Munim Youssef entered a pharmacy in Misrata, 200 kilometers east of Tripoli, holding a prescription and a few moments later, casually walked out with the banned analgesic Tramadol.

Munim, a 43-year-old father of seven children, is like many former rebels who sustained neurological injuries during liberation battles and whose doctors prescribed Tramadol for the treatment of their pain— even though medical research suggests that it has dangerous long-term side effects, such as renal failure, osteoporosis, and destroyed nervous system.

Munim Youssef entered a pharmacy in Misrata, 200 kilometers east of Tripoli, holding a prescription and a few moments later, casually walked out with the banned analgesic Tramadol.

Munim, a 43-year-old father of seven children, is like many former rebels who sustained neurological injuries during liberation battles and whose doctors prescribed Tramadol for the treatment of their pain— even though medical research suggests that it has dangerous long-term side effects, such as renal failure, osteoporosis, and destroyed nervous system.

“I was hit by the shrapnel of a tank shell during one of the liberation battles, causing the amputation of part of the bone of my left leg and loss of vision in my left eye,” Munim said.

Following a doctor’s advice, Munim frequented pharmacies, holding a prescription that allowed him to obtain the drug publically; he became addicted shortly thereafter.

Addiction and moaning

Munim said he received Tramadol for the first time in a Tunisian hospital where he was sent by the Misrata medical committee, accompanied by tens of casualties on board of a fishing boat. There, a Tunisian doctor told him that the only drug that would treat him physically and psychologically was Tramadol. So, he received it via intramuscular and intravenous injections. If it had not been for another Tunisian doctor who intervened at the last minute, Munim’s leg would have been amputated. That doctor performed 21 surgical interventions, cleaning operations and plastic surgeries on Munim.

Munim however complained of what he called a “compulsory addiction to Tramadol” and psychological effects that got worse when the medicine’s effect ended. “I feel pain three times: my sickness, when I take Tramadol, and when its effect as an analgesic ends,” Munim said.

“My frame of mind gets worse, (when it ends). Once, I broke the windows in my house and crashed my car through the fence. If I had had a bomb then, I would have blown it up.” He said taking other painkillers proved to be useless.

Guinea pigs

Munim’s conditions prompted him to approach officials but said: “They are now using us as guinea pigs.”

He also approached the committee concerned with the affairs of the wounded, asking them to send him to an advanced country for treatment, but to no avail. “They find it cheaper to send us to undeveloped countries,” he added.

Apart from what he described as negligence by the government and its ministries, he pointed to voluntary efforts exerted by psychiatrists in order to follow-up on cases like his, where they provided advice and consulted them on negative post-revolution developments.

Increased demand and rock-bottom prices

Muhammad Ali, a pharmacist in Misrata, said he observed an increased demand for Tramadol, unlike the situation before the revolution, when it was only bought by some young Libyan addicts and Egyptian workers.

“Tramadol has become cheap and it is now dispensed by some pharmacies without controls and at very low prices. With three dollars, one can buy ten tablets,” according to Ali.

Several cases frequented his pharmacy, but most of them were addicts. “I treat them all the same and request that they provide a prescription signed by a doctor. Many asked me to give them the medicine to use it for other purposes, but I turned them down,” he explained.

He showed great concern regarding those who were addicted to Tramadol, especially the wounded like Munim, who were afflicted with neurological injuries and only had alternatives to Tramadol that were less effective sedatives.

Negligent pharmacies

Head of the Misrata Branch of the Public Authority for the Combat of Narcotic Drugs and Psychotropic Substances, Colonel Muhammad Abu Zaiyan, said, “Tramadol is an evil that has been exported to Libya; it damages brain cells.”

Abu Zaiyan believed that pain was better than addiction. “Whatever the injury is, I advise not to take it because it will damage the brain cells of addicts,” he explained.

He stressed that his authority had shut down three pharmacies under what he called “a campaign to control negligent pharmacies that dispense narcotics without requesting a prescription signed or sealed by a doctor,” adding that it had already issued a statement to warn against such acts.

Abu Zaiyan accused pharmacies of dispensing Tramadol unconditionally, underlying that senior members of the city society frequented pharmacies to get it, and suggesting that it was their sickness that forced them to do so.

“The solution is in the hands of the Ministry of Health. If it had specific controlled distribution channels, narcotics would have never spread like this.”