Exposing an Indian pharma firm fuelling West Africa's opioid crisis

41 minutes ago BBC Eye Investigations BBC World Service

BBC

An Indian pharmaceutical company is manufacturing unlicensed, highly addictive opioids and exporting them illegally to West Africa where they are driving a major public health crisis in countries including Ghana, Nigeria, and Cote D'Ivoire, a BBC Eye investigation has revealed. Aveo Pharmaceuticals, based in Mumbai, makes a range of pills that 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. This combination of drugs is not licensed for use anywhere in the world and can cause breathing difficulties and seizures. An overdose can kill. Despite the risks, these opioids are popular as street drugs in many West African countries, because they are so cheap and widely available. The BBC World Service found packets of them, branded with the Aveo logo, for sale on the streets of Ghanaian, Nigerian, and Ivoirian towns and cities. Having traced the drugs back to Aveo's factory in India, the BBC sent an undercover operative inside the factory, posing as an African businessman looking to supply opioids to Nigeria. Using a hidden camera, the BBC filmed one of Aveo's directors, Vinod Sharma, showing off the same dangerous products the BBC found for sale across West Africa. In the secretly recorded footage, the operative tells Sharma that his plan is to sell the pills to teenagers in Nigeria "who all love this product". Sharma doesn't flinch. "OK," he replies, before explaining that if users take two or three pills at once, they can "relax" and agrees they can get "high". Towards the end of the meeting, Sharma says: "This is very harmful for the health," adding "nowadays, this is business."

Filmed secretly, Vinod Sharma said Aveo's cocktail drug was "very harmful", adding "this is business".

It is a business that is damaging the health and destroying the potential of millions of young people across West Africa. In the city of Tamale, in northern Ghana, so many young people are taking illegal opioids that one of the city's chiefs, Alhassan Maham, has created a voluntary task force of about 100 local citizens whose mission is to raid drug dealers and take these pills off the streets. "The drugs consume the sanity of those who abuse them," says Maham, "like a fire burns when kerosene is poured on it." One addict in Tamale put it even more simply. The drugs, he said, have "wasted our lives". The BBC team followed the task force as they jumped on to motorbikes and, following a tip off about a drug deal, launched a raid in one of Tamale's poorest neighbourhoods. On the way they passed a young man slumped in a stupor who, according to locals, had taken these drugs.

The task force in Tamale believe this man had taken Tafrodol, which was found in the raid

When the dealer was caught, he was carrying a plastic bag filled with green pills labelled Tafrodol. The packets were stamped with the distinctive logo of Aveo Pharmaceuticals. It's not just in Tamale that Aveo's pills are causing misery. The BBC found similar products, made by Aveo, have been seized by police elsewhere in Ghana. We also found evidence that Aveo's pills are for sale on the streets of Nigeria and Cote D'Ivoire, where teenagers dissolve them in an alcoholic energy drink to increase the high. Publicly-available export data show that Aveo Pharmaceuticals, along with a sister company called Westfin International, is shipping millions of these tablets to Ghana and other West African countries. Nigeria, with a population of 225 million people, provides the biggest market for these pills. It has been estimated that about four million Nigerians abuse some form of opioid, according to Nigeria's National Bureau of Statistics. The Chairman of Nigeria's Drug and Law Enforcement Agency (NDLEA), Brig Gen Mohammed Buba Marwa, told the BBC, opioids are "devastating our youths, our families, it's in every community in Nigeria".

Packets of Tafrodol with Aveo branding were seized in the raid in Tamale, in Ghana

In 2018, following a BBC Africa Eye investigation into the sale of opioids as street drugs, Nigerian authorities tried to get a grip on a widely abused opioid painkiller called tramadol. The government banned the sale of tramadol without prescription, imposed strict limits on the maximum dose, and cracked down on imports of illegal pills. At the same time, Indian authorities tightened export regulations on tramadol. Not long after this crackdown, Aveo Pharmaceuticals began to export a new pill based on tapentadol, an even stronger opioid, mixed with the muscle-relaxant carisoprodol. West African officials are warning that opioid exporters appear to be using these new combination pills as a substitute for tramadol and to evade the crackdown. In the Aveo factory there were cartons of the combination drugs stacked on top of each other, almost ceiling-high. On his desk, Vinod Sharma laid out packet after packet of the tapentadol-carisoprodol cocktail pills that the company markets under a range of names including Tafrodol, the most popular, as well as TimaKing and Super Royal-225. He told the BBC's undercover team that "scientists" working in his factory could combine different drugs to "make a new product".

Watch India's Opioid Kings from BBC Eye Investigations on iPlayer or, if you are outside the UK, watch on YouTube.

Aveo's new product is even more dangerous than the tramadol it has replaced. According to Dr Lekhansh Shukla, assistant professor at the National Institute of Mental Health and Neuro Sciences in Bengaluru, India, tapentadol "gives the effects of an opioid" including very deep sleep. "It could be deep enough that people don't breathe, and that leads to drug overdose," he explained. "And along with that, you are giving another agent, carisoprodol, which also gives very deep sleep, relaxation. It sounds like a very dangerous combination." Carisoprodol has been banned in Europe because it is addictive. It is approved for use in the US but only for short periods of up to three weeks. Withdrawal symptoms include anxiety, insomnia, and hallucinations.

Nigerian authorities store illegal drugs they have seized - mostly opioids - in a warehouse in Lagos

When mixed with tapentadol the withdrawal is even "more severe" compared to regular opioids, said Dr Shukla. "It's a fairly painful experience." He said he knew of no clinical trials on the efficacy of this combination. Unlike tramadol, which is legal for use in limited doses, the tapentadol-carisoprodol cocktail "does not sound like a rational combination", he said. "This is not something that is licensed to be used in our country." In India, pharmaceutical companies cannot legally manufacture and export unlicensed drugs unless these drugs meet the standards of the importing country. Aveo ships Tafrodol and similar products to Ghana, where this combination of tapentadol and carisoprodol is, according to Ghana's national Drug Enforcement Agency, unlicensed and illegal. By shipping Tafrodol to Ghana, Aveo is breaking Indian law. We put these allegations to Vinod Sharma and Aveo Pharmaceuticals. They did not respond. The Indian drugs regulator, the CDSCO, told us the Indian government recognises its responsibility towards global public health and is committed to ensuring India has a responsible and strong pharmaceutical regulatory system. It added that exports from India to other countries are closely monitored and that recently tightened regulation is strictly enforced. It also called importing countries to support India's efforts by ensuring they had similarly strong regulatory systems. The CDSCO stated it has taken up the matter with other countries, including those in West Africa, and is committed to working with them to prevent wrongdoing. The regulator said it will take immediate action against any pharmaceutical firm involved in malpractice.

The Ghanaian task force burned the drugs that it seized in the raid in Tamale, including this Aveo-branded Tafrodol

Soldier's mum says 'no apology will bring her back'

36 minutes ago Bea Swallow BBC News, West of England

Family Handout Leighann McCready (R) described her daughter as "so much more than a soldier"

The mother of a teenage soldier who took her own life following relentless harassment says no apology from the Army "will ever bring our daughter back". Royal Artillery Gunner Jaysley Beck was found hanged in her barracks at Larkhill Camp in Wiltshire on 15 December 2021, following a work Christmas party. Coroner Nicholas Rheinberg ruled the Army's failure to take action after Gunner Beck was harassed by her line manager contributed to her death. She had also been sexually assaulted by another senior colleague, and the Army's failure to take appropriate action "more than minimally" contributed to her death.

Colleagues used a master key to enter Gunner Beck's room after concerns emerged that no one had heard from her all day

At the inquest's conclusion on Thursday, Mr Rheinberg determined Gunner Beck had intended to take her own life as a result of these "frightening" incidents. He concluded: "I find there was a failure on behalf of army to take action over the harassment she was suffering from her line manager. "And there was a failure on behalf of the army to take action against the senior officer at whose hands she'd suffered a sexual assault." He ruled the complaint "should have been reported to police and the failure to do so breached Army policy". "It was a sexual assault carried out on a 19-year-old Gunner by a middle-aged man of senior rank, and was recorded merely as inappropriate behaviour unbecoming of a warrant officer," he added.

Family Handout Gunner Beck (front) filed a complaint but it was dismissed as a 'minor sanction'

Brigadier Melissa Emmett, head of the Army personnel services group, formally accepted failures were made and apologised to Gunner Beck's grieving family. Following the coroner's conclusion, she said "significant changes" have been made within the Army, including the "introduction of clear and unequivocal policies to state that there will be zero tolerance to unacceptable sexual behaviours". She added: "There is more work to do. "It is my hope that such change will give service personnel the confidence they need to report sexual offences and inappropriate behaviours, knowing that they will be listened to."

Leighann McCready said the Army "needs to change" to achieve real justice

However, Gunner Beck's mother Leighann McCready said "true accountability" could only be achieved with independent scrutiny. "Things need to change. The Army cannot be allowed to investigate itself anymore when it comes to cases of sexual harassment, assault, bullying and abuse," she said. "The Army has admitted that it let Jaysley down, and has apologised for its failings - but no apology will ever bring our daughter back. "Too often service women, and men, don't feel able to speak up out of fear of being victimised, and even when they do, the Army is left to investigate itself. "This cannot continue. Jaysley should still be here, we will not stop fighting until immediate action is taken." Mr Rheinberg said he would not prepare a report to prevent future deaths as he had been "reassured" by the Army, including from Brigadier Emmett's evidence, that "matters are currently under review and revision".

Public speaker Gemma Morgan, who served in the military from 1996 to 2002, said she recognised the torment endured by Gunner Beck. She told BBC Radio 4 she had just returned from an operational tour and was experiencing a "severe trauma response" as she grappled with the harrowing scenes she had witnessed.

Gemma Morgan Ms Morgan said sexual harassment in the Army is "not a historic issue, it is current"

Following a night of social drinking, Ms Morgan was raped by one of her colleagues. "It made me quite vulnerable in an environment that to be honest I'd gotten used to, but really it was very predatory," she said. "When I asked for help in the medical centre the next day, no help was given. It was absolutely devastating."

'Measurable action'

Ms Morgan described in her book Pink Camouflage how her "promising career" and mental health "completely spiralled" as a result. "It's taken me 25 years to speak out about the relentless sexual harassment and abuse that I and other women experienced," she said. "My view is that [military] defence have a deeply ingrained cultural problem where harassment and abuse is commonplace. "We need to do better, we have to go beyond words and take real, measurable action. "That starts with defence accepting they have a problem, and having the humility to work with the experts to create much needed change."

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POOL INTERVIEW (PART DONE) soldier/jaysley beck mother intv/sky pool/1546/20/2 "She was just a beautiful, kind, genuinely caring girl. Always full of life, witty, always put others before herself, and a true family girl. "Throughout Jaysley's Army career we were in contact with her daily, up to possibly 10 times a day, if not more. "The first time the sexual harassment because apparent was Thorney Island. She phoned us distraught. She said 'mum, this man has put his arm around my neck and tried to pull me towards him, and also tried to put his hands between my legs'. "She said 'get off me, Sir', because even when she was going through this she still had the respect to call him Sir. (CONTINUED)