In the corners of dimly lit nightclubs, behind the closed doors of roadside pharmacies, and inside private homes and ghettos across Sierra Leone, a silent epidemic is taking root- one driven not only by addiction, but also by cultural expectations and dangerous misconceptions about sex and masculinity.
At the heart of this crisis is Tramadol, a synthetic opioid originally intended for pain relief. Today, it is widely misused by young men hoping to “last longer” during sex.
“Tramadol makes you feel like a lion,” Mohamed Kabia, an addict who began using it at age 22. “You can go for an hour or more. The girls respect that.”
In a society where open discussion about sexual health is rare and often considered taboo, misinformation thrives. Sexual performance is frequently seen as a symbol of power, respect, and masculinity. This intense pressure drives many young men to experiment with substances like Tramadol, believing it enhances their prowess. Often taken with energy drinks or alcohol, the drug numbs the body, delays ejaculation, and creates a dangerous illusion of stamina. But behind this temporary high, the consequences are devastating.
“We’re seeing men in their twenties with kidney and liver damage- issues normally seen in much older patients,” Dr. Alusine Mansaray of Connaught Hospital revealed, attributing it to prolonged Tramadol misuse. “The longer they use opioid, the more damage is done.”
Making matters worse is the glorification of Tramadol use in popular culture. Some songs played in clubs and parties openly romanticize the drug, celebrating its effects and embedding it even deeper into youth behavior. Unlike kush – the highly visible synthetic drug often associated with the unemployed or street life- Tramadol abuse cuts across economic and social lines. It’s not just in ghettos. Students, civil servants, and even professionals in leadership positions are among its users.
“Tramadol is the silent killer,” Dr. Alimamy Koroma, a pharmacist based in Freetown stated. “It’s in our schools, offices, and even within government.” He added that “Kush may be a more obvious and dangerous killer of our youths, but Tramadol is even more so — precisely because it hides in plain sight.”
Despite its deadly impact, there are still no specific figures available for tramadol-related deaths or overdose cases in 2025. Quantitative data linked solely to tramadol remains lacking, as broader trends—such as kush-related deaths—continue to dominate public reporting. These reports often fail to isolate tramadol’s role, leaving a significant gap in understanding the true scale of its harm.
Although Tramadol is officially listed as a controlled substance in Sierra Leone, enforcement remains weak. Pharmacies continue to sell it under the counter, and black-market vendors operate freely in both rural and urban areas.
More troubling, multiple community members alleged that some police officers are part of the problem. “After the raids, the same officers go back to ghettos and sell the Tramadol they seized,” a ghetto youth leader in eastern Freetown claimed. “It’s like business for them- arrest, seize, then resell. Nothing changes.”
A senior health official at the Ministry of Health, speaking anonymously, acknowledged that enforcement is politically sensitive: “We have laws, but they’re not being enforced. And when respected professionals or police are involved, no one wants to push too hard.”
Dr. James Komeh, Registrar of the Pharmacy Board of Sierra Leone, recently issued a stern warning to all pharmacies across the country, cautioning against the illegal stocking of Class A, B, and other controlled substances in patent medicine shops. He made it clear that licenses will be revoked if pharmacies are found in breach of the law.
Echoing that stance, Dr. Joy Bernadette Johnson, head of the Enforcement and Narcotic Control Department, warned that no professional or pharmaceutical outlet will be spared if found stocking restricted medicines in violation of national regulations. “The law is clear, and the consequences will be enforced,” she said.
Meanwhile, neighboring Liberia took a bold step in August 2025 by placing a national moratorium on Tramadol and Shisha, banning distribution outside of strict medical use. Sierra Leone has taken some measures, though the impact remains limited.
In April 2024, President Julius Maada Bio declared a national emergency on kush- a mixture that often includes Tramadol- and launched a five-step strategy focused on prevention, rehabilitation, and law enforcement. By July 2024, the Transnational Organised Crime Unit (TOCU) had destroyed over $1 million worth of illicit drugs, including 4,200 kilograms of Tramadol. And in June 2025, an intelligence-led raid in Tokeh uncovered more than 16 gross of the drug, signaling growing efforts to disrupt trafficking networks.
Despite these actions, structural challenges persist. The Pharmacy Board still operates under outdated regulatory frameworks, making it difficult to prosecute offenders. Fines are minimal, and many illegal vendors are able to avoid meaningful punishment.
Tragically, many users don’t realize they’re addicted until it’s too late. Withdrawal symptoms are intense – including restlessness, insomnia, aggression, and depression.
“I started with one pill,” Lamin Sesay said. “Then I needed two. Then I couldn’t sleep or eat without it.”
Public health advocates argue that this is more than just a drug crisis — it’s a cultural reckoning.
“We’re not just fighting a drug — we’re fighting shame, silence, and a toxic idea of manhood,” Fatmata Jalloh, a public health advocate pointed out. “Tramadol won’t make you more of a man. It will kill you.”
