A synthetic opioid called tapentadol, produced in India, is at the heart of a growing humanitarian crisis in West Africa. These high-strength pills, intended for severe pain relief, are being diverted into the illegal drug trade and mixed into a dangerous substance known as 'kush', which has led to alarming addiction rates and fatalities in countries like Sierra Leone and Liberia. Health officials report that over 400 corpses were collected in Freetown alone within three months, highlighting the crisis's severity. Although India is the largest producer of generic drugs, the specific 250mg tapentadol tablets flooding the market are not approved for general use, and their production requires special permission. Despite a declared crackdown by the Indian government in February 2025, illegal shipments continue, with records linking these exports to manufacturers in Gujarat and Madhya Pradesh. West African authorities assert that these imports are illegal, while the Indian Drug Manufacturers’ Association defends the industry, stating that legitimate manufacturers cannot be held accountable for the supply chain's misuse.