CAPTAGON: THE MOST COMMONLY ABUSED DRUG IN THE MIDDLE EAST DEPENDENCY, SYMPTOMS, EFFECTS - Written by Dean Gustar, Relapse Prevention Specialist

In August 2022 in Saudi Arabia the General Directorate of Narcotics Control announced a record drug seizure in the country. 47 million illegal amphetamine pills were discovered in a shipment of flour. Eight arrests were made. This equates to around 8 tonnes of these pills. Though not officially confirmed, it is the best guess that these pills were a drug called Captagon — or at least purporting to be Captagon. Many people have not even heard of captagon. So, let’s look at what it is, and why it is the most commonly used drug in the Middle East.

Brief History of Captagon as a medicine

Captagon was first synthesised in Germany in 1961. The actual chemical name is Fenethylline. It was used mainly as an alternative to amphetamine-based pharmaceutical drugs, usually for treating ADHD. Fenethylline, when taken, is metabolised by the body into two separate stimulant substances — amphetamine and theophylline.

The main advantage of the drug was that it did not increase blood pressure to such high levels as standard amphetamine-based medications and was less likely to be abused. Despite this, the drug never received FDA approval. In 1981 it was classified as a Schedule 1 controlled drug in the States and in 1986 it was included on the United Nations Convention of Psychotropic Substances. As a result of this, most of the manufacture for medical use of the drug was phased out. By 2009 it was acknowledged that Captagon pills were not being manufactured anywhere, and stocks of the drug in most countries across the world were pretty much depleted.

The shift into the illicit market

Some of the remaining legal stock, after the scheduling of the substance, had undoubtedly ended up in the illicit market as a recreational drug. These days though we can safely say that current seizures of Captagon pills are illicitly produced. This is confirmed in the analysis of seized drugs. Most reports identify amphetamine as the main component. Methamphetamine, caffeine, ephedrine and paracetamol have also been identified.

In Europe in the 1970s and 1980s, amphetamine use was very prevalent. It was often referred to as “poor man’s cocaine”. It is easy to produce and very cheap to produce. The low cost of the drug made it accessible to even the poorest communities. It seems, in the Middle East, that Syria has become one of the main illicit producers of counterfeit Captagon. It is behind the production of billions of tablets and essentially floods the markets in nearby countries. It is so much easier to smuggle drugs across land borders than across the seas and skies.

What are the effects of stimulants

Stimulants essentially speed up the central nervous system and lead to the release of dopamine in the brain. People who consume the drug will notice significant changes in behaviour. They give the user more energy and are often used to stay awake. You may feel more alert and self-confident. It is reported that users will feel a sense of euphoria and excitement. They can stay up late, their appetite is suppressed, and often they’ll be very talkative and focussed.

Of course, there are also other examples of changes that can have serious consequences — particularly if the drug users consume in high doses, or over an extended period of time. Blood pressure will increase. There may be paranoid thoughts, high anxiety, short-term psychosis. People grind their teeth, they can behave in an aggressive or hostile manner. Often, users engage in obsessive behaviours. There are also potential long-term effects of drug abuse, such as addiction, long lasting physical, mental and emotional health issues which need medical treatment.

Why do people take Captagon pills?

This is a very open question, and to consider some answers, let’s reflect on how stimulants such as amphetamines have been used in the last 100 years. Some of the traditional medical uses for amphetamine-based medicines are well known. Medications such as ritalin are used to support people with ADHD or with a medical condition such as sleep disorders, for example, narcolepsy. It is prescribed the world over for the management of these and other related conditions.

Most of us trust medications and do not see them as dangerous. We have a belief that they are safe to use. After all, responsible doctors are prescribing them, people are taking them safely. Tests have been carried out on them. What could possibly go wrong? We believe in the purity of the substance. We certainly believe more in the sanctity of a pill than in a powder. We know powders can be adulterated. We have no way of knowing what we are buying. Producing a drug and packaging it up as a medication gives it some credibility and authenticity.

Because of the effects of stimulants, a person may use them for a variety of reasons. Stimulants can be a convenient, but dangerous, cure for boredom. Sometimes people get into stimulant use because they want to focus for tasks. It is common for people to take Captagon pills in order to lose weight as they increase the metabolism and decrease appetite.

The comparatively low price means that, in general, amphetamines are accessible. Depending on the quality (and the location), in the Middle East, Captagon pills cost anywhere from $1 up to $15 dollars. The effect of the drug in a single dosage is between 2-4 hours. Just a reminder.... virtually none of the so-called Captagon pills sold are genuine, nor do they contain the same components.

We know from research that there are often several underlying causes that can make a person more vulnerable to using drugs, and becoming dependent on drugs. It is not a wilful behaviour, or a moral issue. The drug is fulfilling a purpose, and the more we understand what that purpose is then the better we can assist the person and help them make positive changes. Here are some (not all) of the common underlying causes of abuse.

Do people get addicted to Captagon Pills?

Research of treatment admission in the United States in 2012 showed around 7% of all admissions to treatment services were for amphetamine dependence. So, there is definitely a risk of developing addiction to Captagon pills which, as previously discussed, are most likely to contain amphetamine as the core ingredient.

The criteria for the diagnosis of amphetamine use disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) closely follows other substance use disorders. Four key symptoms that are usually present are:

• Needing more of the substance to get the same effect (tolerance)

• Craving amphetamines when not using them

• Experiencing withdrawal symptoms when not using the drug

• Continuing to use the substance despite negative consequences

The DSM includes other criteria, but these are certainly key signs of amphetamine use disorder or dependency. If you feel that you or someone you know has developed an addiction to Captagon pills or amphetamines, or is at risk of doing so, then you should reach out and seek professional guidance and treatment.

What are the dangers and risks of taking Captagon?

We know that there are some very serious risks associated with Captagon. It is very dangerous to take a substance when you have no way of knowing the strength, or ingredients, of the drug, or whether it has been mixed with other drugs.

If there are underlying medical conditions such as heart disease, stimulants such as Captagon can easily trigger an increase in blood pressure and heart rate which could have very serious consequences.

Another important issue is related to some of the after effects of taking the drug. Any drug that increases the production of dopamine, has the potential to cause periods of depression when the drug wears off. This come-down from the drug may encourage a person to treat the pain of depression by consuming more of the drug.

Sometimes people take stimulants to extend their ability to consume alcohol and stay in control. The increase in alcohol consumption alongside the stimulant use can lead to poor decision-making and high-risk behaviours.

We should also consider some of the legal risks that may occur. As the drug is widely used in the Middle East, being caught in possession of the drug could have very severe legal implications for the user and their families. The consequences of drug charges in many Middle East countries are very severe.

How can the family help?

If you believe that a loved one is addicted to captagon, or any other substance, this can cause a great deal of worry and stress. Though sometimes you might feel angry and upset at the person, you have to remember that nobody sets out to become an addict, and the behaviour is not the person.

The family can provide a compassionate support system that will help to support change and healing. Try to understand why the person is taking the drug and what purpose it is serving. For an addict, even if they are in denial and haven’t accepted that they need help, they need to know that there is a better and healthier way to get happy. Family members should encourage a healthy way of life without Captagon.

Treatment starts by taking a step back without judgement. Judging what they do will only push them further into their addiction. Judgement is also why many addicts don't tell anyone about their drug problem and rather try to work through their issues by themselves.

Embrace your addicted loved one with unconditional love, especially through this challenging time. Talk to them about incorporating healthy habits like eating healthy food and exercising. More importantly, motivate them to talk about their feelings.

PRESCRIPTION DRUGSTreatment from Professionals

We know how difficult it is to see your loved one struggle with addiction and see their lives spiral downward. Be encouraged because there is hope and there is professional addiction treatment available. At The Kusnacht Practice, a holistic and professional approach is taken to healing the whole person. The process of treatment is void of judgement and focuses on the full healing of the individual.

All residents at the practice receive custom treatment that is directly suited to them. They will undergo assessments by highly qualified and experienced in-house doctors who will recommend the best treatment programme going forward.

For addiction, there are many treatment programmes tailored to drugs, alcohol, food, and more. Some patients may need to stay for a longer period depending on the severity of their individual drug addiction. The exclusive practice offers a range of advanced medical treatments, family aid groups, a team of health care providers, and continuing care.

If you or someone you know is battling with prescription drug addiction, don’t hesitate to contact us. We provide discreet and complex treatment to help get your loved one back on track. The Kusnacht Practice endeavours to help patients address important health issues and heal their minds and bodies.

Written by Dean Gustar