency,” declared by Donald Trump in October of 2017.[1] In 2017 alone, over 70,000 Americans died as a result of drug overdose, and 47,600, or 68%, of those fatal overdoses involved illicit and prescription opioids.[2] This means that opioids, whether in the form of illegal heroin or prescription pills such as OxyContin, killed more people in 2017 than car accidents (40,100) and gun violence (39,773). According to data compiled by the Kaiser Family Foundation, 37,113 of the 47,600 opioid-related deaths that year, or 78%, were of “White, non-Hispanic” people.[3] Particularly hard hit by the epidemic were the Rust Belt of the Ohio River Valley and mostly-white suburbs of Florida, New York, Pennsylvania, North Carolina, Michigan, and Massachusetts.

While the label “public health emergency” is apt given these statistics, the current media obsession with the “white prescription opioid cum heroin user”—epitomized in Chris Christies oft-repeated anecdote about his college buddy who was a “great looking guy, well-educated, great career, plenty of money, beautiful, loving wife, beautiful children, great house, and had everything” but then tragically succumbed to prescription opioid addiction after a back injury—is both unhealthy and unethical.[4] As Solomon Jones, a journalist with the Philadelphia Inquirer, recently argued, perceptions of drug addiction in America have become so “gentrified,” that what once “was primarily a black and brown problem” of morals “has been rebranded by whiter and richer” Americans as a public health crisis affecting good, white citizens deemed victims.[5]

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Addiction in African Literature

“Where is my African counterpart?” asks MaryKarr.

Where are the African tales of personal struggles with alcoholism and drug addiction?  I’ve been studying the history of alcohol use in Africa for more than twenty-five years and more recently I’ve also been looking at drug use.  Yet I can’t recall a single such story in my unsystematic sampling of African creative writing.  Here in the United States, hardly a week goes by, it seems, without publication of a memoir or fictional account (or public celebrity testimony) of the individual torments and collateral damage associated with alcohol and drug abuse and the redemption (and royalties) found in sobriety.  Why don’t we have an African Mary Karr? Why aren’t African writers cashing in?

Are Africans simply more abstemious?  This is hardly the case. Scholars have amply documented African drinking practices.  The history of drug use is much less studied, but in the recent past at least illicit drug use has become ubiquitous in many African societies.  And the fact is that African fiction and autobiography are awash in alcohol—and increasingly provide rich accounts of local drug cultures as well.  But the addiction story is mostly missing.  Why is that? Continue reading →

In Search of the Drunken Native

In a March 3, 2012 New York Times article, “At Tribe’s Door, a Hub of Beer and Heartache,” reporter Timothy Williams provides yet another account of the terrible consequences associated with alcohol consumption among native Americans.  This article, which of course joins many others on the same topic, touches on a number of familiar points, in particular the assumed collective susceptibility of Native Americans to alcohol and their vulnerability to the agents of capitalism.

Whiteclay, Nebraska is a ramshackle hamlet on the border not only of South Dakota but of the Pine Ridge Indian Reservation—which has banned alcohol since the 1970s. There, a small number of  white beer store owners sell annually almost five million cans of beer and malt liquor—almost all to members of the Oglala Sioux tribe.

Whiteclay, NE
Pop: 14; Annual revenues from alcohol sales: $3 million

These are the latest version of the unscrupulous white traders who have populated the narratives of Native American drinking since the seventeenth century.  In this case, they offer to cash income tax checks for a 3 percent commission and selling 30 packs of Bud for a price higher than that charged in New York City and more than twice the going price in most of the country.  In this account the ravages of alcohol consumption involve virtually every family.  “As an indication of the depth of the problem,” the Times notes that even a tribal vice president, a leader in the fight to restrict alcohol sales in Whiteclay, was recently arrested on alcohol-related charges.  In 2011 tribal police made 20,000 alcohol-related arrests in a reservation with an apparently undifferentiated population of 45,000.

The article reminds us that this is not just a problem for the Oglala Sioux, but for Native Americans generally.  Without an explanation for the leap to a national/racial scope, we’re reminded that about one third of U.S. reservations ban alcohol and that “excessive alcohol consumption is the leading cause of preventable death among American Indians.”  And in fact the threat of extinction lurks in this article as it has in accounts of native drinking for four centuries.  As one tribal police captain notes, “not to disrespect our elders and ancestors, but we’ve gone through several generations.”

When It's Time to Lose Command over Yourself

In his famous 1802 testimony to Thomas Jefferson, Chief Little Turtle told the President, “your children have not that command over themselves which you have, therefore, before anything can be done to advantage, this evil must be remedied.”And so the Oglala Sioux, implicitly recognizing that they “have not that command over themselves,” have gone to court to lay blame for their affliction not only on the beer stores in Whiteclay but  the Anheuser-Busch company that produces the high-alcohol Hurricane High Gravity Lager that is the current drink of choice in Pine Ridge. The purpose of this post is not to dismiss or intellectualize away the enormous problems linked to alcohol in many of the nation’s Native American communities, but to invite discussion about  the remarkably persistent and pervasive mythology of the drunken native and of the more general susceptibility of aboriginal (or “indigenous”) people to alcohol.  Continue reading →

African Perspectives on Pharmaceuticals and Drugs

Fann-Hock Pharmacy, Dakar

In a panel on “Drugs in Africa” at the African Studies Association annual meeting in Washington, DC in November, Donna Patterson, a historian in the Department of Africana Studies at Wellesley College, presented a paper on “Drug Trafficking in Africa:  Historical Cases from West Africa,” which in contrast to other papers on the panel looked at the commerce in legal pharmaceuticals.  The discussion that followed made clear the value of exploring the histories “legal” and “illegal” drugs in conjunction one with the other—something that has rarely been done for Africa, where the focus has been much more on understanding the linkages between “traditional” and Western medicine.  At the same time, the discussion led us to consider how those very linkages might inform our understanding of the trade and consumption of various kinds of drugs—however categorized—in African societies.

Patterson specializes on Francophone Africa, African-Atlantic exchange, health, and gender and is working on a larger project, “Expanding Professional Horizons:  Pharmacy, Gender, and Entrepreneurship in Twentieth Century Senegal,” that  examines the emergence and expansion of African medical professionalization between 1918 and 2000.  That work explores the growth of the African biomedical industry, African access to French systems, and the training of doctors, pharmacists, and midwives. Continue reading →

Herding Khat

Side Effects May Include Lethargy and Refusal to Cooperate

On January 11th the  BBC reported that the Netherlands government would ban the use of khat—the mild, leaf-based stimulant produced largely in East Africa.  The ban came as something as a surprise, given the liberal Dutch approach to cannabis and the ubiquity of “Coffee Shops” selling joints in Amsterdam and other Dutch cities.  Why this apparent inconsistency?  The answer becomes clear in the comments of the immigration minister, Gerd Leers, who oddly enough, announced the ban.  According to Leers’s comments on Dutch radio, “I’m involved in the ban because it appears to cause serious problems, particularly in the Somali community.”  He went on to claim that 10% of Somali men in the Netherlands were “badly affected” by khat consumption.  According to the minister, “they are lethargic and refuse to co-operate with the government or take responsibility for themselves or their families.”

Khat (often called miraa in East Africa) is the only Africa-produced drug to develop any kind of international market.  It is chewed on a large scale in Ethiopia, Somalia and elsewhere in East Africa, where truck drivers use it to remain alert.  I first encountered it in the 1970s, when I was briefly stranded on the Kenya-Tanzania border and some friendly drivers tutored me in its use.  I can’t say that it did much for me, except keep me awake enough to snag a ride to Nairobi.  Continue reading →

Johnnie Carson on “African (Drug) Issues”

Heeere's Johnnie!

In a recent talk on “African Issues” and US policy on those issues, Assistant Secretary of State for African Affairs, Ambassador Johnnie Carson, chose to conclude by stressing the growing challenge of drug trafficking in Africa.  Having discussed democratization, having covered all of the regional hot spots and having emphasized hot-button topics such as HIV AIDS, malaria, and lagging agricultural production, Carson turned his attention to a topic that he reminded his audience would not have been included on his list of “African problems” a decade or even five years ago.  Addressing a large audience at the African Studies Association meeting in Washington in mid-November, Carson, who has had a long career at State and was formerly Ambassador to Kenya, Zimbabwe and Uganda, reminded fellow Africanists that a claimed 40% of illicit drugs interdicted in Europe had passed through West Africa.  What is a major issue for Europe and the USA must therefore become a major issue for Africa.

"Africa Confidential," UNODC

All of the focus on Guinea Bissau as the first African narcostate (a topic that I addressed in an earlier blog post) has tended to distract us—according to Carson—from a much broader and growing pattern of drug trafficking throughout Africa.  Although Guinea Bissau may provide a dramatic tale of high level politicians in the thrall of global drug lords gunning each other down in the ramshackle capital of a marginal state, the drug trade routes run through virtually every West African country and certainly through Sénégal, Côte d’Ivoire, Ghana and especially Nigeria—which has been a nexus of trafficking and drug gangs that spread across five continents through networks that reach across the Indian Ocean as well as the Atlantic.  Unsurprisingly, Carson made the case for US official support for efforts in African countries to combat the trade.  Again unsurprisingly, he talked exclusively about the need to provide moral, material and training support to the USA’s African allies in a global war on drugs. Continue reading →

Alcoholism, Race, and Decolonization

In the June 1958 issue of the Nchanga Drum, Dominico Chansa, a social welfare worker on the Northern Rhodesian (Zambian) Copperbelt, asked readers the question, “Is Beer Drinking a Good or Bad Habit?”

Zambia and the Copperbelt

 The author claimed that there was “no subject on the Copperbelt today which draws more heated debate”—a surprising yet surprisingly accurate assertion.  Surprising because this was a period of rapid and sometimes violent political change that would culminate in Zambia’s independence from Britain in 1964, and the question of who would rule was by no means settled.  Surprisingly accurate, because the local press and official and corporate records are filled with discussion and debate over alcohol use and regulation (Zambia’s reputation would make it one of the case studies in the well-known WHO cross cultural study of alcohol use from the 1970s).  Writers on this blog have focused a great deal recently on addiction and disease models—to stimulating effect.  Yet I have been struck with just how Eurocentric these debates appear to be.  Today’s post updates Mr. Chansa’s question, asking “was beer drinking a habit in colonial Zambia?” Continue reading →