Under the influence

CAIRO - 4 September 2017: Even with the price of the powerful painkiller skyrocketing to around LE 30 ($1.69) for a single pill, Ali still finds it difficult to quit using Tramadol while he is driving his truck. “It’s only when I take Tramadol that I can stay alert at the wheel for up to 36 continuous hours,” says the trucker, who has requested his name be changed to protect his privacy.

Ali is far from being alone. In 2014, a national survey indicated that 24 percent of Egyptian drivers abuse drugs. The figures saw improvement in 2017, with only 11.8 percent of drivers testing positive for drugs, according to statistics provided by the state-run anti-addiction fund.

Playing a large part in successfully bringing down the figures has been a nationwide campaign rolled out in 2014 aiming to end drug-driving in Egypt and launched on the heels of a tragic multi-vehicle crash in the Nile Delta governorate of Beheira which left 18 students dead. The truck driver in that accident was found to have hashish (cannabis) in his system, meaning the accident could have been avoided. The government campaign administers random urine tests to thousands of drivers on a near-daily basis, and those with drugs in their system are prosecuted.


Traffic police forces check drivers' licenses as part of anti-drug driving campaign-Egypt Today

Trials and Tramadaol

Many drivers who take the drug defend themselves as not “addicts” but rather claim they use it to boost their energy so they can work for longer periods. “Before I start each trip I take one pill. I do not feel high like what some people mistakenly believe. It just helps me bear the long road and relax my stiff muscles,” Ali says. The trucker earns a living by traveling between governorates to transfer goods. His job requires him to remain seated for long hours without stretching; Tramadol reduces the pain.

Ali says he is aware of the dangerous consequences for drivers abusing Tramadol. “Sometimes I drink whisky before I drive and I am still conscious, but I never smoke hashish or take heroin,” he says.

Imprisonment up to three years, withdrawal of driving license and a steep fine of up to LE 20,000 are reasons cited by Ali as behind the sharp decline in the number of people driving under the influence of drugs.

But the abstinence also comes at a price. Ali describes “hard” withdrawal symptoms, like suffering anxiety and fever, saying that he plans to quit gradually because the drug is costing him dearly. Other drivers have not been so strong, finding it easier to quit driving than to give up the drug.

Tramadol is the most abused drug by drivers, followed by hashish and then heroin, according to Amr Othman, head of the anti-addiction fund. Drivers constitute 30 percent of the Tramadol addicts psychiatrist Ehab el-Kharrat receives at his clinic. “Most of the drug abusers use it [Tramadol] to kill the pain due to fatigue and stress, enabling him/her to work for longer periods,” says Kharrat, director of the Freedom Drugs and HIV Program.

Sudden loss of consciousness and hallucination are among the side effects of Tramadol addiction, adds Kharrat, warning of accidents that could happen as a result of truckers driving under the influence. Tramadol is an addictive analgesic and withdrawal “is not easy” because the drug is “obtainable,” explains Kharrat who emphasizes that it is still possible to quit the drug if addicts show willingness. It takes around five days to flush the drug out of the body.

Though Tramadol is the drug of choice, new, deadlier drugs are being used by drivers to get high. “Strox,” for example, is similar to hashish combined with chemicals, but can result in “very dangerous consequences,” including cardiac arrest, Kharrat notes.
Drivers have come to figure out when the tests are given and have hit on a way to ensure theirs come out clean: they temporarily stop taking the pills for a few days and rid their bodies completely of the substance. Some drivers manage to pass the tests this way; others fall into their own traps. One bus driver made headlines in 2014 after he cleared a drug-test by using his wife’s urine, but his ruse was uncovered when the sample revealed his wife was pregnant.

At the Root

Although they comprise the biggest percentage of offenders, truckers are not the only drivers canvassed by the anti-drug driving campaign, which also targets bus and school bus drivers—the percentage of drug abusers in the latter has dropped from 12 percent in 2014 to 3.5 percent in 2017.

Yet though the figures show a remarkable decline in the number of drivers testing positive for drugs as a result of the law amendments, road experts and drivers argue the campaign has had an effect on their incomes. “Many drivers I know have quit taking drugs, and their working hours are down to eight hours a day. Those who work for private companies now face a problem when they are asked to work more. It’s either they drop their jobs or return to drug abuse,” says Ahmed Fawzy, a taxi driver who is not against using Tramadol as long as it is taken in a limited way, saying “when drivers use Tramadol it just like when athletes dope.”

Drivers who test positive to any drugs are subject to license withdrawal, imprisonment term of at least two years and LE 10,000 fine, according to the traffic law. The incarceration term might reach three years in prison and the fine is doubled in case the tested driver caused an accident resulting in casualties.

“This campaign is useless,” argues Roads and Transport Professor at Ain Shams University Osama Okail, maintaining that drivers who can afford to pay the fine will end up abusing drugs to work more hours and compensate their loss.

Okail has conducted studies on the status of truck drivers in Egypt, the results of which have given him a glimpse into why drivers resort to drugs. “Solving the problem requires knowing the reason behind this phenomenon, which will enable us to determine the target group in the campaign,” says Okail, who urges authorities to consider drivers who take such drugs not as criminals or addicts, “but rather professionals who try to adapt and work hard to make their living.”

According to him, truck drivers can be classified into three categories: those working for individual associations, working for private transport companies and others working for semi-governmental companies like contractors. Okail reveals that truckers driving their own vehicles are the most to abuse drugs.


A government report indicated a 1.1% rise in road accidents in Egypt during 2016, where 5,343 people were killed-Egypt Today

A Different Approach

“It is never going to be an easy task to quit Tramadol cold turkey as many drivers have been taking it for years . . . it should come gradually,” says Fawzy who suggests the Health Ministry provide an alternative to Tramadol to help drivers work longer hours “at a time the government is demanding us to work harder to contribute in solving the economic crisis.”

Yousri el-Roubi, an expert in traffic, rescue and rapid intervention in accidents in the Middle East, believes that educating drivers about the dangers of drugs is the best way to overcome the problem, rather than “solely toughening the punishment.”

Laws alone are not sufficient to address drug driving in Egypt, says Okail who suggests designing a social security program for drivers that will reduce their spending. His suggestions include exempting drivers from taxes for a short period and building hospitals for them.