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Captagon Use in Saudi Arabia: What Do we Know?

22 | Volume 2 | Number 2 | January 2019
International Addiction Review
Captagon is a central nervous system stimulant that
was rst introduced in the 1960s as a treatment for
attention decit hyperactivity disorder, depression and
narcolepsy.1–3 There is no current acceptable medical use
for Captagon.4,5 Since its rst production in Germany in
1961, Captagon has never gained any approval for use
by the United States Food and Drug Administration.4
In 1981, it was classied as a controlled drug on the
Schedule 1 of the Controlled Substances Act, and its
production has been banned by almost all countries
since 1986.4,6 The psychoactive substance in Captagon
is fenethylline.1 This substance is chemically composed
of amphetamine that is connected to theophylline
via an alkyl chain.4 As a result, fenethylline’s two major
active metabolites in humans are amphetamine and
theophylline.5,6 Amphetamine is a well-known stimulant
that mainly produces its eects through increasing the
availability of norepinephrine and dopamine.7 Although
amphetamine does have medical uses, it also has high
abusive potential. Individuals who abuse amphetamine
seek the drug to experience euphoria, to increase energy
and to improve concentration.7 Amphetamine use in large
doses can cause serious psychiatric symptoms such as
hallucinations and paranoia that can reach to the level of
acute psychosis (with a presentation similar to paranoid
schizophrenia).7 Chronic use of amphetamines can lead
to “amphetamine use disorder”, a maladaptive behavior
for using amphetamines that can cause signicant
functional and physiological impairment, and is currently
diagnosed based on availability of a set of criteria from
the Diagnostic and Statistical Manual of Mental Disorders
fth edition (DSM-V).8
Captagon Use in Saudi Arabia: What Do we Know?
Rufaidah Dabbagha,*, DrPH, Richard Rawsonb,c, PhD
a Family and Community Medicine Department, College of Medicine, King Saud University, PO Box 2925, Riyadh 11461, Saudi Arabia
b Center for Behavior and Health, Department of Psychiatry, University of Vermont.
c Department of Psychiatry, David Geen School of Medicine, UCLA.
* Corresponding author at: Family and Community Medicine Department, College of Medicine, King Saud University, PO Box 2925, Riyadh 11461, Saudi Arabia.
Telephone: +966 11 469 2705. Fax: +966 11 467 1967. Email address:
Conicts of interest and source of funding
The authors declare no conicts of interest. The authors did not receive any funding for this review.
Background: Captagon is a stimulant that has been banned worldwide since 1981. The greatest number of Captagon
seizures worldwide occurs in Saudi Arabia, yet little is known about its use in this country. This review summarizes
Captagon in Saudi Arabia in terms of drug purity, amounts of pills seized, trends of use in the clinical settings and
complications of use in patients.
Methods: We searched Pubmed, Psychinfo, Annals of Saudi Medicine, Saudi Medical Journal, Arab Journal of Psychiatry
and LexisNexis databases for articles related to Captagon in Saudi Arabia, published in English.
Results: The majority of Captagon tablets examined between 1986 and 2012 were counterfeit that rarely contained
fenethylline, but were rather composed of amphetamine and a mixture of other adulterants. Studies from substance use
treatment centers from 2008 to 2010 suggested that prevalence of amphetamine use among patients was from 39% to
72.8%. Although Captagon was rarely mentioned in these studies, other studies suggest it is the most common source of
amphetamine in Saudi Arabia. Medical complications reported with amphetamine use, in the Saudi literature, included
myocardial infarction, hearing loss, psychosis, suicidal ideation and deterioration of cognitive functions.
Conclusion: Available Captagon tablets are most probably counterfeit; containing amphetamine. The most commonly
used illegal substance by patients in treatment for drug use is amphetamine, and the most common source of
amphetamine might be in the form of “counterfeit Captagon”. Further analytical research is needed to back up these
assumptions and better understand the scope of Captagon use in Saudi Arabia.
Key words: Fenethylline; Captagon; Stimulant; Amphetamine; Saudi Arabia | 23
Captagon is used in the form of pills or injection, and like
amphetamine, it is mainly consumed for its euphoric and
energizing eects.4 It can cause serious adverse eects
such as psychosis, hallucinations and visual distortion.
Physiological eects of this drug mostly target the
cardiovascular system, causing increased cardiac-output,
vasodilatation, hypertension and increased blood ow
to the kidneys and brain.4,9 Other reported side eects
include epileptic ts, hyperthermia, increased respiration
and loss of appetite.10,11
Although the use of Captagon is currently banned around
the world, it is still illegally, manufactured and used in
dierent Eastern European and Middle Eastern countries.4,6
Its purchase and trade are considerably feasible through
the black market.4,10,11 Most of the available Captagon
pills in the Middle East rarely contain fenethylline, but
are rather composed of a mixture of amphetamine,
methamphetamine, theophylline, caeine, and other
adulterants.4,6 However, the brand name “Captagon stuck
with the street drug for marketing purposes.12 The two
C’s that are traditionally found on the white Captagon pill
resemble crescents, which made the drug known as “Abu
Hilalain” in Arabic, meaning “the father of two crescents.12
Regional and international drug control ocials are greatly
concerned about the potential use of local Captagon trade
for funding dierent militant groups ghting in the Syrian
war.4,6 The major source of Middle Eastern Captagon is
Syria, although some reports suggest previously available
production laboratories in Lebanon, Turkey, Bulgaria and
Serbia.3,4,6,11,12 Syrian production of Captagon seems to be at
exponential growth.4,6,12 This has been suggested by annual
increases in the amounts of pills being seized at the borders
of dierent Arab nations, including Syria, Jordan, Lebanon,
Saudi Arabia and the United Arab Emirates.4,6,12
Unfortunately, limited data about Captagon use
prevalence is available from scientic sources and most
information is gathered from news outlets and seizure
reports.13 Captagon trade primarily targets auent Gulf
countries of the Arabian Peninsula, where most of the drug
is seized.4,6,12 In these countries, one Captagon pill can cost
anywhere from $10 to $25.4
Reports from the United Nations Oce on Drug and
Crime (UNODC) indicate that there is a growing market
for amphetamine-type stimulants (ATS) worldwide.14
Although methamphetamine accounts for the bulk of
seizures related to ATS in most parts of the world, this does
not seem to be the case in Middle Eastern countries.14
In this region, amphetamine is the most commonly
seized ATS, which is usually in the form of Captagon.14
Worldwide, the greatest amounts of Captagon seizures
occur in Saudi Arabia.13 However, the use of Captagon in
Saudi Arabia remains understudied in scientic literature.
In this country, the use of alcohol and illegal drugs are
banned both by religion and law.15 Furthermore, Captagon
has been ocially banned in the country since 1986.16
The Saudi authorities have placed severe punishments
for possession, dealing and smuggling of this drug.
According to Saudi law, imprisonment is enforced on
users (unless enrolled to a treatment center) and rst
time dealers. Harsher punishments are implemented for
second time dealers or smugglers, who are sentenced to
death.17 Despite these regulations, Saudi Arabia, like its
neighboring Gulf countries, is susceptible to the growing
worldwide substance use problem.18
The aim of this article is to review the available data
on Captagon use in Saudi Arabia. First, we summarize
information about the chemical purity of the available types
of Captagon in Saudi Arabia and the amounts conscated
from seizure reports. Then, we summarize its use in the
psychiatric and general Saudi populations, in addition to
reported complications associated with its use. We nally
conclude by raising important questions that need to be
addressed in regards to the use of Captagon in Saudi Arabia,
and oer recommendations for future research. Although
this article was not intended to be a systematic review, we
provide a brief description of the search strategy used.
The literature search was conducted in August 2017. We
searched Pubmed and Psychinfo databases for English
studies and reviews that reported on Captagon use in
Saudi Arabia, without specifying a certain time period. We
adopted the terms “Captagon”; “fenethylline”; “Captagon
AND Saudi Arabia”; “fenethylline AND Saudi Arabia”;
“amphetamine AND Saudi Arabia”; “stimulant AND Saudi
Arabia”; “drug abuse AND Saudi Arabia”; and “substance
use AND Saudi Arabia”, for our search. Additionally,
because some Saudi studies may not be indexed in these
two databases, we searched the archives of the Annals of
Saudi Medicine, Saudi Medical Journal and Arab Journal of
Psychiatry using the same search terms. We also scanned
the abstracts for relevant information about the use of
Captagon or amphetamines in Saudi Arabia. Studies with
relevant abstracts were fully reviewed. Only studies that
reported data related to amphetamine or Captagon use in
Saudi Arabia (epidemiology, prevalence, analysis of tablets,
complications of use or seizure reports), which were in
English, were included. Research cited in the selected
studies was searched for relevant information pertaining
amphetamine or Captagon use. We also searched through
the UNODC’s annual reports, from the past ten years, for
additional data.
Because studies on Captagon use are sparse and most
information is obtained from drug-seizure reports, we also
conducted an English search in LexisNexis, adopting the
search term “Captagon AND Saudi Arabia”. Selected news
articles that reported conscation of Captagon by the
Saudi authorities in the past ve years were also included
in this report.
24 | Volume 2 | Number 2 | January 2019
International Addiction Review
Purity of available Captagon in Saudi Arabia
Three studies that explored the composition of Captagon
tablets in Saudi Arabia were identied.16,19 In 1993, Al-
Gharably and Al-Obaid examined a sample of tablets
seized by the General Directorate of Drug Control in
Riyadh.16 They found that 84% of the conscated tablets
contained fenethylline, while the remainder (16%) were
composed of caeine and quinine.16 On the other hand, Al-
Hussaini examined conscated Captagon tablets between
1986 and 1993, only to nd that none of them contained
fenethylline.19 In fact, the tablets he examined contained
mixtures of other adulterants such as acetaminophen and
ephedrine (10%), ephedrine and amphetamine (13%), and
caeine and quinine (16%).19 In 2011, ocials from the Saudi
Ministry of Health examined the content of 98 stimulant
tablets that were seized by law authorities as Captagon
tablets.20 Fenethylline was not found in any of these tablets.
Instead, 38.8% of the tablets contained considerable
amounts of amphetamine, 49% contained trace amounts of
amphetamine, and 12.2% did not contain any amphetamine.
Additionally, the most frequent adulterants identied in
these tablets were caeine (96.9%), theophylline (93.9%),
allopurinol (59.2%), and acetaminophen (57.1%).20 These
ndings come in agreement with a report from Jordan that
showed that most Captagon tablets obtained by authorities
do not contain fenethylline, but are rather composed of
amphetamine and caeine.21 This supports the perception
that most Captagon tablets worldwide are “fake” and rarely
contain fenethylline.22 Furthermore, amphetamine seems
to be the active substance in most of these counterfeit
Amounts of Captagon conscated by Saudi authorities
Amounts of Captagon seizures from 2006 to 2011 were
fairly stable in Saudi Arabia, according to UNODC reports,
with a slight reduction in 2010 [Figure 1].13,22–25 These data
suggested that a total of 72.2 metric tons of Captagon
pills were conscated during this 6-year period. Although
more recent UNODC reports indicate a growing trend of
Captagon seizures in Saudi Arabia, they did not provide
data on the amounts conscated from 2012 onwards.14,26,27
Local newspaper reports suggested that a big portion of
Captagon smuggling attempts were halted at Al-Hadithah
entry port, which is located in the northern part of Saudi
Arabia at the Jordanian border.28,29 Additionally, reports
indicated that smuggled Captagon tablets destined to
Saudi Arabia came from the United Arab Emirates or
Lebanon.30,31 Furthermore, from 2012 to 2016, a total
number of 367,870,293 Captagon pills were seized in
Saudi Arabia, according to law enforcement reports.32 It
is important to point out, however, that newspaper data
should be interpreted with caution, as they do not provide
methodologically sound information about the scope
of Captagon use that can be generalized to the Saudi
Trends of Amphetamine use in clinical and general Saudi
population settings
Although substance abuse has been briey explored
in Saudi Arabia, few studies address amphetamine use,
and none make reference to Captagon as the source
of amphetmaine [Table 1].33–40 In 1995, Hafeiz explored
types and patterns of substance use among 116 patients
admitted for drug abuse treatment at Al-Amal Complex,
Dammam.43 The major substance abused in that population
was heroin (83.6%), while only 10% abused stimulants.43
Unfortunately, amphetamine was not particularly assessed
and it was not clear if it was categorized under “stimulants”.
This pattern of high heroin abuse is consistent with other
studies published between 1992 and 2000, which found
that between 43% and 63% of drug intoxicated patients
admitted to treatment centers were dependent on heroin,
while amphetamine dependence did not exceed 6.5%.33–35
This phenomenon was observed in both male and female
patients. It is important to note that these studies assessed
drug dependence and abuse using criteria from the DSM,
and did not assess drug use per se.34,35,43 In 2000, a study
was conducted on 423 male patients admitted to Buraidah
Mental Hospital (in the central region) and reported
that 25.3% of the admitted patients were diagnosed
with amphetamine abuse.36 In 2012, a study conducted
on adolescent patients admitted for drug dependence
showed that 28.7% were dependent on amphetamine.40
In more recent studies, there was a shift toward more
frequent use of amphetamines. AbuMadini and colleagues
investigated 12,743 medical records from 1986 to 2006
at a substance use treatment center in Dammam. They
assessed frequency of substances used among patients,
demographic characteristics and changes in trend.37 Their
results indicated that the frequency of amphetamine use
increased over time from 12 % in 1987 to 72.8% in 2006.
There was a dramatic rise in amphetamine use between
2000 and 2002 (from 38% to 51%).37 Amphetamines are
also the most used substance among criminal oenders
treated at that same center.39
In 2008, Bassiony explored age at onset and stages of
progression of substance abuse at Al-Amal Complex
in Jeddah.38 He found that, after excluding tobacco,
amphetamine was the most common substance initiated
in both adolescents and adults in his sample. Among
the 101 patients included in that study, the prevalence
of amphetamine use was 71.3%.38 This nding comes in
agreement with a review of substance abuse literature
conducted in 2013, which concluded that the most
commonly abused drug by adolescent and adult males in
the country was amphetamine.44
Despite the eorts in studying drug use trends in Saudi
Arabia, only three studies addressed amphetamine “use”,
while the rest addressed amphetamine use disorder (in
the form of dependence or abuse) [Table 1]. This makes it
dicult to comment on change in trends of use, that did | 25
not reach the level of disorder, across these studies.
Another noteworthy observation is that these studies
rarely addressed drug use among women. The only three
studies that did sample women reported crude prevalence
estimates (for men and women combined)33,39,40 Additionally,
none of these studies assessed amphetamine use patterns,
demographic dierences in trends, or associated risk
factors for amphetamine use. Furthermore, Captagon is not
explicitly mentioned in these studies. However, Bassiony
and colleagues make the assumption that Captagon may
have been generally categorized under “amphetamines”.44
To our knowledge, none of the reviewed studies reported
on Captagon use (or amphetamine use) in the general
population. Newspaper reports suggested an increasing
trend in the use of Captagon by high school and college
students, in order to increase concentration – especially
during the examination season.45 This information is
alarming because this vulnerable age group may be
unaware of the dangers of this substance and could be
easily targeted by drug dealers.
Medical complications of Captagon use reported in
Saudi Arabia
Some Saudi studies have reported complications associated
with amphetamine use, but few relate complications
with Captagon [Table 2].40,56–62 One of the reported
complications for Captagon (when urine was positive for
amphetamines) was myocardial infarction. A case report
was published about a 35-year-old man, with no history
of heart disease, who presented to the ER with acute chest
pain and shortness of breath after using amphetamines
and benzodiazepines.61 After further examination and
testing, he was diagnosed with myocardial infarction.61 A
case series of 7,450 patients, admitted with cardiovascular
conditions at a hospital in Riyadh, showed that 9.6% of the
patients had positive urine screening for amphetamines at
the time of admission.60 Prolonged Captagon use may also
have ocular complications.57 Three cases of hemorrhagic
central retinal vein occlusion have been reported after
prolonged Captagon use.57 Additionally, acute hearing loss
has been reported in association with Captagon use.56
Important psychiatric complications have also been
associated with amphetamine use. Amphetamine-induced
psychosis has been reported, without explicitly referring
to the use of Captagon as the source of amphetamine.40,59
El-Tantawy and colleagues described the psychotic
episodes as brief, acute in onset, with sudden remission
and characteristic of paranoid psychosis. They examined
substances associated with drug-related psychosis in
106 patients at a mental hospital in Al-Qassim and found
that 32% of the psychotic episodes were related to
amphetamine use.59 Interestingly, all of the amphetamine-
related psychotic episodes occurred in males and
the most common symptom presented was auditory
Suicidal ideation has also been reported in association
with amphetamine abuse.62 Additionally, the chronic use
of amphetamines is thought to negatively impact on
cognitive functions.58 Al-Zahrani and Elsayed examined
executive brain functions in substance abuse patients
(who used alcohol, amphetamine tablets or heroin) who
completed detoxication treatment in comparison to
a group of controls (individuals who had no history of
substance use). Their results showed that all substance
users functioned worse than the control group, and
that, after alcohol, amphetamine users functioned more
poorly compared to heroin users.58 However, the source of
amphetamine was not mentioned and Captagon was not
referenced in their study.
This review presents a summary about the use of Captagon
in Saudi Arabia. The reviewed literature suggests that most
of the Captagon pills marketed to Saudi Arabia are most
probably “fake” pills; rarely containing fenethylline, the
psychoactive substance from which the original Captagon
tablet was manufactured. Although this observation was
proven in the retrieved studies,16,19,20 to our knowledge,
the most recent study that analyzed conscated Captagon
tablets was conducted on a small sample (98 tablets).
UNODC seizure reports suggest that the country is a well-
known target for the Captagon market. This is implied by
the considerably large amount of pills conscated over the
past decade.13,14,22–27
Although substance use has been discussed in the clinical
setting in the Saudi medical literature, little reference is given
to the use of Captagon and it is most probably categorized
under “amphetamines”. Most recent studies on substance
use in patients at dependence treatment centers suggest
that amphetamines are the most used illegal substance in
the country.37,38,44 The shift from heroin use to amphetamine
use suggested by these studies, and which possibly took
place in the late 1990s, comes in agreement with UNODC
reports that indicate a rise in ATS use in Middle Eastern
countries from 2000 onwards.64 Additionally, in 2005, there
was a notable jump in the amounts of seized amphetamines
from Saudi Arabia, as compared to 2000.64 Unfortunately,
we could not support this review with information about
prevalence and trends of Captagon use in the general non-
hospitalized Saudi population, which to our knowledge, has
not been explored.
In our review, we found studies that have been published
about complications associated with amphetamine use
in Saudi Arabia. One complication related to short-term
use is amphetamine-induced psychosis.40,59 Captagon-
induced hearing loss that is acute in nature was also
reported.56 Complications related to chronic use include
myocardial infarction, hemorrhagic central retinal vein
occlusion, suicidal ideation, and deterioration of cognitive
26 | Volume 2 | Number 2 | January 2019
International Addiction Review
Even though helpful information was available for this
review, many deciencies in these data should be noted.
First, the latest study that tested the chemical composition
of available Captagon pills was conducted in 2011 and on
a small number of tablets. Additionally, it was not clear if all
tablets in the sample were collected from the same source.
Thus, it is dicult to generalize these ndings to the
composition of all available tablets currently circulating in
the region. Second, few studies are conducted about illegal
substance use in the clinical setting in Saudi Arabia, and
even fewer address the use of Captagon, although there is
a consensus that amphetamine may be the drug for major
public health concern.38,44 Third, we could not nd data for
the prevalence of Captagon use in the general population.
Finally, little attention is given to female illegal substance
use and trends of Captagon use in women are nonexistent
in the Saudi medical literature. In the reviewed studies,
most of the patients were men. This could be related to the
fact that most of the studies were conducted at specialized
substance dependence treatment centers that do not
treat women. Instead, women usually seek treatment for
substance dependence at psychiatric hospitals.44
A noteworthy limitation to our review is that we limited
our search to published articles related to Captagon or
amphetamine use in Saudi Arabia, that were in English.
This subjects our data to selection bias. Additionally, our
ndings cannot be generalized to the Saudi population.
Despite these shortcomings, this review provides an
outlook on Captagon use in Saudi Arabia, pointing out
the related issues that have yet to be addressed in the
literature. We hope that this can stimulate substance use
researchers to understand the need for extended research
on Captagon use in the country, in order to better grasp
the scope of this problem.
Conclusion and recommendations
This review reinforces the common perception of
amphetamines being the most used illegal substance
in Saudi Arabia, and that most of the consumed
amphetamine in the country could be in the form of
counterfeit Captagon. A lot of work needs to be done to
fully understand the scope of Captagon use in the country
and many questions still remain unanswered. For example,
we still do not know the prevalence of Captagon use in
any well-dened population. It is essential to estimate the
prevalence of Captagon use among substance users in the
community. This can be partially achieved by conducting
descriptive studies on institutionalized populations
receiving treatment. It is also important to learn the overall
prevalence of using this substance in the general population
(or at least in potentially vulnerable groups such as high
school and college students) in order to monitor change
of population trends of use over time. The community
needs to be educated about the harms of Captagon
use, in order to abolish false claims about Captagon’s
ability to increase concentration. We also need to explore
psychiatric and medical conditions that may be associated
with chronic Captagon use through conducting case-
control studies, or longitudinal studies in which Captagon
users in treatment centers are followed up for substance-
use relapse and other health complications. Additionally,
other analytical studies could be conducted in order to
understand the demographic characteristics of Captagon
users, and identify potential environmental, medical and
psychological risk factors for its use. Conducting this kind
of research is crucial for directing law enforcement ocials,
substance use treatment experts, and other stakeholders
toward the best methods to prevent and control Captagon
use in Saudi Arabia.
Figure 1: Trends of Captagon Seizures in Saudi Arabia from United Nations Oce on Drugs and Crime Reports, from 2006 to 2011 | 27
Table 1. Studies Addressing Amphetamine Use in Published Saudi Literature, from 1992 to 2010
Qureshi and
et al.37
El-Sayed, et
et al.40
Sample Region, City Estimate ReportedStudy Setting
Western region, Jeddah
Western region, Jeddah
Western region, Jeddah
Central region (Al-Qassim),
Eastern region, Dammam
Eastern region, Dammam
Eastern region, Dammam
Western region, Jeddah
5.2% were identied as
amphetamine abusers*
6.5% were admitted for
amphetamine dependence¥
4% were admitted for
amphetamine dependence¥
25.3% were identied as
amphetamine abusers‡
72.8% o reported using
71.3% reported using
39% reported using
27.8% were admitted for
amphetamine dependence¥
Male and female adult patients admitted for drug abuse*
at Jeddah Psychiatric Hospital
Male adult patients admitted for drug dependence¥ at
Al-Amal Complex
Male adult patients admitted for drug dependence¥ at
Al-Amal Complex
Male adult patients at Buraidah Mental Health Hospital
Male adult patients admitted for polydrug abuse at
Al-Amal Complex
Male patients admitted for substance abuse† or
dependence¥ at Al-Amal Complex (adults and adolescents)
Male and female adult criminal oenders admitted for
legal mental health assessment at Al-Amal Complex
Male and female adolescents admitted for drug
dependence at Al-Amal Complex
* Abuse was dened as “the compulsive use of any psychoactive substance, illicit or prescribed, in enough and regular doses to such an extent that it adversely
aects a person’s health or socio-occupational functioning”.33
¥ Dependence was dened according to criteria from the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV); presence of three
or more of the following over a period of 12 months: 1) tolerance, 2) substance is taken to relive withdrawal symptoms, 3) persistent desire or unsuccessful
attempts to quit, 4) reduced or impaired social, occupational and daily functions because of use, 5) spending prolonged time on obtaining, using and recovering
from use, 6) continued use despite awareness of having physical and psychological problems related to use.41
Abuse was dened according to the revised DSM-III criteria; presence of at least one of the following over a period of 12 months without meeting criteria for
dependence for that substance: 1) persistent use in situations where using the drug is physically hazardous, 2) continued use despite awareness of the social,
occupational, psychological and physical consequences of using the substance.42
Abuse was dened according to DSM-IV criteria; presence of one or more of the following over a period of 12 months and without meeting the criteria for
dependence for that substance: 1) recurrent use resulting in failure to fulll major daily obligations, 2) recurrent legal problems related to substance use, 3)
recurrent use of the substance in situations where use is physically hazardous, 4) recurrent use despite having social or interpersonal problems caused by or
exacerbated by using the substance.41
Table 2. Medical Complications Reported in Association with Captagon or Amphetamine Use in the Saudi Literature, from 2002 to 2016
Medical Complication Drug Reported Study Design Year Published Authors
Hearing loss Captagon Case -series 2002 Iqbal 56
Hemorrhagic central retinal vein occlusion Captagon Case -series 2009 Al-Ghaydan, et al.57
Cognitive impairment Amphetamine Cross-sectional 2009 Al-Zahrani and Elsayed 58
Amphetamine-induced psychosis* Amphetamine Cross-sectional 2010 El-Tentawy, et al.59
Cross-sectional 2012 Alibrahim, et al.40
Cardiovascular conditions¥ Amphetamine Case-series 2016 Alghamdi, et al.60
Myocardial infarction Captagon Case -report 2016 Al-Shehri and Youssef 61
Suicidal ideation Amphetamine Case-control 2016 Youssef, et al.62
* El-Tantawy and colleagues diagnosed amphetamine-induced psychosis using the ICD-10 denition; “A psychotic disorder occurring during or immediately after
drug use (usually within 48 hours) provided that it is not a manifestation of drug- withdrawal state with delirium”.63 Alibrahim and colleagues assessed presence
of psychotic symptoms.40
¥ These included acute coronary syndrome, acute mayopericarditis, cardiomyopathy, heart failure and arrhythmia.
28 | Volume 2 | Number 2 | January 2019
International Addiction Review
ﺔــﻴﺑﺮﻌﻟا ﺔــﻜﻠﻤﻤﻟا ﻲــﻓ ﺰــﺠﺠﻟا تﺎــﻴﻠﻤﻋ ﺮــﺜﻛأ ﻞﻴﺠــﺴﺗ ﻢــﺗ ﺪــﻗ و .1981 ﺔﻨــﺳ ﻢــﻟﺎﻌﻟا ﺮــﺒﻋ هﺮــﻈﺣ ﻢــﺗ ﺰــﻔﺤﻣ «نﻮــﺟﺎﺘﺑﺎﻛ» رﺎــﻘﻋ ﺮــﺒﺘﻌﻳ :ﺔــﺳارﺪﻟا لﻮــﺣ ةﺬــﺒﻧ
رﻮــﻈﻨﻣ ﻦــﻣ ﺔﻳدﻮﻌــﺴﻟا ﺔــﻴﺑﺮﻌﻟا ﺔــﻜﻠﻤﻤﻟا ﻲــﻓ «نﻮــﺟﺎﺘﺑﺎﻛ» رﺎــﻘﻋ ﺔــﺳارﺪﻟا هﺬــﻫ ﺺــﺨﻠﺗ و .ﺪــﻠﺒﻟا اﺬــﻫ ﻲــﻓ رﺎــﻘﻌﻟا اﺬــﻫ ﻲــﻃﺎﻌﺗ فﺮــﻌﻳ ﻞــﻴﻠﻘﻟا نأ ﻻإ ﺔﻳدﻮﻌــﺴﻟا
.ﻰــﺿﺮﻤﻟا ﺪــﻨﻋ ﻲــﻃﺎﻌﺘﻟا تﺎــﻔﻋﺎﻀﻣ و يﺮﻳﺮــﺴﻟا قﺎﻴــﺴﻟا ﻲــﻓ ﻲــﻃﺎﻌﺘﻟا طﺎــﻤﻧأ و ﺎــﻫزﺎﺠﺘﺣا ﻢــﺗ ﻲــﺘﻟا تﺎــﺒﺤﻟا دﺪــﻋ و ﻪــﺋﺎﻘﻧ
و «ﺪــﻴﻣ بﻮــﺑ» ﺚــﺤﺒﻟا كﺮــﺤﻣ ﻲــﻓ ﺔــﻳﺰﻴﻠﺠﻧا ﺔــﻐﻠﻟﺎﺑ ﺔــﺑﻮﺘﻜﻣ ﺔﻳدﻮﻌــﺴﻟا ﺔــﻴﺑﺮﻌﻟا ﺔــﻜﻠﻤﻤﻟا ﻲــﻓ نﻮــﺟﺎﺘﺑﺎﻛ» رﺎــﻘﻌﺑ ﺔــﻄﺒﺗﺮﻣ تﻻﺎــﻘﻣ ﻰــﻠﻋ ﺎــﻨﺜﺤﺑ :ﺔــﻌﺒﺘﻤﻟا ﺔــﻘﻳﺮﻄﻟا
«ﺲــﺴﻜﻧ ﺲــﺴﻜﻟ» تﺎــﻧﺎﻴﺑ ةﺪــﻋﺎﻗ و و «ﻲــﺴﻔﻨﻟا ﺐــﻄﻠﻟ ﺔــﻴﺑﺮﻌﻟا ﺔــﻠﺠﻤﻟا» و «ﺔﻳدﻮﻌــﺴﻟا ﺔــﻴﺒﻄﻟا ﺔــﻠﺠﻤﻟا» و «يدﻮﻌــﺴﻟا ﺐــﻄﻟا تﺎــﻴﻟﻮﺣ«و «ﻮــﻔﻧإ ﻚﻳﺎــﺳ» تﺎــﻧﺎﻴﺒﻟا ةﺪــﻋﺎﻗ
يﻮــﺘﺤﺗ ﺎــﻣ اردﺎــﻧ و ﺔــﺷﻮﺸﻐﻣ صاﺮــﻗأ ﻦــﻋ ةرﺎــﺒﻋ ﻲــﻫ 2012 ﺔﻨــﺳ ﺔــﻳﺎﻏ ﻰــﻟإ و 1986 ﺔﻨــﺳ ﻦــﻣ ﺎــﻬﺘﻨﻳﺎﻌﻣ ﻢــﺗ ﻲــﺘﻟا «نﻮــﺟﺎﺘﺑﺎﻛ» رﺎــﻘﻋ صاﺮــﻗأ ﻢــﻈﻌﻣ :ﺔــﺠﻴﺘﻨﻟا
تاﺮــﺛﺆﻤﻟا ﻲــﻃﺎﻌﺗ جﻼــﻌﺑ ﺔــﺻﺎﺨﻟا تﺎــﺳارﺪﻟا تﺮــﻬﻇأ و .ىﺮــﺧأ تﺎــﺒﻛﺮﻤﺑ ﺔــﺷﻮﺸﻐﻣ «ﻦــﻴﻣﺎﺘﻴﻔﻣا» ﻦــﻣ ﺔــﻧﻮﻜﻣ ﻊــﻗاﻮﻟا ﻲــﻓ ﻲــﻫ و «ﻦــﻴﻠﻴﺜﻴﻨﻴﻔﻟا» ﺐــﻛﺮﻣ ﻰــﻠﻋ
رﺎــﻘﻋ ﺮــﻛذ ءﺎــﺟ ﺎــﻣ اردﺎــﻧ ﻪــﻧأ ﻢــﻏر و .٪٧٢٫٨ و ٪٣٩ ﻦــﻴﺑ حواﺮــﺗ ﻰــﺿﺮﻤﻟا ﻦــﻴﺑ «ﻦــﻴﻣﺎﺘﻴﻔﻣا» ﻲــﻃﺎﻌﺗ رﺎــﺸﺘﻧا نأ ٢٠١٠ و ٢٠٠٨ ﻦــﻴﺑ ةﺮــﺘﻔﻟا ﻲــﻓ ﺖــﻳﺮﺟأ ﻲــﺘﻟا ﺔــﻴﻠﻘﻌﻟا
ﺖﻠﻤــﺷ و .ﺔﻳدﻮﻌــﺴﻟا ﺔــﻴﺑﺮﻌﻟا ﺔــﻜﻠﻤﻤﻟا ﻲــﻓ «ﻦــﻴﻣﺎﺘﻴﻔﻣا» رﺎﻘﻌـــﻟ ﺲــﻴﺋﺮﻟا رﺪــﺼﻤﻟا ﻪــﻧأ ﻰــﻟإ ترﺎــﺷأ ىﺮــﺧأ تﺎــﺳارد نأ ﻻإ تﺎــﺳارﺪﻟا ﻚــﻠﺗ ﻦــﻤﺿ «نﻮــﺟﺎﺘﺑﺎﻛ»
و سﻮــﻬﻟا و ﻊﻤــﺴﻟا ﺔــﺳﺎﺣ ناﺪــﻘﻓ و ﺔــﻴﺒﻠﻘﻟا ﺔﺘﻜــﺴﻟا ﺔﻳدﻮﻌــﺴﻟا تﺎــﺳارﺪﻟا ﻦــﻤﺿ ﺎــﻫﺮﻛذ ءﺎــﺟ ﻲــﺘﻟا «ﻦــﻴﻣﺎﺘﻴﻔﻣا«ﻲﻃﺎﻌﺘﺑ ﺔــﻄﺒﺗﺮﻤﻟا ﺔــﻴﺒﻄﻟا تﺎــﻔﻋﺎﻀﻤﻟا
.ﺔــﻴﻛاردا ﻒــﺋﺎﻇﻮﻟا ﻲــﻓ رﻮــﻫﺪﺗ و رﺎــﺤﺘﻧا ﻲــﻓ ﺮــﻴﻜﻔﺘﻟا
ﺎــﻴﻃﺎﻌﺗ ﺮــﺜﻛا ﻲﻋﺮــﺸﻟا ﺮــﻴﻏ ﻲــﻠﻘﻌﻟا ﺮــﺛﺆﻤﻟا ﺮــﺒﺘﻌﻳ يﺬــﻟا «ﻦــﻴﻣﺎﺘﻴﻔﻣا» رﺎــﻘﻋ ﻰــﻠﻋ يﻮــﺘﺤﺗ و ﺔــﺷﻮﺸﻐﻣ «نﻮــﺟﺎﺘﺑﺎﻛ» صاﺮــﻗأ نأ ﻦــﻀﻟا ﺐــﻟﺎﻏ ﻲــﻓ :ﺔــﺻﻼﺨﻟا
ﺔــﺟﺎﺣ كﺎــﻨﻫ و .«شﻮــﺸﻐﻣ نﻮــﺟﺎﺘﺒﻛ» ﻦــﻋ ةرﺎــﺒﻋ «ﻦــﻴﻣﺎﺘﻴﻔﻣ» ـــﻟ ﺪﺋﺎــﺴﻟا رﺪــﺼﻤﻟا ﺮــﺒﺘﻌﻳ ﺎــﻤﻛ تارﺪــﺨﻤﻟا ﻲــﻃﺎﻌﺗ ﺐﺒــﺴﺑ جﻼــﻌﻠﻟ ﻦــﻴﻘﻠﺘﻤﻟا ﻰــﺿﺮﻤﻟا ﻞــﺒﻗ ﻦــﻣ
.ﺔﻳدﻮﻌــﺴﻟا ﺔــﻴﺑﺮﻌﻟا ﺔــﻜﻠﻤﻤﻟا ﻲــﻓ «نﻮــﺟﺎﺘﺑﺎﻛ» رﺎــﻘﻋ ﻲــﻃﺎﻌﺗ ىﺪــﻤﻟ ﻞــﻀﻓأ ﻢــﻬﻔﻟ ﻞــﺻﻮﺘﻠﻟ و تﺎــﻴﺿاﺮﺘﻓا هﺬــﻫ ﻦــﻣ ﻖــﻘﺤﺘﻠﻟ ﺮــﻓوأ تﺎــﺳارد ءاﺮــﺟ
Contexte: Captagon est un stimulant interdit dans le monde entier depuis 1981. Le plus grand nombre de saisies de
Captagon dans le monde ont lieu en Arabie saoudite, déjà peu est connu au sujet de son utilisation dans ce pays.
Cette revue résume Captagon en Arabie saoudite en termes de pureté de la drogue, les quantités de pilules saisies, les
tendances d’utilisation dans les milieux cliniques et les complications liées à l’utilisation chez les patients.
Méthodes: Nous avons eectué des recherches Pubmed, Psychinfo, Annales de médecine saoudienne, Journal Médical Saoudien,
Journal arabe de Psychiatrie et bases de données LexisNexis pour les articles liés à Captagon en Arabie Saoudite, publié en anglais.
Résultats: La majorité des comprimés Captagon examinés entre 1986 et 2012 étaient des médicaments contrefaits
contenant rarement de la fénéthylline, mais étaient plutôt composés d’amphétamine et d’un mélange d’autres
adultérant. Les études des centres de traitement de la toxicomanie de 2008 à 2010 ont suggéré que la prévalence de la
consommation d’amphétamine chez les patients allait de 39% à 72,8%.
Bien que la Captagon ait rarement été mentionnée dans ces études, d’autres études suggèrent que c’est la source la plus
commune d’amphétamines en Arabie saoudite.
Les complications médicales rapportées avec l’utilisation d’amphétamine, dans la littérature saoudienne, incluaient
l’infarctus du myocarde, la perte auditive, la psychose, les idées suicidaires et la détérioration des fonctions cognitives.
Conclusion: les comprimés Captagon disponibles sont probablement contrefaits; contenant des amphétamines. La
substance illégale la plus couramment utilisée par les patients dans le traitement de l’usage de drogues est l’amphétamine,
et la source la plus commune d’amphétamine pourrait être sous la forme de «Captagon contrefaits».
D’autres recherches analytiques sont nécessaires pour sauvegarder ces hypothèses et mieux comprendre la portée de
l’utilisation Captagon en Arabie saoudite.
Mots clés : Fenethylline; Captagon; Stimulant; Amphétamine; Arabie Saoudite
Rufaidah Dabbagha, *, DrPH, Richard Rawsonb, c, PhD
a Département de médecine familiale et communautaire, faculté de médecine de l›Université King Saud, PO Box 2925, Riyad 11461, Arabie saoudite.
b Centre pour le comportement et la santé, Département de psychiatrie, Université du Vermont.
c Département de psychiatrie, École de médecine David Geen, UCLA.
Conits d’intérêts et source de nancement: Les auteurs ne déclarent aucun conit d›intérêts. Les auteurs n›ont reçu aucun nancement pour cet examen.
Utilisation de Captagon en Arabie Saoudite: Que savons-nous? | 29
1. Kristen G, Schaefer A, von Schlichtegroll A. Fenetylline: therapeutic use,
misuse and/or abuse. Drug Alcohol Depend 1986;17(2-3):259-71.
2. Nickel B, Niebch G, Peter G, von Schlichtegroll A, Tibes U. Fenetylline: new
results on pharmacology, metabolism and kinetics. Drug Alcohol Depend
3. Nevescanin M, Stevic S, Petrovic S, Vajs V. Analysis of amphetamines
illegally produced in Serbia. J Serb Chem Soc 2008;73(7):691-701.
4. Katselou M, Papoutsis I, Nikolaou P, Qammaz S, Spiliopoulou C,
Athanaselis S. Fenthylline (Captagon) abuse - local problems from an old
drug become universal. Basic Clin Pharmacol Toxicol 2016;119:133-40.
5. Mussho F. Illegal or illegitimate use? precursor compounds to amphetamine
and methamphetamine. Drug Metabol Rev 2001;32(1):15-44.
6. Van Hout MC, Wells J. Is Captagon (fenethylline) helping to fuel the Syrian
conict? Addiction 2016;111(4):748-9.
7. Koob GF, Arends MA, Le Moal M. Chapter 4 - Psychostimulants. Drugs,
Addiction, and the Brain. San Diego: Academic Press; 2014. p. 93-132.
8. American Psychiatric Association: Diagnostic and statistical manual
of mental disorders, Fifth Edition. Arlington, VA: American Psychiatric
Association; 2013.
9. Preve M, Casigliani S, Godio M, Saurdi NE, Traber R, Colombo RA.
Fenethylline (Captagon) abuse: case report and literature review. Eur
Psychiatry 2017;41:S393-S94.
10. Al-Imam A, Santacroce R, Roman-Urrestarazu A, Chilcott R, Bersani G,
Martinotti G, et al. Captagon: use and trade in the Middle East. Hum
Psychopharmacol 2017;32(3).
11. Lut A. Fenethylline in the Middle East, a thriving trade in the post-
Saddam era. Asian J Med Sci 2016;7(4):116-19.
12. Kravitz M, Nichols W. A bitter pill to swallow: connections between
Captagon, Syria and the Gulf. J Int A 2016;69(2):31-42.
13. United Nations Oce on Drug and Crime (UNODC). World Drug Report
2009. Vienna, Austria: United Nations; 2009.
14. United Nations Oce on Drug and Crime (UNODC). World Drug Report
2017. Vienna, Austria: United Nations; 2017.
15. Al-Haqwi AI. Perception among medical students in Riyadh, Saudi
Arabia, regarding alcohol and substance abuse in the community: a
cross-sectional survey. Subst Abuse Treat Prev Policy 2010;5:2.
16. Al-Gharably N, Al-Obaid A. The Characterization of counterfeit Captagon
tablets. J Forensic Sci Soc 1994;34:165-7.
17. Ministry of Interior, General Directorate of Narcotics Control. Penalties.
Available at:
Zw!!/dz/d5/L2dBISEvZ0FBIS9nQSEh/. Accessed on: Nov 20, 2017.
18. AlMarri TS, Oei TPS. Alcohol and substance use in the Arabian Gulf region:
A review. Int J Psychol 2009;44(3):222-33.
19. Al-Hussaini SR. Counterfeit Captagon: an analytical study. Sci Justice
20. Al-Mazroua M. Analysis of captagon tablets in Saudi Arabia. Available
Saudi%20Arabia.pdf. Accessed on: Nov 20, 2017.
21. Alabdalla MA. Chemical characterization of counterfeit captagon tablets
seized in Jordan. Forensic Sci Int 2005;152(2-3):185-8.
22. United Nations Oce on Drug and Crime (UNODC). World Drug Report
2013. Vienna, Austria: United Nations; 2013.
23. United Nations Oce on Drug and Crime (UNODC). World Drug Report
2008. Vienna, Austria: United Nations; 2008.
24. United Nations Oce on Drug and Crime (UNODC). World Drug Report
2010. Vienna, Austria: United Nations; 2010.
25. United Nations Oce on Drug and Crime (UNODC). World Drug Report
2011. Vienna, Austria: United Nations; 2011.
26. United Nations Oce on Drug and Crime (UNODC). World Drug Report 2015.
Vienna, Austria: United Nations; 2015.
27. United Nations Oce on Drug and Crime (UNODC). World Drug Report
2016. Vienna, Austria: United Nations; 2016.
28. Al-Haditha customs foils 3 attempts of smuggling Captagon pills. Saudi
Arabia News Gazette. 2017 Apr 16.
29. Toumi H. Saudi Arabia: attempt to smuggle 15m Captagon pills foiled.
Gulf News. 2014 Jul 25.
30. Dubai police sieze four million Captagon capsules in UAE’s drug operation.
BBC Monitoring Middle East. 2009 Dec 18.
31. Saudi-Lebanese joint operation foils attempt to smuggle drugs. The Daily
Star. 2015 Mar 7.
32. Crown prince: war on drugs needed. Arab News. 2016 Dec 19.
33. Osman AA. Substance abuse among patients attending a psychiatric
hospital in Jeddah: a descriptive study. Ann Saudi Med 1992;12(3):289-93.
34. Abalkhail BA. Characteristics, nutritional and health status of addicts
hospitalized for detoxication. Saudi Med J 1999;20(7):536-40.
35. Iqbal N. Substance dependence. A hospital based survey. Saudi Med J
36. Qureshi NA, Al-Habeeb TA. Sociodemographic parameters and clinical
patterns of drug abuse in Al-Qassim region -- Saudi Arabia. Arab J
Psychiatry 2000;11(1):10-21.
37. AbuMadini MS, Rahim SI, Al-Zahrani MA, Al-Johi AO. Two decades of
treatment seeking for substance use disorders in Saudi Arabia: trends and
patterns in a rehabilitation facility in Dammam. Drug Alcohol Depend
38. Bassiony MM. Stages of progressinon in drug abuse involvement across
generations in Jeddah, Saudi Arabia. Neurosciences 2008; 13(1): 37¬-40.
39. Elsayed YA, Al-Zahrani M, Rashad MM. Characteristics of mentally
ill oenders from 100 psychiatric court reports. Ann Gen Psychiatry
40. Alibrahim O, Elawad N, Misau YA, Shaikh TM, Allam N. Drug Dependence
and Psychotic Symptoms: A Retrospective Study of Adolescents Who
Abuse Drugs at Al-Amal Hospital in Jeddah, Saudi Arabia. J Public Health
Afr 2012;3(1):e5.
41. American Psychiatric Association: Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric
Association, 2000.
42. American Psychiatric Association: Diagnostic and statistical manual
of mental disorders, Third Edition Revised. Washington, DC: American
Psychiatric Association, 1987.
43. Hafeiz HB. Socio-demographic correlates and pattern of drug abuse in
eastern Saudi Arabia. Drug Alcohol Depend 1995;38(3):255-9.
44. Bassiony M. Substance use disorders in Saudi Arabia: review article. J
30 | Volume 2 | Number 2 | January 2019
International Addiction Review
Subst Use 2013;18(6):450-66.
45. Muhammad F. Expert calls for cooperation to combat drugs as exams
near. Saudi Gazette. 2014 May 12.
56. Iqbal N. Hearing loss in amphetamine users. J Psychoactive Drugs
57. Al-Ghaydan A, Rushood AA, Alhumeidan AA. Fenethylline as a possible
etiology for retinal vein occlusion. Ann Ophtalmol (Skokie) 2009;41(3-
58. Al-Zahrani MA, Elsayed YA. The impacts of substance abuse and
dependence on neuropsychological functions in a sample of patients
from Saudi Arabia. Behav Brain Funct 2009;5:48.
59. El-Tantawy A, Raya Y, Al-Yahya A, El-Desoky I. Amphetamine abuse
among patients with rst episode of acute psychosis. Curr Psychiatry
[Egypt]. 2010;17(1):1-5.
60. Alghamdi M, Alqahtani B, Alhowti S. Cardiovascular complications among
individuals with amphetamine-positive urine drug screening admitted to
a tertiary care hospital in Riyadh. J Saudi Heart Assoc 2016;28(3):129-35.
61. Al Shehri MA, Youssef AA. Acute myocardial infarction with multiple
coronary thromboses in a young addict of amphetamines and
benzodiazepines. J Saudi Heart Assoc 2016;28(3):180-4.
62. Youssef IM, Fahmy MT, Haggag WL, Mohamed KA, Baalash AA. Dual
Diagnosis and Suicide Probability in Poly-Drug Users. J Coll Physicians
Surg Pak 2016;26(2):130-3.
63. World Health Organization. The ICD-10 classication of mental and
behavioural disorders: Clinical descriptions and diagnostic guidelines.
Geneva: World Health Organization, 1992.
64. United Nations Oce On Drug and Crime (UNODC). World Drug Report
2007. Vienna, Austria: United Nations; 2007.
... A number of cases of seizure of captagon tablets have been reported from countries such as Saudi Arabia, Jordan, Iraq, Bulgaria, Lebanon, Turkey, Serbia and Yemen during the period 1992-2013 and is still counting. The forensic analysis of these tablets revealed the psychoactive agent amphetamine as the principle constituent, often present with other substances (Alabdalla, 2005;Dabbagh and Rawson, 2019;Al-Gharably and Al-Obaid, 1993;Dimova and Dinkof, 1994;Nevescanin et al., 2008;DEA, 2009;UNODC, 2009;TUBIM, 2013;Demirkiran et al., 2014). The amount of amphetamine varied in different seized tablets when analyzed, which varied from trace quantities to more than one third of the total tablet weight. ...
... The amount of amphetamine varied in different seized tablets when analyzed, which varied from trace quantities to more than one third of the total tablet weight. Earlier, a forensic analysis of captagon tablets seized in Saudi Arabia led to the finding that nearly half of the seized tablets contained amphetamine in trace amount, whereas, the other half contained approximately 38% amphetamine which was highly significant (Dabbagh and Rawson 2019). ...
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A number of illegal amphetamine tablets were seized from three different cities of Jazan province of southern Saudi Arabia and were analyzed for amphetamine and methamphetamine contents using LC-MS/MS technique. Analyses were performed using a previously reported method taking 0.1 M ammonium formate buffer (85%) and 15% acetonitrile with 0.1% formic acid as mobile phase with a total runtime of 12 minutes. This method was successfully applied for the routine analysis of amphetamine and methamphetamine in the seized tablets using amphetamine-D5 and methamphetamine-D5 as internal standards. Hierarchical cluster analysis was performed to establish the similarity between samples. The retention times (RT) for internal standard, amphetamine and methamphetamine were observed to be within 6.0-7.1 minutes. Ten tablet samples from each city were subjected to analysis and the amount of amphetamine in all the samples were found to be in the range of 9.07-14.77 mg, whereas, the amount of methamphetamine ranged from 0.12-0.24 mg in each tablet. Hierarchical cluster analysis showed presence of five clusters of samples indicating different characteristics and possible sources of amphetamine tablets. The largest cluster consisted of 15 samples which are expected to be of the same origin. Both amphetamine and methamphetamine are considered to be illegal products and their illegal trade and use is banned in many countries including Saudi Arabia. Therefore, there is an urgent need of strict regulations worldwide to check the illicit trafficking of these psychoactive substances and should be considered on priority.
... This may be due to prohibitions and the conservative culture, which makes psychoactive substances less available to them than to males [7]. Amphetamine in Saudi Arabia is usually available as white pills called Captagon, which is the brand name of fenethylline, an amphetamine connected to theophylline via an alkyl chain [10]. ...
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Numerous agents with anxiolytic or stimulant effects have the potential to be overused, and their misuse is associated with serious side effects. In Saudi Arabia, the estimated percentage of Saudis who abuse drugs is around 7–8% and the age range is 12–22 years. Methamphetamine, captagon, tramadol, heroin, and cannabis/cannabinoids have been proven to be the most commonly abused drugs in Saudi Arabia, with methamphetamine being at the top of the list. The present study focuses on the chromatographic analytical methods used for the analysis of methamphetamine in combination with commonly abused drugs, aiming to point out the greenest among them. These mixtures have been chosen as they are analyzed periodically and frequently in criminal evidence and forensic medicine. Therefore, the chances of hazards for analysts and the environment are high if the mixtures are not handled appropriately. This study aims to compare 23 chromatographic methods used for the analysis of methamphetamine mixtures in four major combinations, and to assess their greenness by using three greenness assessment tools, namely, NEMI, ESA and AGREE, to recommend the greenest analytical method. The NEMI results were proven to have low discriminating abilities and, accordingly, the comparisons are based on ESA and AGREE scores. The analysis results show that the safest methods with the most eco-friendly results (based on ESA and AGREE) are the GC-MS method proposed by Mohammed et al. to analyze methamphetamine and captagon mixtures (ESA = 79 and AGREE = 0.57), the UHPLC–MS-MS method proposed by Busardò et al. to analyze methamphetamine and cannabis/cannabinoid mixtures (ESA = 78 and AGREE = 0.57), the LC-MS method proposed by Herrin et al. to analyze methamphetamine and tramadol mixtures (ESA = 81 and AGREE = 0.56), and the LC-MS method proposed by Postigo-et al to analyze methamphetamine and heroin mixtures (ESA = 76 and AGREE = 0.58).
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Amphetamine abuse is a known problem in Saudi Arabia; it is estimated that 40% of drug abusers misuse amphetamines. Here, our aim was to perform an up-to-date epidemiological study of amphetamine-related postmortem cases in Jeddah, Saudi Arabia, in which 235 postmortem cases were included. The largest number of cases was recorded for the groups aged between 31 and 40 years (86 cases) and the lowest number of cases was recorded for the group aged between 61 and 70 years old (5 cases). Amphetamine was co-ingested with other drug(s) in 55% of the total cases (blood with sodium fluoride (BN), median, 0.3 mg/L). Approximately 23% of all deaths were due to other co-ingested drugs (BN, median, 0.2 mg/L). Amphetamines alone were detected in 107 cases, (BN, median, 0.5 mg/L). Amphetamine was the sole cause of death in 16% of the studied cases (BN, median, 1.0 mg/L). The combination of amphetamine and a pre-existing disease were observed in 9.4% of all deaths (BN, median, 0.7 mg/L). The causes of death were determined to be accidental in the majority (47%) of cases, homicides in 26% of cases, suicides in 11% of cases, and unknown in 7% of cases. This is the first discussion of the amphetamine concentration in bile in amphetamine-related deaths, the relationship between amphetamine concentration in different bodily fluids, and the amphetamine concentration in putrefied corpses. This study concluded that amphetamine abuse in Jeddah, Saudi Arabia, increased over 400% between 2012 and 2018, and 41% of these cases involved violence. This result also suggests that preventive programs targeting youth and adolescent students are required to keep schools and universities free from drugs, especially amphetamines.
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Background: Fenetheylline, a psychostimulant drug, often branded as Captagon, is a combination of amphetamine and theophylline. Since the cessation of its legal production in 1986, counterfeited products have been produced illicitly in south-east Europe and far-east Asia. Its profitable trade has been linked to terrorist organizations, including Islamic State of Iraq and the Levant. This study aims to reach up-to-date data, concerning the Captagon e-commerce and use in the Middle East. Methods: A multi-staged and multi-lingual literature search was carried out. A list of prespecified keywords was applied across medical and paramedical databases, web and Dark web, search engines, social communication media, electronic commerce websites, media networks, and the Global Public Health Intelligence Network database. Results: The use of Captagon as a stimulant in terrorist settings has been marginally covered in the literature. Data can widely be retrieved from Google and AOL search engines, YouTube, and Amazon e-commerce websites, and to a lesser extent from Alibaba and eBay. On the contrary, Middle Eastern e-commerce websites yielded almost no results. Interestingly, the Dark web generated original data for Captagon e-commerce in the Middle East. Conclusion: Further investigations are needed on the role that psychoactive drugs play in terrorist attacks and civil war zones. Unless a comprehensive methodological strategy, inclusive of unconventional methods of research, is implemented, it will not be feasible to face such a threat to humanity.
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p> Aims and Objectives: To collect up-to-date knowledge using a systematic review of the literature and to get evidence-based data concerning Fenethylline , and its illegal commerce in the region of the Middle East after 2003. Materials and Methods: Four main medicalliterature databases were scrutinized using a list of pre-specified keywords. Additionally, social networks, and other resources were utilized to retrieve relevant data. The total number of references that were used in this paper is twenty-two. Results: The literature search was conducted from the 3rd of December to the 29th of December 2015. The search was done from Baghdad, Iraq via the Earth link-Telenet Internet Service Provider (ISP). The Total Search Engine Results Pages (SERPs) were 463137. The highest SERPs were for the keywords “Amphetamine” and “Fitton.” Google Scholar and PubMed were the databases that scored the highest SERPs. Captagon is a dangerous psychoactive substance. Its production was officially stopped in the 1980s. Currently, Captagon, and counterfeit Captagonare being illegally produced in South-East Europe and trafficked to the region of the Middle East. Conclusion: In the post-Saddam era of the Middle East, this substance has been traded and distributed at an exponential rate. The main explanation is that the rise of this illegal commerce is related to the chaos and the lack of order in the regions of conflict and civil war in Syria and Iraq in particular. Asian Journal of Medical Sciences Vol.7(4) 2016 116-119</p
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Background: Amphetamine-type stimulants (ATS) are the most commonly used illicit drugs in Saudi Arabia. Frequency and outcome of ATS-related cardiovascular (CV) complications in the Saudi community have not been previously studied. Aim: We aimed to determine the incidence and the clinical outcomes of CV complications among individuals with amphetamine-positive urine drug screening (APUDS) tests admitted to a tertiary care facility in Riyadh, Saudi Arabia. Methods: Retrospective review of consecutive cases with APUDS and concurrently positive cardiac biomarkers admitted to King Abdul-Aziz Medical City in Riyadh, Saudi Arabia, between January 2006 and December 2013. The laboratory database was queried to identify patients with positive APUDS and abnormal cardiac biomarkers. Clinical data were extracted from the electronic medical records. Results: A total of 7450 urine drug screening tests were performed during the study period, out of which 720 (9.6%) were positive for ATS (APUDS group). Forty-two cases in the APUDS group were documented to have CV complications. All cases were men with a median age of 39 years (range, 21–60 years). Acute coronary syndrome/myocardial infarction was the most frequent clinical presentation (n = 31, 74%), predominantly in the form of ST-elevation myocardial infarction. Other less frequent complications included myopericarditis, cardiomyopathy, and arrhythmia. Coronary procedures were performed in 30 cases. Median hospital stay was 5 days (range, 1–28 days) and in-hospital mortality was 7.2%. Conclusion: APUDS is frequently encountered in young Saudi men presenting to the emergency department of our institution. Individuals with APUDS are at increased risk of CV complications and in-hospital mortality. The most frequent APUDS-related CV complication is acute coronary syndrome.
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A 35-year-old man, average built and smoker, with a background of psychiatric disorder, was brought by his neighbor to the emergency department after an hour of severe chest pain. Upon arrival to the hospital he got cardiac arrest, resuscitated and shifted to the Cath. Lab. with inferior, posterior and lateral myocardial infarction. Coronary angiography showed unusual nasty thrombosis in multiple coronary branches. Toxicology report showed high levels of amphetamines and benzodiazepines in the patient’s original blood sample. The patient was kept under ventilation for 18 days, with stormy recovery due to severe withdrawal manifestations, ventilation acquired pneumonia and rhabdomyolysis inducing acute renal failure. The patient regained near normal left ventricular function after baseline severe regional and global dysfunction. We postulate a relationship between the use of amphetamines, potentiated by benzodiazepines, and occurrence of acute thrombosis of multiple major coronary arteries.
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Drug abuse is reported to be on the increase among young persons using illicit substances but little is known about the frequency with which they occur, the symptoms on presenta-tion to health institutions, and the different substances abused. To establish this, we reviewed patient data collected at Al-Amal Hospital in Jeddah Kingdom of Saudi Arabia on young persons who are refered to the hospital for problems related to drug abuse. Data on 69 adolescent drug users were reviewed and ana-lyzed using the Composite International Diagnostic Interview -Substance Abuse Model (CIDI-SAM) to assess dependence on sub-stances including amphetamines, cannabis, cocaine, and opioids. Furthermore, we assessed the adolescents' data on history of delusions and hallucinations in the context of use of, or withdrawal from, these specific sub-stances. Our analysis shows that 10 to 79.6% of users of amphetamines, cannabis, cocaine, and opiates met DSM-III-R dependence crite-ria for each specific substance. The prevalence of psychotic symptoms associated with each specific substance ranged from users with no diagnosis to users with severe dependence as follows: amphetamines (3-100%), cannabis (7-60.0%), cocaine (5-70.7%), and opiates (4-88%). The risk of psychotic symptoms increased for respondents who abused (OR=7.2) or had mild (OR=8.1), moderate (OR=20.0), or severe dependence (OR=14.0) on cocaine when compared to those who were users with no diagnosis. A similar pattern was evident in cannabis, opiate, and amphetamine users. In conclusion, most adolescent drug users in Saudi Arabia who are dependent on illicit substances experience psychotic symp-toms in the context of use of, or withdrawal from, these substances. Psychotic symptoms increased with the severity of the disorders associated with use of all four substances. These findings underscore the importance of developing services to target this population; a population at risk of developing psychotic symptoms.
Fenethylline is a theophylline derivative of amphetamine having stimulant effects similar to those of other amphetamine type derivatives. Fenethylline was used as medicament for hyperactivity disorders in children, narcolepsy and depression, but it has also been used as a drug of abuse under the common name of "captagon". Unlike other drugs of abuse, the clandestine synthesis of fenethylline is simple, using inexpensive laboratory instrumentation and raw materials legal to obtain. A review of all the existing knowledge of fenethylline is reported, concerning its chemistry, synthesis, pharmacology and toxicology, legislation, its prevalence and use as drug of abuse, as well as its analysis in biological or seized samples. Published or reported captagon-related cases and seizures are also presented. All the reviewed information was gathered through a detailed search of PubMed and the internet. The primary drug market for fenethylline (as captagon) has traditionally been countries located on the Arabian Peninsula but also North Africa since 2013. In Arab countries, millions of captagon tablets are seized every year which represents one-third of global amphetamines seizures within a year. Furthermore, three out of four patients treated for drug problems in Saudi Arabia are addicted to amphetamines, almost exclusively in the form of captagon. Significant information on fenethylline is provided for pharmacologists, toxicologists and forensic pathologists. Fenethylline, although old, has recently been introduced to the drug market, especially in Arab countries. Continuous community alertness is needed to tackle this current growing phenomenon. This article is protected by copyright. All rights reserved.
Objective: To determine the frequency of suicidal thoughts and suicidal probability among poly-substance abusers in Saudi population, and to examine the relation between dual diagnosis and suicidal thoughts. Study design: Case control study. Place and duration of study: Al-Baha Psychiatric Hospital, Saudi Arabia, from May 2011 to June 2012. Methodology: Participants were 239 subjects, aged 18 - 45 years. We reviewed 122 individuals who fulfilled the DSM-IV-TR criteria of substance abuse for two or more substances, and their data were compared with that collected from 117 control persons. Results: Suicidal cases were highly present among poly-substance abusers 64.75%. Amphetamine and cannabis were the most abused substances, (87.7% and 70.49%, respectively). Astatistically significant association with suicidality was found with longer duration of substance abuse (p < 0.001), using alcohol (p=0.001), amphetamine (p=0.007), volatile substances (p=0.034), presence of comorbid psychiatric disorders (dual diagnosis) as substance induced mood disorder (p=0.001), schizo-affective disorder (p=0.017), major depressive disorders (p=0.001), antisocial (p=0.016) and borderline (p=0.005) personality disorder. Suicidal cases showed significant higher scores (p < 0.001) of suicide probability scale and higher scores in Beck depressive inventory (p < 0.001). Conclusion: Abusing certain substances for long duration, in addition to comorbid psychiatric disorders especially with disturbed-mood element, may trigger suicidal thoughts in poly-substance abusers. Depression and suicide probability is common consequences of substance abuse.
Amphetamine-type stimulant (ATS);Captagon;fenethylline;Middle East;Syria;conflict
Objectives: To identify the characteristics, nutritional and health status of drug addicts hospitalized for detoxification in Jeddah Al-Amal Hospital. Also, to assess the detoxification therapy and its impact on the nutritional status Methods: All patients admitted to Jeddah Al-Amal hospital from January to June 1996 were examined and followed until the end of the detoxification therapy. Results: The majority of drug abusers were between 20 and 34 years and below university education. Unemployment was a common feature among 57.1% of them. Smoking, alcohol consumption and family history of drug and alcohol intake were important contributing factors. Most addicts (63.6%) used heroin intravenously. Depletion of body fat, muscle protein in addition to depleted visceral protein and depressed immune function were prevalent features. Liver damage was reflected by elevated mean aspartate transaminase. High prevalence of hepatitis C and B infections were detected. Human immunodeficiency vins infection, tuberculosis and gastrointestinal disorders were also reported by some addicts. A significant gain in mean body weight was seen after detoxification therapy and 11.3% of patients experienced symptoms in the form of vomiting, nausea, constipation and loss of appetite. Failure of previous detoxification therapy was reported by 69.1 % of patients. Conclusion: Drug addiction attacks the nutritional and health status of individuals who become more prone to various infectious diseases and less productive. Extensive education health programs, directed to all population categories, are crucial to prevent and control the spread of drug abuse. More research is recommended to identify the determinants of drug addiction and evaluate the detoxification therapy.
Objective: The objective was to review all the available published studies and reports with particular reference to substance abuse in Saudi Arabia. Methods: Data were collected from a PubMed search and reviewing national journals, the United Nations Office on Drug and Crime (UNODC) reports, World Health Organization (WHO) reports and conference presentations over the last two decades. Results: Among Saudi patients in addiction treatment settings, the most commonly abused substances were amphetamine (4–70.7%,), heroin (6.6–83.6%), alcohol (9–70.3%) and cannabis (1–60%). Over the past decade, there was an increase in the use of cannabis and amphetamine and decrease in the use of heroin and volatile substances. Peer pressure and psychosocial stresses were risk factors for initiation as well as relapse of substance abuse. Anxiety, depression and hepatitis were the most common co-morbid disorders among the Saudi patients. Conclusion: Substance abuse is a public health problem in Saudi Arabia. It was associated with many psychiatric disorders, medical diseases and educational, occupational, legal and social consequences. School- and community-based prevention programmes are highly required in Saudi Arabia as a first-line strategy in the fight against substance abuse.