New concerns on drugs

Sarah Elhosary , Tuesday 14 Jan 2025

Drug addiction has long posed a significant challenge for society and the families of those affected, with the situation worsening with the rise of synthetic drugs, writes Sarah Elhosary

New concerns on drugs

 

Despite ongoing efforts that have been in place for decades, illegal drug use worldwide has continued to rise, especially in recent years. According to the United Nations, the number of users was estimated at approximately 210 million in 2009, increasing to 269 million in 2018. By 2022, around 275 million people had used drugs, with the total number reaching nearly 300 million in 2024, according to the UN Office on Drugs and Crime (UNODC).

While the rise in the number of drug users is concerning, an even more serious threat is the nature of the substances they are consuming. Emad Al-Din Nosseir, a senior consultant in psychiatry and an expert on drug addiction, said that “what is striking is the impossibility for most users today to know the nature and composition of the drugs they are consuming, especially with advances in the production of chemical substances and synthetic drugs.”

“Drug dealers combine synthetic substances with natural drugs to expand their supply, intensify addiction, and ensure customer dependence on the same source. Users frequently remain unaware of the detrimental effects of these additives,” he said.

“Many individuals with substance use disorders believe that their preference for a particular dealer stems from the quality or purity of the drugs he sells, as they feel stronger effects,” Nosseir added. “However, this is due to the addition of other substances to the drugs that are many times more potent than the known narcotic substance and even more harmful.”

“A significant number of my patients mistakenly believe they are only consuming cannabis. However, upon conducting tests, we discovered they had been using up to four other synthetic substances mixed with the cannabis. These substances are chemically manufactured and have significantly higher addictive effects than cannabis itself.”

“As a result, the individual becomes addicted to this mixed drug more quickly, suffering severe and rapid psychological and physical harm. In many cases, users may experience overdoses or allergic reactions that can be fatal due to their unawareness of the substances included in the drug mixture they consume,” Nosseir said.

According to Egypt’s National Council for Drug Control and Treatment, narcotics and psychoactive substances are classified based on their source into natural drugs and semi-synthetic and synthetic drugs. Natural drugs come from plants containing psychoactive elements in their leaves, flowers, or fruit. Examples include the cannabis plant, which can be used to produce hashish, marijuana, and bango, the poppy plant, which yields opium, the coca plant, used to produce cocaine, and the qat plant.

Next are semi-synthetic narcotics and psychoactive substances, which have more dangerous effects and a higher potential for addiction. These drugs are created through chemical processes that modify natural compounds and to which additional substances are added to enhance their effects and make them easier to use. Examples include heroin, crack, tramadol, and magic mushrooms.

Finally, there are wholly synthetic drugs, which are the most dangerous. These substances are entirely produced in laboratories without relying on natural sources and aim to mimic the effects of natural substances or create new effects. Examples include crystal meth, known on the streets as al-chapo or “ice”, ecstasy, and strox or “voodoo”.

An example of the dangers of synthetic drugs is flakka, which has recently spread in the US and some European countries. This is known as the “zombie drug” due to its effect on users, causing them to move and walk in strange ways. It also causes skin lesions and bodily decay that makes users resemble the undead in horror movies.

 

SYNTHETIC DRUGS: Synthetic drugs are made by mixing chemicals to create stimulating, hallucinogenic, or narcotic effects. These chemical mixtures include substances that are unsuitable for human use and are highly toxic.

Ahmed Fayed, a psychologist at an addiction treatment hospital in Cairo, said that “most of the cases we receive are treated for highly harmful substances, with patients being unaware that they were addicted to them.”

“For example, when testing patients who believe they are addicted to substances like heroin or hashish, we may discover the presence of ketamine, a substance used in veterinary medicine to anaesthetise large animals. Some cases show test results revealing highly harmful synthetic drugs, such as al-chapo and voodoo, mixed with other drugs like hashish, without the patients’ knowledge, which exacerbates the health risks.”

“Users of synthetic drugs suffer from mental health disorders, such as psychosis where they become detached from reality and experience a distorted version of reality with false images and events that they live in and act upon. Synthetic drug users are also prone to causing their own deaths or the deaths of others. The hallucinations increase their involvement in criminal activities, with nearly four out of every 10 patients we receive committing crimes that expose them to legal consequences that vary in severity,” Fayed said.

“Many patients who were previously treated for addiction to substances like heroin later also turn to using more dangerous synthetic drugs after their recovery, believing them to be less harmful and less addictive. This belief is 100 per cent false, as the users of synthetic drugs experience both physical and mental health issues more rapidly compared to those using other substances.”

 “This is especially true if they have a genetic predisposition to addiction, which worsens their susceptibility to the substance and accelerates their addiction.”

“The use of synthetic drugs disrupts the brain’s chemistry, leading to mental health disorders such as psychosis and depression. The symptoms of psychosis can begin to appear in synthetic drug users after about three months, or even less, of use. Under the influence of these drugs, users experience delusions and bizarre behaviours.”

The 2022 annual report issued by Egypt’s Fund for Drug Control and the Treatment of Addiction (FDCTA) at the Ministry of Social Solidarity said that the most common types of drugs used by patients who contacted its helpline were synthetic, prevalent among 24.20 per cent of those who called.

The drugs included al-chapo, shado, ice, crystal meth, and speed, all different names for the same substance and accounting for 12.2 per cent of users. The drug powder made up seven per cent, strox four per cent, and voodoo 0.78 per cent. The report emphasised that the results highlight the need for expanded awareness campaigns against synthetic drugs due to their significant effects on the nervous system and their promoting aggressive behaviour.

In a television interview, Amr Othman, head of the FDCTA, said that there are various factors influencing the spread of synthetic drugs across the world including in Egypt. One of these was the coronavirus pandemic, which led drug dealers to start manufacturing alternative drugs using locally available materials, as it became difficult to import drugs or their ingredients from one country to another during lockdowns. This contributed to the increased production of synthetic drugs globally, Othman said.

“Concerns are also mounting over the anticipated global increase in synthetic drug production following a 95 per cent drop in Afghanistan’s poppy cultivation in 2023 due to a cultivation ban. This decline is particularly alarming, as UNODC reports previously indicated that Afghanistan produced approximately 85 per cent of the world’s opium, a key ingredient in heroin,” he added, citing the 2023 Afghanistan Opium Survey published by the UNODC.

“Another factor contributing to the increased trend towards manufacturing synthetic drugs is the fact that this offers advantages to criminal suppliers and may be attractive to both sellers and users of the drugs,” said the 2023 World Drug Report, titled “The Synthetic Drug Phenomenon” and also published by the UNODC.

The report explains that the chemical manufacturing of drugs eliminates the need for hundreds of thousands of acres of arable land and large amounts of labour. It also spares traffickers from the fluctuations in agricultural input prices, the risk of crop loss due to government raids or other damages, and the long wait for crops to grow and be harvested compared to the few days required to manufacture the drugs chemically.

In contrast, drug synthesis can occur secretly in laboratories and facilities that are easier to conceal from the authorities.

It also highlights how semi-synthetic and fully synthetic drugs are being modified to meet user demands, offering more convenient consumption methods or longer-lasting effects. These adaptations not only boost demand but also simplify sales.

The high potency of synthetic substances makes transporting small quantities easier while reaching a broader user base. For instance, fentanyl, which is about 50 times stronger than heroin, is often mixed with heroin or cocaine to amplify their effects. This allows traffickers to smuggle smaller, purer amounts of fentanyl or other synthetic drugs, which are cheaper and less risky to transport than larger quantities of plant-based narcotics, the report says.

“Many chemicals and chemical precursors, which are raw materials used in the production of synthetic drugs, are often not monitored because they are used in the production of legitimate medical and industrial products. Drug manufacturers obtain and import them, possibly online in different countries, and use them in drug production. Some of these substances may be components of medical compounds available without prescriptions, but they can be modified or combined with other substances to create new drugs,” says a 2023 report from the International Narcotics Control Board (INCB).

 

PROACTIVE APPROACH: The development of the synthetic drugs industry, its widespread distribution, and the speed at which addiction sets in, sometimes starting with the first dose, has encouraged countries to focus on prevention programmes to reduce the number of people who try drugs for the first time.

Harm-reduction programmes aimed at reducing the health and social risks associated with drug use have also been implemented.

The 20204 UN General Assembly report “Harm Reduction for Sustainable Peace and Development” emphasises the importance of education and awareness in reducing drug demand. It also highlights the need to spread comprehensive educational programmes targeting young people in schools, noting that studies have shown that early education reduces the likelihood of drug use by 30 per cent.

“There is also a significant correlation between a lowered perception of the risks of drug use and an increase in drug use rates. For example, the 2021 World Drug Report issued by the UNODC recorded an increase in cannabis use, coinciding with a 40 per cent decrease in the number of teens who considered cannabis harmful in the United States and a 25 per cent decrease in Europe,” it said.

In Egypt, the FDCTA has taken extensive steps within its prevention programme, including implementing an initiative to protect school students from drug use in collaboration with the Ministry of Education and Technical Education. The drug prevention programme has been carried out in 2,000 schools across 17 governorates to reach 10,000 schools over the 2024/2025 academic years.

In addition, several awareness campaigns have been launched to reduce the demand for drugs and decrease the number of users. These include the Arrive Safely Initiative, targeting railway and metro passengers and car-drivers, and the They Misled You Campaign aimed at youth in universities, youth centres, and rural areas to correct false beliefs about drugs. Another initiative, The Decision Is Yours, focuses on raising awareness among government employees about early drug-testing laws and encouraging them to seek treatment through the hotline 16023.

To address the growing number of female drug users, the FDCTA has launched its Makeover Initiative, which aims to reach out to young women in universities and youth centres to educate them about the dangers of smoking and the impact of drugs on women’s psychological and physical health. It also offers a range of direct programmes and awareness activities for individuals and families, including door-to-door campaigns, seminars, workshops with children, family and child festivals, sports activities, and other early awareness efforts to combat drug addiction.

The FDCTA has announced the results of implementing Law 73 of 2021, which mandates that employees in the state administration undergo drug tests, especially when being promoted, transferred, seconded, or appointed. This step contributed to reducing the percentage of drug-using employees from eight per cent to one per cent in 2024. Similarly, the implementation of drug tests for school bus drivers, which showed a 12 per cent drug use rate in 2017, has led to a reduction of this rate to 0.4 per cent.

In addition to prevention programmes, the UN General Assembly report also highlighted the importance of adopting harm-reduction policies to minimise the damage caused by drug use. It suggests that drug use should be treated as a health issue, requiring support and rehabilitation rather than criminalisation and strict penalties. It calls for guidance from the experiences of various countries, including Portugal which has adopted a harm-reduction policy and decriminalised drug use.

Portugal has seen a 50 per cent decrease in deaths from overdoses and a reduction in blood-borne diseases, such as HIV, which can be transmitted among individuals who inject drugs. The UN report confirms that these policies have led to a decline in drug-related crime rates and an increase in individuals seeking treatment instead of avoiding the health system out of fear of punishment.

In Egypt, steps have been taken in various harm-reduction programs, as Fayed explained. “Some government hospitals provide heroin addicts with methadone, a painkiller and an opioid used in the detoxification process for those dependent on heroin or other morphine-based substances. Methadone reduces the withdrawal symptoms caused by stopping the use of such drugs,” he said.

“Under the programme, the patients visit the hospital daily to receive a specific dose to manage the problem, instead of their dying from an overdose. The harm reduction is an attempt to reduce crime rates resulting from their need to find money for doses. However, this is a temporary solution for treating the patient in limited cases.”

In addition to harm-reduction programmes, the fight against drug addiction continues through the provision of treatment services for drug addicts, as explained by Ahmed Al-Ketami, director of the Treatment Programme at the FDCTA, to Al-Ahram Weekly.

“In recent years, there has been significant expansion in addiction treatment centres, with the number increasing from 12 in seven governorates in 2014 to 34 in 19 currently, as part of the national strategy to combat addiction. The government continues to provide addiction treatment services free of charge and with complete confidentiality, with over 170,000 patients visiting these centres annually,” Al-Ketami said.

“The FDCTA has adopted the concept of work therapy with its Azima Centre workshops, which include carpentry, blacksmithing, sewing, farming, and other training workshops provided to patients within treatment centres. These workshops have led to important results. Three addiction treatment centres received furniture made by recovering drug addicts. A notable example is the production of olive oil at an addiction treatment centre in the Marsa Matrouh governorate, which has become a source of income,” he added.

“There are many misconceptions people have about addiction; it is a disease, not a moral issue. Moreover, addiction treatment is not as distressing as often portrayed in the media. The withdrawal symptoms from the drug are managed with medication to ensure that the patient does not experience pain, and the detoxification phase lasts no more than 15 days. Next, the patient undergoes a rehabilitation period lasting from 45 to 70 days,” Al-Ketami said.

“The treatment programmes include educating patients about the stages of addiction, starting from experimentation, moving through occasional and regular use, and culminating in full addiction. Special focus is placed on raising awareness about the dangers of synthetic drugs, which almost lack a regular usage phase; instead, the user quickly moves from experimentation to addiction due to their intense effects.”

“During the treatment period, we rely on creative expression as part of the therapeutic programme, as many patients face difficulty expressing themselves verbally. Therefore, activities such as drawing and writing are provided. These activities allow them to express their experiences during active use and recovery, helping them explore their emotions and build a deeper connection with themselves.”

“The treatment programmes also include creative activities such as playing musical instruments, acting, and painting to discover patients’ talents and redefine their identities away from drugs. The creative activities encourage the recovering individuals to recognise positive alternatives in life, boosting their self-confidence and ability to change,” he added.

“Sports play an essential part in the treatment programmes, as they help the recovering individuals achieve tangible personal accomplishments. For example, one recovering patient won a championship in kickboxing, which reflects the success of the treatment in channeling their energy into positive paths,” Al-Ketami explained.

“To ensure the integration of the recovering individuals into society, they are trained in vocational skills to prepare them for work after recovery. The Fund has also signed a cooperation protocol with the Nasser Bank to provide the necessary funding for small businesses set up by such individuals, which helps enhance their chances of integration and reduces the likelihood of relapse as a complementary phase to medical, psychological, and social treatment.”

* A version of this article appears in print in the 16 January, 2025 edition of Al-Ahram Weekly

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