Tramadol, captagon and khat use in the Eastern Mediterranean Region: opening Pandora's box

Akbari, Abolfazl; Rafei, Parnian; Butner, Jenna; Khan, Riaz Ahmad; Khazaal, Yasser; Arab, Abdulmalik Zuhair; Qazizada, Mohammed Rafiq; Al-Ansari, Basma; Baldacchino, Alex

doi:10.1192/bji.2021.53

Cited by 11 publications

(13 citation statements)

References 15 publications

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“…The drugs of abuse used in the EMR differ from the drugs abused in Western Europe and the United States. The EMR is defined by the World Health Organization (WHO) as encompassing 22 members with about 700 million inhabitants [ 8 ], many of these countries are facing increasing rates of use of other illicit substances, including but not limited to the use of captagon [ 9 ]. The EMR is a vast and heterogeneous region, home to economically devastated nations, such as Yemen and Somalia, as well as some of the wealthiest nations on earth, such as the United Arab Emirates and Qatar.…”

Section: Reviewmentioning

confidence: 99%

“…Polysubstance drug abuse may be intentional, opportunistic, or unintentional, when a user takes a contaminated product mixed with other substances. Polysubstance abuse is a global trend that occurs in the EMR as well as in other regions [ 9 , 52 ]. However polysubstance abuse in the EMR is more likely to include captagon in the mix than polysubstance cocktails in Western Europe and North America.…”

Section: Reviewmentioning

confidence: 99%

“…However polysubstance abuse in the EMR is more likely to include captagon in the mix than polysubstance cocktails in Western Europe and North America. Captagon plus an opioid is a common combination, including captagon plus methadone [ 9 ]. Other captagon combinations are its use with alcohol and/or cannabis [ 3 ].…”

Section: Reviewmentioning

confidence: 99%

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The Emergence of the Old Drug Captagon as a New Illicit Drug: A Narrative Review

Pergolizzi Jr,

LeQuang,

Vortsman

et al. 2024

Cureus

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First developed in the 1960s in Europe and approved briefly for use in the United States, fenethylline (sold as Captagon, one of its early trade names) is now a prominent drug of abuse in the Eastern Mediterranean Region. The drug was withdrawn from the United States market because of side effects that included hallucinations, visual distortions, and psychosis; it has also been linked to rare cases of myocardial infarction, seizures, and delusions. The chemical synthesis of fenethylline is straightforward and inexpensive. Manufactured in clandestine labs in Southern Europe and the Middle East, these amphetamines had been used by affluent Middle Eastern young people for recreation or study aids. Captagon has periodically emerged as a drug used in combat and conflict, and it was implicated in the 2015 riots in Paris. It has been described as “chemical courage” for combatants giving them focus, energy, and endurance in battle situations. Captagon is addictive but no cases of direct captagon-associated mortality have been reported. The use of drugs in war is nothing new, but captagon is also used heavily in the civilian population in war-torn areas to help them cope with food insecurity and maintain courage in dangerous situations. Captagon production and distribution drives the Syrian economy, but the drug’s use is limited to certain regions and is rarely seen in North America. The drug is available online, but product may be contaminated with the inclusion of procaine, caffeine, or other substances.

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Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

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The Emergence of the Old Drug Captagon as a New Illicit Drug: A Narrative Review

Pergolizzi Jr,

LeQuang,

Vortsman

et al. 2024

Cureus

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“…This is compounded by the long-standing position of this region as one of the largest opium production sites globally. In the second article on our theme, Mohaddes Ardabili et al 3 shed light on patterns of substance use in the region.…”

Section: Substance Use In the Eastern Mediterranean Regionmentioning

confidence: 99%

Addiction medicine in modern contexts: hot topics from around the globe

Elkholy¹

2022

BJPsych Int.

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Addiction is a chronic yet treatable disorder. Patterns of addiction, whether substance related or behavioural, vary among countries and regions. Addiction medicine practice and approaches used in management are not only different from one country to another but are influenced by other factors, including environmental ones. The COVID-19 pandemic is one of the major environmental changes that had an impact on addiction. In this editorial, light will be shed on three articles covering recent updates in addiction medicine, ranging from types of substances and service provision to inclusion of gaming disorder in ICD-11.

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“…In most African countries, it is easy to obtain in pharmacies without a medical prescription [ 2 ]. In North African countries, a literature review showed that tramadol is the second most used drug by students in Egypt due to its psychoactive properties [ 15 ] and more generally in countries in the Eastern Mediterranean region, including Libya, Morocco, Somalia and Tunisia [ 16 ]. In Central Africa, especially Cameroon, tramadol is used illicitly for its psychoactive properties and to increase work efficiency [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and health consequences of nonmedical use of tramadol in Africa: A systematic scoping review

Boun,

Omonaiye,

Yaya

2024

PLOS Glob Public Health

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Tramadol is a widely prescribed painkiller around the world. As a synthetic opioid, it offers a valuable substitute for morphine and its derivatives in African countries. However, the adverse health effects of tramadol use resulting from illicit trafficking, like those caused by fentanyl and methadone in North America, have not been well-documented in Africa. This scoping review aims to shed light on the nature and scope of the nonmedical use (NMU) of tramadol in Africa and its associated health consequences. To carry out our scoping review, we used Arksey and O’Malley’s (2005) five-step approach for exploratory analysis and followed Joanna Briggs Institute guidelines for scoping reviews to ensure systematic and replicable studies. We then searched six databases: Medline, Global Health (EBSCO), Scopus, Web of Science, the African Journals online database, and for grey literature via Google Scholar without any time restriction. The articles were imported into Covidence and reviewed by two independent researchers. Eighty-three studies on NMU of tramadol’s prevalence or health consequences were selected from 532 titles/abstracts screened, including 60 cross-sectional and six qualitative studies from 10 African countries. Findings from the included studies highlighted five distinct groups significantly affected by the NMU of tramadol. These groups include: 1) young adults/active populations with varying degrees of prevalence ranging from 1.9% to 77.04%, 2) professionals, where drivers exhibit a relatively high prevalence of tramadol NMU, ranging from 7.2% to 35.1%, and commercial motorcyclists, with a prevalence of 76%, 3) patients, who have a high rate of tramadol NMUs, with prevalence rates ranging from 77.1% to 92%, 4) academics, with a considerable rate of tramadol misuse among substance-using undergraduates (74.2%) and substance-using high school students (83.3%), and 5) other individuals impacted in various ways. The health consequences are classified into four distinct types: intoxication, dependence syndrome, withdrawal syndrome and other symptoms. Despite providing a comprehensive global overview of the phenomenon described in the African literature, this systematic scoping review’s main limitations stem from the relatively limited exploration of various consequences of the NMU of tramadol, notably those of a social and economic nature. Our review shows that tramadol misuse affects diverse populations in Africa. The prevalence of misuse varies within sub-populations, indicating the complexity of the issue. Professional and academic groups have different rates of misuse across regions. This highlights the need for targeted interventions to address unique challenges contributing to tramadol misuse. Future studies should focus on the social and economic costs of abuse on households to better understand the impact on well-being. Systematic review registration: Open Science Framework: https://osf.io/ykt25/.

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Tramadol, captagon and khat use in the Eastern Mediterranean Region: opening Pandora's box

Cited by 11 publications

References 15 publications

The Emergence of the Old Drug Captagon as a New Illicit Drug: A Narrative Review

The Emergence of the Old Drug Captagon as a New Illicit Drug: A Narrative Review

Addiction medicine in modern contexts: hot topics from around the globe

Prevalence and health consequences of nonmedical use of tramadol in Africa: A systematic scoping review

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