By Matthew Chidozie Ogwu, MalikMatěj Malík, Pavel Tlustoš, Jiří Patočka

Fenethylline (street name, captagon) is a synthetic amphetamine-type stimulant that is emerging as a significant public health and security concern, particularly in the Middle East. This systematic review synthesizes original research articles, epidemiological studies, systematic reviews, policy analyses, and case reports to provide a comprehensive analysis of fenethylline’s health impacts, addiction potential, and dynamics of illicit trade. Initially developed for therapeutic use, fenethylline illicit production and use have escalated, raising concern about its physiological, psychological, and socio-economic impacts. This stimulant profoundly affects the central nervous system, enhancing wakefulness, concentration, and physical stamina while inducing euphoria. These effects come at the cost of serious adverse health outcomes, particularly with prolonged or heavy use, including cardiovascular complications, neurological damage, and addiction. The dependence-forming nature of captagon contributes to escalating substance use disorders, placing a burden on healthcare systems. Beyond its biomedical implications, fenethylline trafficking has become a global issue, with supply chains deeply intertwined with politically unstable regions where illicit economies thrive. The geopolitical dimensions of captagon’s trade amplify its global security threat, influencing international relations and regional stability. This paper underscores the urgent need for systematic data collection and coordinated efforts to regulate illicit fenethylline production and distribution. Strategies such as improved surveillance, public health interventions, and international cooperation are essential to mitigate its escalating risks. Addressing this issue requires a multidisciplinary approach, integrating public health, law enforcement, and policy development to curb its impact on global health and security.

Drug and Alcohol Dependence Reports, March 2025, 39 p.

Edited by Bradley D. Stein, Beau Kilmer, Jirka Taylor, Mary E. Vaiana

Opioids play an outsized role in America's drug problems, but they also play a critically important role in medicine. Thus, they deserve special attention. Illegally manufactured opioids (such as fentanyl) are involved in a majority of U.S. drug overdoses, but the problems are broader and deeper than drug fatalities. Depending on the drugs involved, there can be myriad physical and mental health consequences associated with having a substance use disorder. And it is not just those using drugs who suffer. Substance use and related behaviors can significantly affect individuals' families, friends, employers, and wider communities. Efforts to address problems related to opioids are insufficient and sometimes contradictory. In this 600-page report, researchers provide a nuanced assessment of America's opioid ecosystem, highlighting how leveraging system interactions can reduce addiction, overdose, suffering, and other harms. At the core of the opioid ecosystem are the individuals who use opioids and their families. Researchers also include chapters on ten major components of the opioid ecosystem: substance use disorder treatment, harm reduction, medical care, the criminal legal system, illegal supply and supply control, first responders, the child welfare system, income support and homeless services, employment, and education.

Santa Monica, CA: RAND, 2023. 618p.

By W. Travis Hanes III and Frank Sanello

In this tragic and powerful story, the two Opium Wars of 1839–1842 and 1856–1860 between Britain and China are recounted for the first time through the eyes of the Chinese as well as the Imperial West. Opium entered China during the Middle Ages when Arab traders brought it into China for medicinal purposes. As it took hold as a recreational drug, opium wrought havoc on Chinese society. By the early nineteenth century, 90 percent of the Emperor’s court and the majority of the army were opium addicts.Britain was also a nation addicted-to tea, grown in China, and paid for with profits made from the opium trade. When China tried to ban the use of the drug and bar its Western smugglers from its gates, England decided to fight to keep open China’s ports for its importation. England, the superpower of its time, managed to do so in two wars, resulting in a drug-induced devastation of the Chinese people that would last 150 years.In this page-turning, dramatic and colorful history, The Opium Wars responds to past, biased Western accounts by representing the neglected Chinese version of the story and showing how the wars stand as one of the monumental clashes between the cultures of East and West.

Naperville, IL: Sourcebooks, 2004.  352p.

By Maia Dolphin-Krute

An epidemic is a feeling set within time as much as it is a matter of statistics and epidemiology: it is the feeling of many of us in the same desperate place at the same desperate time. Opioid epidemic thus names a present moment — at once historic and historical — centered on the substance of opioids as much as it names the urgency of all of us who are currently in proximity to these substances. What is the relationship between these historic and historical moments, the present moment, the history of pharmacological capitalism, and a set of repeated neurological activities, as well as human loss and desire, that has fueled the exponential rise in the rates of opioid use and abuse between 2000-2018? Opioids: Addiction, Narrative, Freedom is an auto-ethnography written from deep within—biologically within—this opioid epidemic. Tracing opioids around and through the bodies, governmental, and medical structures they are moving and being moved through, Opioids is an examination of what it means to live within an environment saturated with a substance of deep economic, political, neuroscientific, and pharmacological implications. From exploring media coverage of the epidemic and emerging medical narratives of addiction to detailing the legal inscription of differences between “pain patients” and people addicted to drugs, Opioids consistently asks: what is it like to live within an epidemic? What forms of freedom become possible when continually modulated by our physical experiences of the material proximities of an epidemic? How do you live with something for a long time?

Brooklyn, NY: Punctum Books, 2018. 192p.