THE little pills of Tramadol are ubiquitous in Egypt. Taxi drivers take them to stay awake on the road. Men use them to improve their sexual prowess. Petty officials readily accept them as a bribe. And wedding guests even receive them as token gifts. Tramadol has become Egypt’s favourite recreational drug, supplanting heroin and cannabis.

An opioid prescribed as a painkiller, Tramadol has a reputation for improving alertness and male sexual stamina—qualities much sought after in a country where people often have several jobs to make ends meet and where few women find it easy to experience orgasm because of widespread female genital mutilation. “It just makes you feel relaxed. Even if there are two men fighting to the death beside you, you wouldn’t care,” explains Taha, a bank teller, as he buys pills from a pharmacist willing to turn a blind eye. He says the drugs help him at work.

...

Until recently, Tramadol was selling for one or two Egyptian pounds a pill ($0.15-$0.3). It offers an affordable buzz in a country where average household income is less than $4,000 a year. “There is no social stigma attached to Tramadol,” says Hisham Mamdouh, who heads a Cairo rehabilitation centre. At least 40% of those attending his clinic are addicted to the pills. Among them is Ibrahim, a socially awkward 17-year-old schoolboy. As a child, he took just half a tablet. “I found myself feeling unusually outgoing and positive,” he says. Ten years on, he was ingesting a whole sheet of ten tablets a day and even then the effects quickly wore off. The symptoms of overuse include dizziness, shivers (many suffer these), headaches, difficulty sleeping, nausea and seizures.


...


Egypt is a transit point for pharmaceuticals shipped to nearby countries. Customs inspections under President Abdel-Fattah al-Sisi have recently been tightened. In 2013 the government seized 35m pills which, it said, had been smuggled in. Pharmacists caught dealing on the side in theory face long prison sentences. The price of Tramadol has risen sharply, at one point reaching $1-$3 a pill. “Since then we have seen a flood of people seeking help,” says Mr Kharrat.

...