Ben Hubbard / Associated Press – 2008-12-16 00:34:33

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/12/14/MN5P14LG6T.DTL

GAZA CITY, Gaza Strip (December 14, 2008) — The new drug overtaking the Gaza Strip doesn’t cause hallucinations or increase endurance at the dance club. It merely chills you out, which is exactly what many Gazans say they need.

Ruled by Islamic hard-liners from Hamas and locked in by Israel, Gazans can’t travel outside the strip, have few places to go for fun and are faced with a failing economy. Thus the boom in the popularity of tramadol, a painkiller known here by a common brand name, “Tramal.”

Growing numbers of Gazans have begun using the drug over the past year and a half to take the edge off life in the impoverished seaside strip, pharmacists and residents say.

This worries medical personnel, who say the drug can cause dependence. It is a prescription drug in many countries, and the Hamas-run Health Ministry has made efforts to control it, but without much success in a society where medicines available only by prescription elsewhere are often sold over the counter.

Tramadol is especially popular among young men. Some down the pills with coffee or dissolve them in tea. Others pop them freely when hanging out with friends. Grooms have been seen passing them out at weddings.

“You feel calmness through your whole body, absolute quiet,” said one regular user, 27-year-old Bassem, in describing the drug’s effect. He, like others interviewed for this report, refused to give his last name for fear of being arrested as a drug user.

Tramadol is an opioid painkiller, related to morphine and heroin, though much milder, said Marta Weinstock, professor of pharmacology at the Hadassah Medical Center in Jerusalem. Users who stop after taking it regularly could get flulike withdrawal symptoms, she said, though other long-term negative effects are rare.

Developed by the German company Grunenthal in the 1970s to treat moderate to severe pain, tramadol is now sold under different brand names around the world, such as Zydol, Topalgic, Nobligon and, in the United States, Ultram.

Most countries do not treat it as a controlled substance, but the U.S. Drug Enforcement Administration has named it a drug “of concern” because it may cause dependence. Heavy doses have also been linked to seizures. Other than in Gaza, it does not seem to have wide use as a recreational drug.

Dyaa Saymah, mental health officer with the World Health Organization in Gaza, said the drug’s popularity has been encouraged by its availability, since large quantities have been smuggled through tunnels under the Gaza-Egypt border.

“Tramadol has spread widely and very fast because, unfortunately, it is available over the counter in pharmacies, but it’s also available in the streets,” Saymah said. “You can get it easily on the black market.”

The booming black market sales also have sent prices down to as little as 26 cents a pill, the cost of two cigarettes.

No statistics exist on how many Gazans take the drug. Mazen el-Sakka of the Drug Abuse Research Center in Gaza estimates that up to 30 percent of men between 14 and 30 take it regularly. Fewer women take it for fear of being seen as promiscuous.

“We’re talking about a huge slice of the population, a big group of the youth and others who are using this drug,” said Health Ministry spokesman Hammam Nasman.

Tramadol first appeared here about five years ago, marketed as a nonaddictive painkiller with few side effects, said Hani Saker, board member of Gaza’s pharmacists’ association and owner of four Gaza pharmacies.

Some who took it for pain noticed unintended – but appreciated – side effects, such as mild euphoria and delayed ejaculation. The drug also spread because it lacked the social stigma that kept other drugs like hashish confined to the margins of society, Saker said.

The Islamic militant group Hamas’ seizure of Gaza in June 2007 – ousting forces loyal to Palestinian President Mahmoud Abbas – increased the drug’s popularity, because living conditions plummeted as Israel and the international community isolated Gaza.

Concerned about the drug’s possible ill effects, the Health Ministry banned its sale without a prescription in February. Since then, inspectors have destroyed $250,000 worth of the drug and closed a number of pharmacies for flouting the ban, Nasman said.

But this has made little difference to regular users like Bassem, who learned of tramadol through his job at a government clinic. He first tried it a year and a half ago and now takes a pill or two each evening, he said, adding he had never considered taking any kind of drug before Hamas seized control of Gaza.

“After the coup, I got scared because of what we were going though,” he said. “There’s no hope, so you look for anything to quiet your nerves. I tried it once and it worked, so here I am still taking it.”

He said he buys the pills from a pharmacist friend, paying about $4 for a sheet of 10. He toyed with a yellow tramadol box as he spoke, adding that he has friends who take four pills a day and suffer withdrawal if they miss doses. But he’s not scared of addiction himself.

“I’m in control of it,” he said.

Other users say they’d give tramadol up quickly if they had other ways to distract themselves.

“The main thing it does is keep you from thinking too much,” said Ahmed, 25, who works in broadcasting and takes tramadol a few times a week. “If we could travel and get out, have a place to go and have a good time, we’d never think about taking tramadol.”

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