Thousands of young men in Gaza are becoming addicted to a prescription painkiller used to alleviate the stress of living in the besieged Palestinian territory. Students, labourers and even professionals are buying large quantities of tramadol, a synthetic opioid painkiller similar to morphine, although milder, on the black market.
Besieged and stressed Gazans fall victim to black market painkiller
Thousands of young men now addicted, says doctor Crisis blamed on tensions created by Israeli blockade
Toni O'Loughlin in Jerusalem
There are no exact figures, but one researcher estimates that up to 30% of males between 14 and 30 use it regularly, and that as many as 15,000 are addicted.
"Every day I see them with symptoms of withdrawal from this drug," said Dr Mahoud Khozendar, of Shifa hospital in Gaza city. "Dozens come to emergency telling me that they are suffering vomiting, drowsiness and lack of concentration."
Professor Mazen al-Sakka, a pharmacologist at Gaza's al-Azhar university who researched the epidemic, said the problem mushroomed after Israel blockaded the tiny coastal territory in June last year.
The siege was intended to break Hamas, but instead the Islamists have strengthened their grip. Yesterday, 150,000 loyalists marched in the streets, waving green flags in celebration of Hamas's 21st anniversary. The movement's political leader in Damascus, Khaled Meshaal, also cast doubt over the prospect of the six-month truce with Israel being renewed when it expires at the end of this week.
But while Hamas has used its superior force to disarm rival militias and control arms smuggling through the massive network of tunnels to Egypt in the south, it has been unable to stop the booming illicit trade in tramadol.
The drug is so widely available that one tablet costs as little as one shekel (17p), much cheaper than via the internet.
"A maximum of 5% of users are buying it with a prescription," said Sakka, who was alerted to the scale of the problem by his students after he delivered a lecture about the potential dangers of the drug. He said he was particularly alarmed when he heard professionals such as surgeons say they needed the drug to concentrate. Students also use it, he said. In the short term, the drug improves concentration and promotes a feeling of well being.
Khozendar said the stress of working in the smuggling tunnels, where dozens are killed each month, was also driving demand for the drug. "Each tunnel has about 40 labourers, so we are talking about 4,000 to 6,000 people working underground. It's very hard work and tramadol moves the mood of these people. It gives them some leisure and it removes their fear."
Another reason is that the drug helps sexual performance, which often deteriorates under stress.
In Gaza where electricity, water or sewage services are often cut for up to 16 hours a day and where unemployment stands at 50%, thousands of men spend the day chatting in the streets or cafes, unable to help their families. Even those lucky enough to still have a job feel the pressure, as each breadwinner supports an average of seven people on a salary of about 58 shekels a day, according to the UN.
"It's a way of avoiding or escaping the political situation - the unemployment, the closure. It's a huge source of stress," said Dr Taysir Diab, a psychiatrist at the Gaza Community Mental Health Programme.
Rats like tramadol
Tramadol and analgesia
Tramadol and acute pain
Tramadol versus venlafaxine
The Pain Survival Guide (pdf)
Tramadol as an antidepressant
Tramadol: risk/benefit analysis
Tramadol versus buprenorphine
Depression, opioids and the HPA
Pharmacokinetics and pharmacodynamics
Morphine: a mood-brightening smart-drug?
Tramadil and TRPV1, "the capsaicin receptor"
Tramadol, depression and Parkinson's disease
and further reading
The Abolitionist Project
The Hedonistic Imperative
MDMA: Utopian Pharmacology
When Is It Best to Take Crack Cocaine?