A nurse struggles to find a viable vein while treating Jennifer Dossouvi (17) for a vaso-occlusive crisis at the National Sickle Cell Research and Care Centre. It took seven painful attempts to find a vein that did not collapse, with the needle finally ending up at the base of her thumb. Jennifer suffers from sickle cell disease, a hereditary condition prevalent in West Africa that causes red blood cells to become sickle-shaped rather than maintaining the typical doughnut-like form. Such cells tend to block capillaries and thus impede blood flow, leading to excruciatingly painful episodes known as vaso-occlusive crises. During such crises, patients such as Jennifer are heavily dependent on the opioid painkiller tramadol. But because illicit and falsified tramadol is widely abused for non-medical purposes in the region, consideration is being given to scheduling it internationally in the manner of other opioid analgesics such as morphine. Some experts are of the opinion that this will further reduce the already limited pain management options for people with a legitimate need, while doing little to curb illicit use.