In addition to the high levels of misuse of prescription opioids reported by many countries in Asia and Africa,112 there is growing evidence of the non-medical use of tramadol in some countries in Africa and the Near and Middle East. These have been corroborated in recent years by seizures of considerable amounts of tramadol in North, West and Central Africa and in the Near and Middle East.118 Between 2012 and 2014, the Islamic Republic of Iran, countries in the Near and Middle East and many countries in Africa reported to UNODC that seizures had been made of large amounts of tramadol that was being trafficked into those countries. Countries in the Middle East reported seizures of 310 kg in 2012; a quantity that increased to over 22 tons in 2014.