Doctors call for EU-Gulf taskforce to combat Captagon crisis

Drug use in Syria is driven by people coping with trauma, unemployment or pain from conflict-related injuries

Fighters affiliated with Syria's Hayat Tahrir Al Sham group display drugs seized at a checkpoint they control in Daret Ezza, Aleppo province, in 2022. AFP

Doctors in Syria have called for better co-operation between Europe, the Gulf and Syria’s neighbouring countries to help curb a drug crisis fuelled by the amphetamine Captagon.

The proposed Mediterranean-Gulf taskforce would serve as a platform to share intelligence and develop a joint strategy to curb Captagon trafficking in the Middle East.

The highly addictive drug is believed to be produced in Syria and has been seized in bordering countries, as well as in the Gulf and Europe. Little is known about the healthcare effects of Captagon, owing to taboos around drug abuse in the Middle East.

The US-charity MedGlobal, which made the call, will publish the first healthcare survey of Syria’s growing narcotics crisis on Tuesday, and will present its findings at its conference in Chicago this week.

The report, which has been seen by The National, shows the creeping effects of addiction on Syria’s war-afflicted communities – from fighters using Captagon and other stimulants on the battlefield to patients with traumatic injuries developing opiate addictions.

Substance abuse has almost tripled among Syrians since the war began in 2011, with almost one in 10 users aged under 30. Captagon was consumed by more than 56 per cent of surveyed users – making it the second most commonly used drug after cannabis.

Dr Zaher Sahloul, MedGlobal’s chief executive, said the findings were the “tip of the iceberg”. “I wouldn’t just be worried about Captagon. It is a gateway drug to other more dangerous drugs,” he said. He warned the crisis could spread quickly to neighbouring countries and the region, including the Gulf. “Don’t think that because we are Arab countries that this won’t affect our societies. Don’t hide your head under the sand. We’re seeing the pattern spreading,” he said.

The societal impacts of Syria’s narcotics crisis are profound, the report found. Captagon causes depression and irritability, and the families and children of users are also at risk of becoming users. Muayad, a 26-year-old former user from north-west Syria, told MedGlobal doctors how years of abuse had made him suicidal. A doctor leading a forensic medicine department in Aleppo, whose name was withheld in the report, said drug use was linked to “half” of the cases he had dealt with in 2022.

The report sheds new light on the widespread use of Captagon and other drugs. “It’s becoming clearer and clearer that these [users] are [also] women and children or healthcare workers,” said psychiatrist Dr Maya Bizri, a lead author of the report and an assistant professor at the American University of Beirut. “We have to stop thinking of the Captagon epidemic as limited to combat fighters and being exported to the Gulf areas for a high-functioning student that needs to work.”

People are using Captagon to cope with trauma from the war, but also with the state of limbo from living in a protracted conflict with few job prospects. Some 72 per cent of users surveyed said people in their areas took drugs as an escape “from reality”. “It’s telling of the trauma that’s intergenerational and direct,” Dr Bizri added.

The drug is also being used as “currency”. “You use it instead of dollars or to lure people to become providers for their family,” Dr Bizri said. Though 65 per cent of drug users surveyed were unemployed or had a monthly income of less than $100, they could obtain drugs for as little as $10 a month.

The Syrian regime is alleged to be involved in Captagon trafficking to the Middle East and Europe to fund itself. UK and US sanctions were imposed on relatives of President Bashar Al Assad last year, due to their suspected involvement in the production and trafficking of the drug. In May the World Bank estimated the Captagon trade to be worth between $0.6 billion and $1.9 billion annually.

Syria rejoined the Arab League last year, with the hope that Mr Al Assad would help curb the narcotics crisis spilling into their borders. Yet the seizures have continued, with Saudi Arabia making a seizure of more than a million tablets in March this year. European ports have been used for trans-shipment, and there have been cases of the drug being made in Europe.

The continuing seizures are a sign that new measures are needed. “I don’t think [the sanctions] are effective," Dr Sahloul said. "Every few days we're seeing more seizures. These things are profitable, that’s why smugglers do it.”

He warned that the crisis could begin to resemble the drug ganglands of Latin America, which have led to huge refugee outflows to the US. “The first wave of refugees and illegal migrants [from Latin America] was due to wars and political instability, the second wave from economic deterioration and sanctions, and the current one is in part due to violence, crime, and drug cartels,” he said. “We should expect the same pattern from Syria and the Middle East to Europe if we don’t deal with the festering addiction crisis now.”

The crisis is compounded by the absence of adequate healthcare services and rehabilitation centres in the war-torn country. The Azzaz Specialty Psychiatric Hospital, which is supported by MedGlobal through a partnership with Physicians Across Continents, is the only specialist psychiatric hospital serving a population of four million in north-western Syria, and includes a drug rehabilitation centre. The area has only four psychiatrists, according to the World Health Organisation. Authorities had resorted to sending addicts to prison for rehabilitation, Dr Sahloul said, in the hope that they could be isolated from the drug.

The taboo around substance abuse prevents people from seeking help. Dr Bizri proposed creating drug rehabilitation clinics within hospital buildings, so that patients could feel comfortable getting help. MedGlobal has also trained healthcare workers working in north-western Syria or with Syrian refugees in Turkey to spot early signs of addiction. “You have to educate healthcare providers about what to do with the limited medication they have in treating withdrawal symptoms, and depression and anxiety,” said Dr Bizri.

Captagon is a “gateway” to other more dangerous drugs such as crystal meth, which was also used by 24 per cent of users, according to the survey. A doctor in Idlib, speaking to MedGlobal anonymously, said the first signs of crystal meth being used in the city emerged in 2021. “We’re witnessing the beginning of something similar to the crack cocaine epidemic in the US,” Dr Sahloul said.

Young people whose childhoods have been marred by the conflict are also more vulnerable to drugs and addiction. “People who’ve grown up exposed to this conflict, and with just one gateway drug, or one instance of using an illicit substance, become dependent, and then they just spiral," said Dr Diana Rayes, a contributor to the report and chair of the Syria Public Health Network, specialising in refugee mental health. "They’re such a vulnerable population that we under-report on.”

Earlier wars in Afghanistan and Colombia have shown how conflict provides fertile ground for illegal drug trades to thrive. "The intersection of economic hardship, postwar trauma and displacement has really correlated with the rise of an illicit drug trade, and then the dependence of people on those drugs to cope with the reality. So it's not a unique situation," she said.

She fears similar patterns could emerge due to the wars in Gaza and Lebanon. "With Syria being so proximal to Lebanon and the Palestinian territory, there's certainly a role that these actors can play in capitalising on the situation and being able to more readily move drugs around."

MedGlobal’s report is based on the findings of a 2022 survey, previously reported on by The National, recent cases from the Azzaz rehabilitation clinic, and workshops conducted by the authors in Turkey and north-western Syria. Responses came from Syrians who were either living in regime or opposition-held areas, or were refugees in neighbouring countries such as Turkey and Lebanon. The Kurdish-run north-east of Syria did not take part in the survey.

In Syria’s regime areas, more than one in 10 (11 per cent) of people reported taking drugs. That figure more than doubled among Syrian refugees who had sought asylum in Lebanon, Turkey and Jordan, where one in five people (20 per cent) reported using drugs. The opposition-held regions of north-western Syria recorded the lowest cases of drug use, at five per cent, with those living in displacement camps at higher risk.

This is an exponential rise since the start of the conflict in 2011, the report found. Three per cent of Syrians from all three groups reported using drugs before that year, compared to eight per cent today.