After a BBC investigation in April showed the extent of codeine addiction in Nigeria, the production of codeine-based cough syrup was banned in Nigeria.
But codeine is not the only opioid scourge spreading across West Africa. Another painkiller, Tramadol, is fuelling widespread addiction – and as the BBC’s Stephanie Hegarty found out, it may even be fuelling insurgency in the north-east.
When Mustafa Kolo, 23, takes the bright red pills he feels like he can push a tree. It’s like his body isn’t his. They obliterate the negative thoughts.
“When I take it, I forget everything,” he says.
It’s 10:00, Mr Kolo and his friend Modu Mohamed are with their boss, the commander of a vigilante unit set up to protect the city of Maiduguri from Boko Haram.
The young recruits are clearly uncomfortable.
‘People have lost everything’
“How many did you take today?” I asked them.
“Today? None,” came the reply.
Mr Kolo’s eyes are dark and bloody red, he slurs slightly as he talks. Mr Mohamed is listless and distracted. His head is hanging between his bony shoulders.
It’s obvious they’re lying. The commander steps in and urges them to tell the truth.
“I used to take three to four when I first began taking it. But now I have reduced it to one or half,” Mr Kolo says, unwilling to go further.
In this troubled town, thousands of people are addicted to Tramadol – the vigilante fighters, those displaced by the war and even the militants themselves.
The cheap opioid painkiller is meant to be used to treat moderate to acute pain. But, like most opioids, it is addictive – although just how addictive is a matter for debate.
The World Health Organization (WHO) says Tramadol is generally thought to have a “low potential for dependence relative to morphine”.
But the epidemic of addiction erupting across West Africa could yet disprove that.
“The problem is really huge,” says Marcus Ayuba, head of Nigeria’s National Drug Law Enforcement Agency (NDLEA) in Borno state, bowing his head sadly.
“It’s really huge.”
Mr Ayuba runs a drug treatment centre in Maiduguri, the state capital where, by his own estimate, one in three young people are addicted to the drug – an epidemic which, he believes, can be traced back to a decade of war.
“People have lost everything,” he says. “They are young people who were basically farmers, they’ve lost their farms, their homes.”
“Parents have seen children killed in their presence,” he adds.
Mr Ayuba says during counselling, people have told him, “What else can we do? We just want to get out of the world.”
But the crisis didn’t bring Tramadol to Nigeria. Mr Kolo started taking Tramadol in 2007, two years before the insurgency began.
At first, he says he took it to help him to work. It dulled the pain of physical labour while helping to keep him awake.
But now because of his addiction, he can’t get work. Instead he volunteers with the civilian vigilante force.
“It really helps me in fighting Boko Haram,” he says. “When I go into the bush, even the way I run, the way I walk, it’s different. It gives me strength.”
But the enemy too seems to have caught on to this trick.
An army of addicts
A former militant fighter is sitting in a soft, lilac coloured Hawaiian shirt.
The 21-year-old is in the custody of the Nigerian army after running away from Boko Haram in January.
For four years, he lived in a forest camp where there wasn’t enough food or water – but there was Tramadol.
“When you are going for a military operation you will be given it to take, otherwise if you take it you will be killed,” he says.
“They told us when you take it you will be less afraid – you will be strong and courageous.”
The drug was once plentiful, but in the past few months, as the Nigerian army closed in on their camps, supplies became scarce.