Fenethylline (Captagon) in West Asia: chemical profile, socio-political drivers, public health impact, and strategies for regional control

The illicit production, trafficking, and consumption of Captagon an amphetamine-type stimulant (ATS) has surged dramatically in West Asia, posing complex public health, security, and socio-political challenges. Originally synthesized as a therapeutic agent, Captagon's potent stimulant effects have made it a favored substance among combatants and youth in conflict zones, notably in Syria and neighboring countries. This comprehensive review synthesizes current knowledge on Captagon's chemical properties, pharmacology, and associated health consequences, alongside the socio-cultural, religious, regulatory, and geopolitical factors underpinning its endemic presence in West Asia. We critically examine the roles of conflict economies, fragile governance, and regional rivalries in sustaining illicit markets and assess the fragmented regulatory frameworks and enforcement challenges. Drawing on successful drug control models from low-prevalence countries, we propose integrated, context-sensitive strategies emphasizing governance reform, regional cooperation, public health expansion, and socio-economic interventions. Significant knowledge gaps remain, particularly regarding epidemiology, trafficking networks, and demand drivers, underscoring the urgent need for interdisciplinary research and enhanced real-time surveillance. Our findings highlight that multidimensional, regionally coordinated efforts, informed by robust evidence, are essential for mitigating the Captagon crisis and its far-reaching impacts in West Asia.