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A year later, German rivals came up with a different explanation for the unusual plant. Inexpensive, imported tramadol is so heavily abused in northern Cameroon that it seeps from human and animal waste into the groundwater and soil, where vegetation absorbs it, wrote Michael Spiteller and Souvik Kusari, chemists at the University of Dortmund. Farmers in Northern Cameroon told the researchers that they take double or triple the safe dosage, and feed tramadol to cattle to help them pull plows through the scorching afternoon sun. He pulled a red pill from his pocket and washed it down with warm pineapple soda. He started using tramadol five years ago, and says he now takes about milligrams daily—more than double the recommended short-term dosage. Fueled by cut-rate Indian exports and inaction by world narcotics regulators, tramadol dependency extends across Africa, the Middle East and into parts of Asia and Eastern Europe. Tramadol is abused in Guangzhou, Chinese researchers found.

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A year later, German rivals came up with a different explanation for the unusual plant. Write to Justin Scheck at justin.

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Wherever possible, drugs should be prescribed by their generic name; this allows any suitable product to be dispensed and in many cases, it saves the health service money. The only exception to this rule is when a patient must always receive the same brand of a drug because different preparations can result in different blood levels of the drug. No details of dosages are given in this book, because these are subject to change and often have to be varied to suit individual patients. In practice, the BNF or MIMS should be used as a guide to dosages. Examples of individual drugs have been kept to a minimum in the text, with usually just one or two examples given in each section.

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Tuberculosis is caused by Mycobacterium tuberculosis and Mycobacterium bovis.

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