Getting opioids off the streets of west Africa

Hey there,

This is a newsletter that’s all about stories sparking change in the world. But did you know that this newsletter has itself sparked a story?

A little over a year ago, my colleague Paul was helping me interview Professor Marya Lieberman for an edition of The Spark. I wanted to ask Marya about how an investigation by TBIJ into useless childhood cancer drugs had inspired her to start developing inexpensive tests to detect the dodgy medicines.

Speaking from her lab in Indiana, she poignantly described the sheer injustice of people who are seriously ill receiving bad medicines. It was an early edition, so if you’re a newer reader, I really recommend checking it out.

As the interview drew to a close, she mentioned she was working on something else that might be of interest. Her team was testing hundreds of samples of common cancer drugs gathered from different countries. Some had failed – and in some cases by quite a margin.

As she spoke, Paul took a breath to steady himself. These were medicines that millions of people depend on every year to treat breast cancer, ovarian cancer and leukaemia, among other cancers. People close to him had been treated with the types of drugs Marya listed.

And so, what started as a quick interview for this newsletter sparked months of investigating for Paul and his teammate Andjela – tracking the spread of the failed drugs to more than 100 countries, speaking to doctors and patients about the life-threatening risks they posed, and looking at why the safety nets that should protect people were failing.

Almost all of the companies making the drugs featured in the investigation were based in India. The country is known as the world’s pharmacy thanks to the huge amount of medicines made there. A lot of those drugs are very good. But there have been high profile and tragic scandals in recent years – and with them accusations that the Indian government is reluctant to take action against bad actors in an industry estimated to be worth $28bn a year in global exports.

Forcing those in power to take notice and take action is what good accountability journalism is for. And that’s exactly what the BBC Eye Investigations team has done with its documentary India’s Opioid Kings.

First aired in February, the film documents the devastating spread of opioid addiction across west Africa. It exposed the companies exploiting the addictive power of these drugs, and the grip they have on the lives of millions.

In Tamale, Ghana, so many young people are taking illegal opioids that one of the city’s chiefs, Alhassan Maham, has created a voluntary task force to tackle the problem. “The drugs consume the sanity of those who abuse them,” Alhassan told the filmmakers, “like a fire burns when kerosene is poured on it.”

BBC reporters followed Alhassan’s task force on a raid. Men in collared shirts and football kits charge down back streets in pursuit of local dealers. Moments later they return with fistfulls of shiny silver blister packs loaded with emerald pills. Later, they’ll burn the drugs – but not before the reporters look at the packaging.

There’s a lot a blister pack can tell you. The packs seized in the raid all have “Made in India” emblazoned across the back, alongside an ‘A’ logo. It stands for Aveo Pharmaceuticals, an Indian drug company. The BBC found Aveo’s medical opioids on the streets in Nigeria and Cote D’Ivoire, as well as Ghana. The drugs go under different brand names and are packaged to look like legitimate medicines. But all contain the same harmful mix of ingredients: tapentadol, a powerful opioid, and carisoprodol, a muscle relaxant so addictive it’s banned in Europe.

“It sounds like a very dangerous combination,” Dr Lekhansh Shukla, an addiction specialist, told a reporter. “I cannot understand why one would make this.”

The BBC’s team tracked the manufacture of the pills to a factory two hours outside of Mumbai. There, they posed undercover as buyers looking to purchase drugs to distribute in Nigeria. They were taken on a tour of a pristine factory and then met one company’s directors, Vinod Sharma.

Vinod is the picture of a successful businessman. A well-groomed man in a bright blue suit, the hidden camera caught him leaning back in his chair, his huge watch catching the light as he spread piles of opioid products over the table in front of him. The packaging was the same as those the reporters found across west Africa.

The BBC’s undercover reporter outlined to Vinod a bogus plan to sell the drugs to young people in Nigeria. Vinod didn’t bat an eye. Instead he talked nonchalantly about bypassing regulators and of how the people who misuse his company’s products have no idea just how harmful they are. “This is business,” he shrugged, as an assistant moved the piles of slickly marketed opioids to one side to make space for bowls of pistachios, cashews and freshly cut fruit.

Or rather, it was business for Aveo.

Just days after BBC Eye’s documentary was released, India’s drugs regulator announced that Aveo Pharmaceuticals had been ordered to stop production. A team of investigators had audited Aveo’s premises and all raw materials, medicines in production, and finished products were seized.

But that wasn’t all. Keep reading to hear from Surabhi Tandon, one of the BBC’s reporting team, about what happened next.

“This is the crisis of our times. All over the world, we have seen what prescription opioids have done to unsuspecting people, making them addicts before they even realise what's going on. In west Africa, we found that such drugs were making their way into countries in huge numbers by finding small loopholes in the system.

For example, Nigeria had a huge Tramadol [a type of opioid] crisis in 2018 and banned the import of certain formulations of Tramadol. So very quickly, what you see happen is Tramadol changes to Tapentadol. The composition slightly changes. The packaging remains more or less the same, because that’s what addicts and users recognise, and it floods the market very quickly before the government can respond. These small tricks have made it very difficult for governments to clamp down on illegitimate prescription opioids.

What I think really surprised me is how companies [like Aveo] have all the legitimate certification for manufacture and exports to do what they do – they have a business as a front and then undertake all of these other kinds of illegal activities. It’s always worrying when people learn how to game a system that has been put in place to help people and make processes more transparent and accountable.

~ Lucy here! Proving how Aveo had done this was the most difficult part – not least because it meant marching into territory known to be risky for journalists ~

With increased government intervention, journalism in India has seen a severe loss of freedom in the last decade – making any investigation even more difficult and risky. So within that kind of environment, reporting on any industry is a big risk. And whenever you take on something that involves the government and a big industry, that risk is just double fold.

The extra layer to this in India specifically is that the pharmaceutical industry is something that we are extremely proud of. When I was younger, Indian news was full of headlines about India fighting Big Pharma companies at the WTO on intellectual property rights. We did not back down and we stood for the right of our nation to make life-saving generic drugs [cheap versions of drugs made off-patent] to help the vast population of developing countries. We have, in one sense, always been seen as the hero in this industry. So to say to anyone in India that this industry now has bad players is always a hard task – often met with denial.

~ If you want to know more about the history of drugs manufacture in India and its role in the global drugs market, TBIJ has a helpful explainer ~

Prior to the release of the film, as is protocol, the BBC sent out right of replies to all the parties involved in our investigation. While Aveo chose not to respond, we did get a call from the Indian government, who asked for all details of what the film would say prior to its release. Of course, the BBC did not share that, but it made all of us really nervous about how the government would react to our film.

Fortunately, it looks like there are some good people at the helm of the CDSCO [India’s drugs regulator] at the moment. They saw the film and the sort of evidence that we were presenting and they were actually very quick in taking action. When that happens, it's always a reminder of why you do what you do – despite the risks and the sleepless nights that all of this work causes you!

Along with the CDSCO shutting down the manufacturing unit of that company, the Drugs Controller General of India put a blanket ban on Tafrodol [the drug at the heart of the investigation] itself. So any other company making this combination pill could no longer export it.

This means that we were able to make an impact, not just in catching ‘the bad guys’, as one would say, but also in having this dubious prescription opioid banned altogether. So that’s at least one less drug that these countries have to deal with.”

Chronic pain and cancer; many of us have to, or could struggle with these in our lifetimes. And we take medication to treat them in the good faith that they will work and that they are safe to use. But sometimes it takes a team of experts and journalists to crack open the secrets behind these drugs.

The ban on Tafrodol is an incredible result that Surabhi and the BBC team should be proud of: inspiring action that can help protect the lives of millions from a truly grave public threat. I know Paul and Andjela hope their recent investigation into the efficacy of cancer drugs can similarly protect the public.

TBIJ exists to hold these drug companies accountable – that’s the power of public interest journalism. But we need people like you to make sure we can continue to shine a light on this issue. Please join us today as an Insider:

See you for another edition next week – and here’s to The Spark being the start of many more investigations!

Take care,