After the fall of the al-Assad regime in Syria, large stockpiles of the illicit drug captagon have reportedly been uncovered.
The stockpiles, found by Syrian rebels, are believed to be linked to al-Assad military headquarters, implicating the fallen regime in the drug’s manufacture and distribution.
But as we’ll see, captagon was once a pharmaceutical drug, similar to some of the legally available stimulants we still use today for conditions including attention-deficit hyperactivity disorder (ADHD).
Captagon was once a pharmaceutical
Captagon is the original brand name of an old synthetic pharmaceutical stimulant originally made in Germany in the 1960s. It was an alternative to amphetamine and methamphetamine, which were both used as medicines at the time.
Captagon has similar effects to amphetamines. It increases dopamine in the brain, leading to feelings of wellbeing, pleasure and euphoria. It also improves focus, concentration and stamina. But it has a lot of unwanted side effects, such as low-level psychosis.
The drug was originally sold mostly in the Middle East and parts of Europe. It was available over the counter (without a prescription) in Europe for a short time before it became prescription-only.
It was approved only briefly in the United States before becoming a controlled substance in the 1980s, but was still legal for the treatment of narcolepsy in many European countries until relatively recently.
The illegally manufactured version is usually referred to as captagon (with a small c). It is sometimes called “chemical courage” because it is thought to be used by soldiers in war-torn areas of the Middle East to help give them focus and energy.
For instance, it’s been reportedly found on the bodies of Hamas soldiers during the conflict with Israel.
Black-market captagon is now nearly exclusively manufactured in Syria and surrounding countries such as Lebanon. It’s mostly used in the Middle East, including recreationally in some Gulf states.
A recent report suggests captagon generated more than US$7.3 billion in Syria and Lebanon between 2020 and 2022 (about $2.4 billion a year).
What we know about illicit drugs generally is that any seizures or crackdowns on manufacturing or sale have a very limited impact on the drug market because another manufacturer or distributor pops up to meet demand.
So in all likelihood, given the size of the captagon market in the Middle East, these latest drug discoveries and seizures are likely to reduce manufacture only for a short time.
Young adults at risk of psychosis show reduced brain connectivity, a deficit that cannabis use appears to worsen, a new study has found. The breakthrough paves the way for psychosis treatments targeting symptoms that current medications miss. In the first-of-its-kind study, McGill University researchers detected a marked decrease in synaptic density in individuals at risk of psychosis, compared to a healthy control group.
“Not every cannabis user will develop psychosis, but for some, the risks are high. Our research helps clarify why,” said Dr Romina Mizrahi, senior author of the study and professor in McGill’s Department of Psychiatry.
“Cannabis appears to disrupt the brain’s natural process of refining and pruning synapses, which is essential for healthy brain development.”
Hope for new treatments
Using advanced brain scanning technology, the team studied 49 participants aged 16 to 30, including individuals with recent psychotic symptoms and those considered at high risk. The results, published in JAMA Psychiatry, indicate that lower synaptic density is linked to social withdrawal and lack of motivation, symptoms the researchers say are difficult to treat.
“Current medications largely target hallucinations, but they don’t address symptoms that make it difficult to manage social relationships, work, or school,” said first author Belen Blasco, a PhD student at McGill’s Integrated Program in Neuroscience. “By focusing on synaptic density, we may eventually develop therapies that enhance social function and quality of life for those affected.”
While cannabis is a known risk factor for developing psychosis, which can progress to schizophrenia, this is the first time researchers have measured structural changes in the brains of a high-risk population in real time.
The team’s next research phase will explore whether these observed brain changes could predict psychosis development, potentially enabling earlier intervention.
People’s finger lengths may hold a vital clue to their drinking habits, a new study suggests. There is evidence that alcohol consumption is influenced by prenatal sex steroids – so experts from Swansea University and colleagues from the Medical University of Lodz decided to use a sample of students for their research into the subject.
Their findings, published in the American Journal of Human Biology, revealed relationships between high alcohol consumption and long 4th digits (ring fingers) relative to 2nd digits (index fingers). This showed that high prenatal testosterone relative to oestrogen is linked to high student alcohol consumption.
Professor John Manning said: “Alcohol consumption is a major social and economic problem. Therefore, it is important to understand why alcohol use shows considerable differences across individuals.”
The study used a sample of 258 participants – 169 of them female – and it revealed consumption rates varied between the sexes. In comparison to women, men show higher alcohol consumption and higher mortality from alcohol abuse.
He said:“A pattern like this suggests an involvement of sex hormones, such as testosterone and oestrogen. Digit ratio (2D:4D: the relative lengths of the 2nd and 4th fingers) is thought to be an index of early testosterone (long 4th digit) and oestrogen (long 2nd digit).
“It is known that alcohol-dependent patients have very long 4th digits relative to their 2nd digits, suggesting high testosterone relative to oestrogen exposure before birth. As expected, the associations were stronger for men than women.”
Now the researchers hope their conclusions will bring a better understanding of the factors underlying the pattern of alcohol consumption, from abstinence to occasional use to harmful dependence.
New research, led by experts at the University of Nottingham, has found that a certain class of diabetes medication may be effective in reducing alcohol use. The study, which is published in eClinicalMedicine, looked at whether GLP-1 receptor agonists (GLP-1 RAs), could also be used to help people cut down on drinking.
The study was led by Dr Mohsen Subhani, Clinical Assistant Professor of Gastroenterology at the NIHR Nottingham Biomedical Research Centre, in the School of Medicine, at the University of Nottingham. It was funded by the National Institute for Health and Care Research (NIHR) and the NIHR Nottingham Biomedical Research Centre.
In the new study, researchers evaluated existing literature on GLP-1 RAs use and the change in alcohol consumption.
They gathered studies up to August 2024 that examined whether GLP-1 RAs affect alcohol use, alcohol-related health problems, hospital visits, and brain reactions to alcohol cues. The team evaluated six articles, including two randomised control trials made up of 88,190 participants, of these 38,740 (43.9%) of participants received GLP-1RA.
Our findings show that this type of diabetes medication shows promise in reducing alcohol consumption, potentially by targeting the brain’s reward centre, especially in people with a BMI over 30.”Dr Mohsen Subhani, Clinical Assistant Professor of Gastroenterology at the NIHR Nottingham Biomedical Research Centre, in the School of Medicine
The key findings:
In one main study, the medication exenatide did not significantly reduce drinking overall after six months, but people with obesity showed some positive results.
Another study found that people taking the drug dulaglutide were 29% more likely to reduce drinking than those on a placebo.
Observational studies (non-randomised) showed fewer alcohol-related health problems and lower alcohol use in people taking GLP-1 RAs compared to other treatments.
“Whilst further research is needed, our findings suggest this could be a potential treatment option in the future for excessive alcohol use and subsequently could lead to a reduction in alcohol-related deaths,” adds Dr Subhani.
Research by scientists at the University of Sydney has identified cannabinol (CBN), a constituent in the cannabis plant that improves sleep. Their report is the first to use objective measures to show that (CBN), while not intoxicating, does increase sleep in rats. The study, which has been published in the leading journal Neuropsychopharmacology, found that CBN was comparable in efficacy to zolpidem.
“Our study provides the first objective evidence that CBN increases sleep, at least in rats, by modifying the architecture of sleep in a beneficial way.”
CBN is an end-product of the main intoxicating constituent of cannabis, delta9-tetrahydrocannabinol (THC). THC in cannabis is slowly converted to CBN over time, which means older cannabis contains higher levels of this compound. It has been suggested that the consumption of older cannabis is associated with a sleepier cannabis “high”.
In the United States, highly purified CBN products are being sold as sleep aids, but there has been little high-quality scientific evidence to support this application.
The research team at the Lambert Initiative for Cannabinoid Therapeutics tested the effects of purified CBN on sleep in rats. Using high-tech monitoring, the experiments provided insights into the rats’ sleep patterns including the amount of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep.
NREM is deep sleep that promotes physical recovery and strengthens memories, while REM sleep is associated with dreaming and processing of emotions.
Professor Arnold said: “CBN was found to increase both NREM and REM sleep, leading to increased total sleep time, with a comparable effect to the known sleep drug zolpidem.”
Non-intoxicating
Unlike its parent molecule THC, CBN did not appear to intoxicate rats. THC intoxicates by activating CB1 cannabinoid receptors, which are present in the brain. The study showed that unlike THC, CBN only weakly activates these receptors. To their surprise, the researchers found that a metabolite of CBN had significant effects on cannabinoid CB1 receptors.
A metabolite is a chemical produced via the metabolism of a larger molecule in the body.
They also found that the 11-OH CBN metabolite had some impact on sleep architecture, which might contribute to the overall effects of CBN on sleep.
“This provides the first evidence that CBN indeed increases sleep using objective sleep measures. It was a surprise that CBN metabolism in the body can yield a much greater effect on cannabinoid CB1 receptors than the parent molecule CBN, which has much more limited activity,” Professor Arnold said.
“At this stage our results are confined to testing in rats. Further research is needed to see if this translates to humans.”
Further study
In a parallel study, yet to be published, Professor Iain McGregor, Director of Clinical Research at the Lambert Initiative, initiated a placebo-controlled randomised human clinical trial in insomnia patients. This was led by PhD student Isobel Lavender with leading sleep researcher Dr Camilla Hoyos from the Woolcock Institute of Medical Research. The trial has now been completed with very promising results that were recently announced at the International Cannabinoid Research Society and Sleep DownUnder scientific conferences.
“Our research encourages further basic and clinical research on CBN as a new treatment strategy for sleep disorders, including insomnia. Our clinical study only administered CBN on a single occasion. A trial on a larger scale, that includes repeated dosing, is the logical next step,” Professor McGregor said.
Professor Arnold said: “The team has now commenced a preclinical drug discovery program around CBN, as well as observing whether the pro-sleep effects of CBN can be further amplified by other molecules found in cannabis, or by conventional sleep aids, such as melatonin.”
Rates of HIV and Hepatitis C are “extremely high” among people who inject illicit drugs, according to new research by TB HIV Care. The organisation tested over 1200 injecting drug users in Tshwane, eThekwini, Mashishing and Mbombela (formerly Nelspruit).
In Tshwane 72% tested positive for HIV and nearly 90% had antibodies for hepatitis C virus (HCV), which could indicate past or present infection.
HCV is a blood-borne virus which damages the liver. When left undiagnosed it can be fatal, though it’s usually curable if treated.
Less than half of those who tested positive for HIV in Tshwane were aware of their HIV status. As such they would not have been on treatment and could have been spreading the virus without knowing.
Survey Site
HIV Prevalence among people who inject drugs
Antibodies for Hepatitis C among people who inject drugs
Share of HIV positive people who knew their status
eThekwini
49%
75%
76%
Mashishing
45%
41%
77%
Mbombela
30%
91%
64%
Tshwane
72%
89%
48%
Results of the TB HIV Care survey of four cities.
People who inject drugs (such as heroin) are at a higher risk of contracting HIV and HCV when needles are shared – something which happens because drug users don’t have easy access to new ones.
This has long been a problem in South Africa and appears to be getting worse. Research conducted in eThekwini in 2013 found that 17% of injecting drug users were HIV-positive. According to the new research, a decade later the figure has nearly tripled to 49%.
Professor Harry Hausler, CEO of TB HIV Care and a former technical advisor to the National Department of Health on TB/HIV, believes the main reason for this “massive” uptick in blood-borne diseases among drug users is “the limited access to needle and syringe programs” in the country.
Government ignored its own solution
Research shows overwhelmingly that providing clean needles to drug users reduces the spread of HIV, not only by removing the need to share injecting equipment but often because needle programs offer other services such as health education and condoms.
A large review published in 2017 identified 133 academic studies on needle and syringe programs (commonly known as NSP). The results were “supportive of the effectiveness of NSP in reducing HIV transmission among [people who inject drugs], as well as in reducing HCV infection, although the latter to a lesser extent”.
Yet despite these formal policy commitments, there is virtually no public funding for such interventions.
A person discards used needles in a specialised bin provided by TB HIV Care at a mobile clinic in Wynberg, Cape Town.
One exception is the Pretoria-based Community Oriented Substance Use Program, sponsored by the Tshwane Municipality. It has been left to non-profit groups, such as TB HIV Care, to provide these services. According to Hausler, the organisation currently provides clean needles to nearly 10 000 injecting drug users in Cape Town, Nelson Mandela Bay, eThekwini, Tshwane and Mbombela.
Users access needles from drop-in centres as well as mobile clinics – usually vans that get driven on set days to areas where injecting users congregate. Users discard their old needles in specialised bins provided by TB HIV Care. They will then receive a pack, which includes clean needles, alcohol swabs and sterile water.
Nurses are present at the mobile clinics so users can also get tested for HIV and HCV. They also offer ordinary medical services, such as cleaning and bandaging wounds.
Mobile clinics are also manned by psychosocial and human rights workers, and peer educators (people who were beneficiaries but now work for TB HIV Care) from whom users can get counselling or report abuses.
“We’re not just a needle provision organisation”, says Loraine Moses, who oversees quality standards for the program. “We’re a health services organisation”. Users have to register with peers and get health counselling and education before getting their needles, she says.
Beneficiaries have access to various amenities at TB HIV Care’s drop-in centres, including showers, lounging areas and washing machines.
Anthony (surname withheld), previously a heroin user for 15 years, who now volunteers for TB HIV Care, spoke to GroundUp at a drop-in centre in Cape Town.
“In the beginning, I started experimenting with friends in school [but] after my mother passed away, I found that there are those properties in [heroin] that calm you and numb pain, so that’s when I started to delve [into the drug] more.”
After ending up on the street and becoming “a slave to that drug”, he increasingly wanted to get sober. Fetching needles from a TB HIV Care site, he began speaking with one of the peers. The person told him about TB HIV Care’s opioid agonist program, which helps users to quit or reduce their heroin intake.
Opioid agonists are drugs which block heroin withdrawal. Methadone is the most widely known. Numerous clinical trials show that initiatives which offer methadone to heroin users over an extended period are more effective than rehab programs that force users to quit cold turkey.
Hausler says that TB HIV Care currently provides methadone to over 1100 people. Along with the medicine, they receive counselling and are assisted with finding shelter, and in some cases to reintegrate with their families.
Anthony says he’s been taking methadone since June last year. The program also helped him link up with a shelter and get an ID document so that he could find work.
“Being a client at TB HIV Care has helped me a lot to reintegrate back into society,” he says. “Being on the street, you lose a lot of yourself”.
A notice board at the TB HIV Care drop-in centre in central Cape Town.
Law enforcement continues to confiscate needles
Local governments have assisted TB HIV Care with some of its services. The City of Cape Town provides the HIV tests for use at mobile clinics, according to Hausler.
And yet, not only has the government failed to directly fund the sterile needle programs but in some cases it appears to work against them.
Research carried out by TB HIV Care shows that users frequently have their injecting equipment confiscated by law enforcement officers.
In Tshwane and eThekwini more than half of all people surveyed said that the authorities had seized or destroyed their needles at least once in the previous six months.
Outcome
Mashishing
Mbombela
eThekwini
Tshwane
No
57%
76%
31%
36%
Yes, In the last 6 months
18%
20%
64%
54%
Yes, but not in the last 6 months
25%
4%
5%
10%
Results of survey question: Have you ever had your needles and syringes confiscated or destroyed by a police officer/law enforcement? Source: TB HIV Care
“What’s very frustrating is that there are two arms of government,” says Hausler. “There’s health and then there’s police. And police are confiscating needles and syringes that we’ve been providing to clients – [even though what we’re doing] is a clearly endorsed health intervention.”
Hausler notes that in some cases the organisation has “really good alliances with local police”, but in other cases it is a constant battle.
“There needs to be better mainstreaming of education of officials across all government departments on the … HIV and TB response [plans],” says Hausler. “If people were really sensitised, we would not run up against as many obstacles.”
Asked for comment, Gauteng SAPS spokesperson Lieutenant Colonel Mavela Masondo told GroundUp that “possession of needles is not a criminal offence. Therefore, we cannot arrest a person [for] possession of needles, and neither can we confiscate needles”.
Note: The full report by TB HIV Care, which received assistance from the United States CDC, is not yet publicly available. A 16 page summary of some of the findings can be found here.
Professor Harry Hausler, CEO of TB HIV Care, at his office in Cape Town.
In research published in Environmental Toxicology & Chemistry, investigators sampled water from 19 locations across the Hudson and East Rivers in 2021 and 2022 to identify and quantify the prescribed pharmaceuticals and drugs of abuse that are making their way into New York City’s rivers and to determine the source of these pollutants.
Metoprolol and atenolol (blood pressure medications), benzoylecgonine (the main metabolite of cocaine), methamphetamine (a stimulant), and methadone (an opioid) were the most prevalent drugs, present in more than 60% of water samples.
More drugs and higher concentrations were detected in water contaminated by Enterococci (bacteria that live in the intestinal tract) and after rainfall, indicating an impact from sewer overflow. However, the presence of drugs in clean water and during periods of dry weather indicated that wastewater treatment plant discharge may also contribute to the presence of drugs in rivers.
“This study shows how pharmaceuticals and drugs of abuse enter the New York City aquatic environment, highlighting the necessity of improving the current water management system,” said corresponding author Marta Concheiro-Guisan, PharmD, PhD, of the John Jay College of Criminal Justice.
The effects of sustained drug abuse can manifest in many ways. Loss of memory and reduced cognitive functions are some of the effects that can persist for years. Neurobiologists at the University of California San Diego have now identified a mechanism in the brain that generates drug-induced cognitive impairments.
The researchers investigated how methamphetamine and phencyclidine (PCP or “angel dust”), which take effect by activating different targets in the brain, induce a similar reduction in cognitive ability. How could the same difficulties in memory emerge in response to drugs that trigger different actions in the brain?
The results of this investigation, led by Assistant Project Scientist Marta Pratelli in Professor Nicholas Spitzer’s laboratory, appear in Nature Communications. They showed that meth and PCP caused neurons to change the way they communicate through a process known as neurotransmitter switching.
Neurotransmitter switching is a form of brain plasticity, an evolving area of research investigating how the brain changes function and structure in response to experience. In recent years, Spitzer and his colleagues have also identified roles for neurotransmitter switching in autism spectrum disorder, post-traumatic stress disorder and in exercise.
Examining the cerebral cortex of mice, the investigators found that meth and PCP each caused a switch from the excitatory neurotransmitter glutamate to the inhibitory neurotransmitter GABA (gamma-aminobutyric acid) in the same neurons in the prelimbic region, an area of the frontal cortex involved in executive functions. This switch was linked to a decrease in memory task performance since drug-treated mice performed well in the tasks when the expression of GABA was blocked.
Further experiments showed that even after repeated exposure to the drugs, the researchers were able to reverse this neurotransmitter switch using molecular tools to locally decrease the brain’s electrical activity or using clozapine, an antipsychotic drug. Each of these treatments reversed the memory loss, restoring the performance of mice in the cognitive tasks.
“These results suggest that targeted manipulation of neuronal activity may be used to ameliorate some of the negative effects of repeated drug abuse,” said Pratelli.
In this new study, the researchers found that a drug-induced increase in the release of dopamine, a neurotransmitter involved in reward, and an increase in the electrical activity of neurons in the cerebral cortex, were required to produce the neurotransmitter switch.
“This study reveals a shared and reversible mechanism that regulates the appearance of cognitive deficits upon exposure to different drugs,” said Spitzer.
The researchers note in their paper that a deeper understanding of brain mechanisms tied to loss of memory from drug use could boost prospects for new treatments, not only resulting in therapy for meth and PCP consumption, but for other disorders as well.
Researchers exploring the role memory plays in alcohol consumption believe it could help people reduce their intake. They published their findings in Food Quality and Preference.
Previous work has found people don’t eat as much food when they are reminded of an earlier meal just before tucking in. The latest study, led by the University of Portsmouth, wanted to further investigate the relationship between memory and consumption, but with alcohol instead.
The team carried out a study involving 50 women aged 18 to 46-years-old who were randomly split into two groups: The first group were asked to recall a recent alcohol experience in detail, and the second had to recall a car journey, as a control. Participants were then asked to consume a vodka-based drink, at a rate that felt comfortable to them.
Participants watched a mood-neutral program while drinking to provide a more naturalistic environment and distract them from any suspicion that their rate of consumption was being recorded.
The findings revealed individuals asked to recall a previous drinking episode took longer to consume the alcoholic beverage, which suggests a lower motivation for alcohol.
Dr Lorenzo Stafford, a multisensory researcher at the University of Portsmouth, said: “Following on from previous work, we think an important part of the observed effect was that individuals in the alcohol memory cue condition had to estimate the number of alcohol calories they consumed.
“Our theory is that females may have had less desire for alcohol because they wish to avoid excess calories, which could also be linked to work showing that females are more likely to change their consumption habits because they are more receptive to the risks alcohol poses to health and weight.”
Despite this, it is estimated that more than a quarter (28%) of drinkers consume more than the recommended 14 units a week in England alone.
The study also found that those individuals who drink regularly – categorising them at a high risk – consumed the alcohol faster than those in the low risk group. The authors say this demonstrates that the speed of consumption is a valid measure of alcohol motivation.
In two related studies, Dr Stafford and his colleagues found that strong health warning labels on alcohol products also reduced desire for alcohol and slowed down their drinking rate. While these approaches were more effective than memory cues, they could both offer a potentially useful way to help avoid excess alcohol consumption.
The paper, , recommends further research to help understand the alcohol memory effect in males, especially as males typically consume more alcohol than females and are therefore at a heightened risk.
A team of researchers led by the University of California, Irvine has discovered that an antioxidant found in rosemary extract can reduce volitional intakes of cocaine by moderating the brain’s reward response, offering a new therapeutic target for treating addiction.
The study, recently published online in the journal Neuron, describes team members’ focus on a region of the brain called the globus pallidus externus, which acts as a gatekeeper that regulates how we react to cocaine. They discovered that within the GPe, parvalbumin-positive neurons are crucial in controlling the response to cocaine by changing the activity neurons releasing the pleasure molecule dopamine.
“There are currently no effective therapeutics for dependence on psychostimulants such as cocaine, which, along with opioids, represent a substantial health burden,” said corresponding author Kevin Beier, UC Irvine associate professor of physiology and biophysics. “Our study deepens our understanding of the basic brain mechanisms that increase vulnerability to substance use disorder-related outcomes and provides a foundation for the development of new interventions.”
Findings in mice revealed that globus pallidus externus parvalbumin-positive cells, which indirectly influence the release of dopamine, become more excitable after being exposed to cocaine. This caused a drop in the expression of certain proteins that encode membrane channels that usually help keep the globus pallidus cell activity in check. Researchers found that carnosic acid, an isolate of rosemary extract, selectively binds to the affected channels, providing an avenue to reduce response to the drug in a relatively specific fashion.
“Only a subset of individuals are vulnerable to developing a substance use disorder, but we cannot yet identify who they are. If globus pallidus cell activity can effectively predict response to cocaine, it could be used to measure likely responses and thus serve as a biomarker for the most vulnerable,” Beier said. “Furthermore, it’s possible that carnosic acid could be given to those at high risk to reduce the response to cocaine.”
The next steps in this research include thoroughly assessing negative side effects of carnosic acid and determining the ideal dosage and timing. The team is also interested in testing its efficacy in reducing the desire for other drugs and in developing more potent and targeted variants.
