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Ayao (not his real name) smoking a joint in an abandoned building. The 15 year-old is addicted to tramadol, a prescription-only opioid analgesic intended for the treatment of moderate to moderately severe pain. Eventually his addiction led to his expulsion from school. In West Africa there is a proliferation of illicit and counterfeit versions of the drug that are manufactured in high, non-therapeutic dosages and sold outside the legitimate pharmaceutical supply chain.