320 Million Pills and Where They Went

Indian pharmaceutical companies have shipped over 320 million tapentadol pills — a synthetic opioid not approved by regulators in most of West Africa — to the region over a three-year period, a joint investigation by Bellingcat and Indian outlet Newslaundry has found. Trade records from data provider 52wmb show more than 1,400 consignments worth nearly USD $130 million were exported between January 2023 and December 2025.

Over 80 percent of the total shipment value listed Sierra Leone and Ghana as declared destinations. Where dosages were recorded, more than half the pills exceeded 200mg — strengths not even approved within India itself.

Why This Matters

Tapentadol is two to three times more potent than tramadol, another widely trafficked synthetic opioid. West Africa is already grappling with an escalating opioid crisis. Sierra Leone's President Julius Maada Bio declared a national emergency in 2024 over the spread of 'kush' — a toxic blend of cannabis and synthetic opioids described as a 'death trap.'

The combination of high-potency, unapproved dosages and a region already in crisis makes this supply chain a major public health threat.

A Recurring Pattern Since 2018

This is not the first time international drug control systems have been outpaced by traffickers. When India tightened export controls on tramadol in 2018, the International Narcotics Control Board (INCB) warned in 2021 that traffickers could shift to tapentadol and other synthetic opioids. That warning has proven prescient.

Export values of tapentadol to West Africa rose from approximately $27 million between 2020 and 2022, to nearly $130 million between 2023 and 2025 — a roughly five-fold increase. A BBC investigation revealed Indian firm Aveo Pharmaceuticals had been illegally exporting tapentadol-carisoprodol combination tablets, prompting India's drug regulator CDSCO to ban such combinations. Yet this investigation shows that single-ingredient tapentadol exports have surged regardless.

Outlook [Expert Analysis]

Experts suggest India will likely need to move beyond blanket bans and link export licensing to receiving countries' regulatory approval status. Without binding bilateral agreements between India and West African nations, analysts say the 'painkiller pipeline' is likely to continue — simply under a different drug name. Demand-side interventions in West Africa, including addiction treatment infrastructure, are seen as essential complements to supply-side enforcement.