A look at how a man-made opioid – marketed as less dangerous than similar drugs that are more tightly regulated – has spread addiction in the world’s most vulnerable nations.

It was supposed to be the safer opioid, a way to fight pain with little risk of addiction. 

That promise has meant much less regulation of tramadol than other opioids. And its relatively low cost has made tramadol the drug of choice in many developing countries, where it is touted as everything from a mood enhancer to an elixir that can improve sexual stamina. 

National writer Claire Galofaro spent months researching the issue after this summer’s United Nations world drug report depicted tramadol as “the other opioid crisis.” She downloaded so many documents about tramadol that she ultimately ran out of space on her computer and had to buy an external hard drive. 

But how to illustrate the story from a fresh perspective? 

India offered the answer. As both a center for the manufacture of counterfeit tramadol pills and a place where addiction was skyrocketing, India began regulating the drug in 2018, but tramadol is still widely available. Galofaro turned to New Delhi-based correspondent Emily Schmall, who traveled to Punjab state with senior video journalist Rishi Lekhi and photographer Channi Anand. The team gained unprecedented access to officials trying to stem the crisis, visited a treatment center and talked to people struggling with addiction. One woman became a heroin addict when her 14-year-old son died. A doctor prescribed tramadol to help her kick the habit — instead, she formed a new one. 

The deeply reported story, produced with support from the Pulitzer Center on Crisis Reporting, also delved into the toll tramadol is taking in Africa. In some countries there are now more people dealing with tramadol addiction than  living with AIDS or HIV. Hundreds of thousands of pills, many knock-offs made in India, have found their way into the hands of Islamic State and Boko Haram terrorists, who sell them to fund their activities. 

The story was one of the top-read pieces on AP News, with nearly 50,000 page views. It was used widely by AP customers in the United States and India, and cited prominently by an influential global newsletter on health. 

For their work exposing an aspect of the international opioid crisis that has received far less attention, Galofaro and Schmall win AP’s Best of the Week award.