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Captagon Abuse: Analysis for its Constituents in Drug Rehabilitation in the UAE

Abuelgasim Elrasheed, Samya Almamari, Simon Elliott, Basma Alharthy, Tarek A. Gawad, Mansour Assaf, Ahmed Yousif, Muneeb Venayikot

Stimulants in the form of Amphetamine Type Stimulants (ATS) are the most commonly abused drug class in the UAE and the wider Middle East region and has been reflected in the National Rehabilitation Centre (NRC) drug trend data for many years. The NRC is the major center in the United Arab Emirates (UAE) for drug addiction prevention, treatment and rehabilitation.

Of the (ATS) the most commonly abused drug is Fenethylline (Captagon^®) a stimulant drug that has been banned worldwide since 1986. Counterfeit Captagon produced illicitly in the region contains mainly amphetamine, theophylline and/or caffeine among other chemicals, rather than fenethylline itself. Production is fueled by conflicts and instability in the region. Fenethylline breaks down in the body to produce amphetamine and theophylline and unlike drug seizure analysis, this poses a problem for biological fluid analysis to determine the exact constituents of Captagon consumed.

Aim: In order to study whether ATS-positive patients’ samples contain counterfeit Captagon, as part of routine diagnostic immunoassay, LC-MS/MS and GC-MS testing, urine samples from the 2021 NRC patient cohort were analysed for the presence of possible Captagon counterfeit constituents such as amphetamine and/or methamphetamine with ephedrine, theophylline and/or caffeine.

Results: A total of 992 ATS positive patient samples were analyzed with the most frequently detected combination being (methamphetamine + amphetamine with caffeine and theophylline) representing 29% of all ATS-positive cases, followed by (methamphetamine + amphetamine with caffeine) representing 15.6%. All other combinations were less than 1.5%, with only two cases where only amphetamine was detected along with ephedrine, caffeine and/or theophylline

Conclusion: The data support the wide use of amphetamines and whilst caffeine and theophylline can be present due to intake of certain foods and beverages, their presence with amphetamines could be due to their presence in counterfeit Captagon.