Frictions in drug control: prescription opioids, prohibition and consumption cultures in Africa
The misuse of prescription opioids, though a global public health and social policy issue, is framed in different ways in different parts of the world. In North America, the problem is framed around the significantly large number of deaths from a Fentanyl overdose (UNODC, 2021a). In Africa, moral panics have resulted from media reports of social and health harms associated with the non-medical use of tramadol, codeine and other opioid analgesics. These moral panics have generated “governing images” of deviance and disease around consumption of the drug, resulting in stricter controls on their availability and prescribing in many countries on the continent. In addition to bolstering and extending drug prohibition across the continent, these images have also stimulated calls by some countries (e.g. Nigeria and Egypt) for the scheduling of Tramadol under relevant international conventions. These developments have transpired despite the fact that opioid dispensing is low in the continent, and further restrictions on supply have potential to exacerbate barriers to essential medicine for pain management (Knaul et al., 2018; Nelson, 2021). As with the traditional illegal drugs (heroin, cocaine and cannabis), prohibition of so called “non-medical use” of prescription opioids (particularly Tramadol) has not resulted in reduction in consumption. Instead, it has enabled informal markets in substandard products that include clones of registered opioid analgesics (UNODC, 2021b). Bulk of the products sold in informal markets are falsified and counterfeit medications with much higher potency that increase the risk of health harms (Klein, Patwardhan, & Loglo, 2019). It has also given rise to diverse cultures of consumption around these substances that reflects their health, social and enhancement benefits for different groups. These developments highlight the frictions that often occurs when a global force such as prohibition collides with local worlds. “Friction” has been used by Anna Tsing to describe the creative tension that results when universalizing forces (in this case, prohibition) and local particularities (local drug markets and consumption practices) collide, and how they could generate new social forms in the process (Tsing, 2005). In the African context, the global force that is drug prohibition has generated both traction and resistance in the course of its encounter with realities on the continent. It has generated traction by strengthening prohibition, including restrictions on essential medications. On the other hand, it has produced resistance by stimulating channels of supply and cultures of consumption that resist state control. The friction between the logic of prohibition (reducing non-medical use) and local consumption cultures (shaped by the social and health benefits of these substances for diverse groups) deserves scholarly interrogations, not only because of the paucity of research on this subject in the continent but also because of its policy salience (e.g. improving access to essential medicines, guaranteeing right to health). For this special issue, we seek theoretically-informed studies that explore and contextualize cultures of prescription opioids consumption in Africa as complex outcomes of the friction generated by prohibition-based policies. This includes (but is not limited to) studies that:
- Analyse prescription opioids consumption as practices of health management and self-care, and show how such practices intersect with the notion of non-medical use that underlies prohibition.
- Situate prescription opioids use within the context of social marginalization and barriers to healthcare services (including pain management), focusing on marginalized populations such as sex workers and people who use drugs.
- Explore frictions between prescription opioids consumption for human enhancement and the prohibition logic that conflates non-medical use with harms.
- Interrogate state responses to non-medical use of prescription opioids, including drug market enforcements, and diverse forms of regulatory accommodation, hybridization and quasi-legality.
- Explore gender dynamics, including trends toward feminization of prescription opioid misuse, and how gendered occupational cultures (e.g. sex work, manual labour) shape the social meanings and practices of prescription opioid consumption.
- Explore prescription opioids consumption in diverse youth populations, including the affective underpinnings and social contexts of use, and how they intersect with images of deviance, criminality and addiction that undergird prohibition.
The abstracts (not more than 250 words) should be e-mailed to [email protected] and [email protected]. The e-mail subject should read “DH&SP: Special Issue – Prescription Opioids”. Deadline for submission of abstracts is May 31, 2022. Authors will be notified of abstract acceptance by June 24, 2022. If accepted, the full manuscript will be due on November 30, 2022. Submissions will undergo the standard DH&SP peer review process. All accepted papers will be published on Earlycite immediately after acceptance. The special issue is to be published in June 2023.
Klein, A., Patwardhan, S., & Loglo, M. G. A. (2020). Divergences and commonalities between the US opioid crisis and prescription medicine mis/use in West Africa. International Journal of Drug Policy, 76, 102640.
Knaul, F. M., Bhadelia, A., Rodriguez, N. M., Arreola-Ornelas, H., & Zimmermann, C. (2018). The Lancet Commission on Palliative Care and Pain Relief—findings, recommendations, and future directions. The Lancet Global Health, 6, S5-S6.
Nelson, E. U. E. (2021). Structural violence and barriers to pain management during an opioid crisis: accounts of women who use drugs in Nigeria. Health Sociology Review, https://doi.org/10.1080/14461242.2021.1950024
Tsing, A. L. (2005). Friction: An ethnography of global connection. Oxford: Princeton University Press.
United Nations Office on Drugs and Crime (2019). Drug use in Nigeria 2018. Vienna: UNODC.
United Nations Office on Drugs and Crime (2021a). World drug report 2021. Vienna: UNODC.
United Nations Office on Drugs and Crime (2021b). At the cross roads of licit and illicit: Tramadol and other pharmaceutical opioids trafficking in West Africa. Abuja: UNODC
 The 2021 World Drug Report of the United Nations Office on Drugs and Crime (UNODC) estimated a fourfold increase in past year prevalence of opioid use in Africa between 2010 and 2019.