Will ‘Poor Man’s Cocaine’ Fuel the Next U.S. Drug Crisis?

Yves here. The anecdote below may be a fabrication to discourage cocaine use, but it sounds plausible.

Two rats are in separate cages. One has a lot of rat amusements, such as toys, a running wheel, decoration, even regular access to a lady rat, food and access to cocaine, which it can self-dispense.

The second rat is in an empty cage save for its food and water bowls and its cocaine dispenser.

The first rat has a varied diet, including occasional cocaine use.

The second rat starts doing cocaine obsessively until it dies.

Keep in mind that there is considerable evidence that impoverishment, both financial and environmental, are known drivers of substance abuse. For instance, former California prosecutor David in Friday Harbor has pointed out that homelessness often leads to drug addiction. His point has been that if you were sleeping on the streets, you’d be likely to need to self-medicate.

By Jim Crotty, the former Deputy Chief of Staff at the U.S. Drug Enforcement Administration and a member of the Global Initiative against Transnational Organized Crime’s network of experts. He is currently a Supervisory Criminal Research Specialist with the DC Metropolitan Police Department and a Senior Fellow at the Center for Advanced Defense Studies. Originally published at Undark

The opioid crisis continues to rage across the U.S., but there are some positive, if modest, signs that it may be slowing. Overdose deaths due to opioids are flattening in many places and dropping in others, awareness of the dangers of opioid abuse continues to increase, and more than $50 billion in opioid settlement funds are finally making their way to state and local governments after years of delay. There is still much work to be done, but all public health emergencies eventually subside. Then what?

First, it’s important to realize that synthetic opioids like fentanyl will never fully disappear from the drug supply. They are too potent, too addictive, and perhaps most importantly, too lucrative. Opioids, like Covid-19, are here to stay, consistently circulating in the community but at more manageable levels.

More alarming is what may take its place. Since 2010, overdoses involving both stimulants and fentanyl have increased 50-fold. Experts suggest this dramatic rise in polysubstance use represents a “fourth wave” in the opioid crisis, but what if it is really the start of a new wave of an emerging stimulant crisis?

Substance abuse tends to move in cycles. Periods with high rates of depressant drug use (like opioids) are almost always followed by ones with high rates of stimulant drug use (like methamphetamine and cocaine), and vice versa. The heroin crisis of the 1960s and 1970s was followed by the crack epidemic of the 1980s and 1990s, which gave way to the current opioid epidemic. As the think tank scholar Charles Fain Lehman quipped, “As with fashion, so with drugs — whatever the last generation did, the next generation tends to abhor.” The difference now is the primacy of synthetic drugs — that is, illicit substances created in a lab that are designed to mimic the effects of naturally occurring drugs.

Today, anyone with a few thousand dollars and internet access can find instructions to build their own little drug empire. Look no further than “Breaking Bad,” the hit television series in which a high school chemistry teacher starts cooking high-quality methamphetamine out of an RV to help provide for his family. “Breaking Bad” is of course a work of fiction, but in the age of synthetic drugs, the plotline is not that far-fetched.

Back in the real world, methamphetamine has already become a significant threat. From 2015 to 2019, overdose deaths attributed to methamphetamine nearly tripled, according to a study by the National Institute on Drug Abuse, a staggering increase driven primarily by its combination with fentanyl. And yet, even with methamphetamine’s use on the rise, it still trails America’s favorite illicit stimulant drug — cocaine — by a significant margin. In the latest National Survey on Drug Use and Health, more than twice as many adults aged 18 or older reported using cocaine over methamphetamine in their lifetime.

Cocaine holds a special place in American pop culture. Long considered a party drug, cocaine has often been associated with celebrities, lawyers, and so-called finance bros, and its sale and use has been romanticized in music, TV, and cinema. The sad reality is that for the year preceding April 2023, more than 27,000 Americans died while using cocaine, according to provisional statistics from the U.S. Centers for Disease Control and Prevention. It is indeed a hell of a drug.

But its days may be numbered.

The vast majority of cocaine is currently produced in three countries in the world — Colombia, Peru, and Bolivia — primarily due to a favorable climate and a cultural affinity for the coca plant from which cocaine is derived. But what if, instead of being produced in the jungles of South America, cocaine — or something like it — could be manufactured anywhere?

This is not a new idea. In the last decade alone, illicit drug chemists have synthesized more than 1,200 new psychoactive substances, or NPS, also known as designer drugs or research chemicals, in search of a better high. So far, none of these lab-made drugs have threatened to unseat cocaine, but with advances in artificial intelligence, synthetic biology, and biotechnology, it is only a matter of time until some enterprising chemist strikes white gold.

Officials in Europe recently sounded the alarm about counterfeit Captagon, an amphetamine-like drug that produces many of the same physiological effects as cocaine. Often referred to as “poor man’s cocaine,” Captagon is already wildly popular in the Middle East where it sells for as little as $3 per pill and fuels the Gulf states’ party scene.

Captagon is the trade name for fenethylline, a chemical compound related to natural neurotransmitters like dopamine and epinephrine. It was first developed in the 1960s to treat attention deficit hyperactivity disorder, narcolepsy, and depression, but was later banned worldwide due to its high potential for abuse. Although still referred to as Captagon, virtually all the pills seized today are counterfeit and comprised of a hodge-podge of dangerous substances, including fenethylline, amphetamine, methamphetamine, and even caffeine.

In this way, Captagon is a lot like the counterfeit oxycodone pills flooding the U.S. drug market: They are advertised as one drug but contain another. And because they come in pill form, they are more approachable to the average drug consumer, who tend to associate pills with legitimate prescription medications.

While most drug overdose deaths are currently attributed to synthetic opioids like fentanyl, cocaine and methamphetamine carry significant risks of their own. Stimulants place extreme strain on the body’s regulatory and cardiovascular system and increase the risk of heart attack, stroke, or death. And unlike opioids, there is no miracle overdose reversal drug like naloxone — which was recently made available over the counter in the U.S. — or medication-assisted treatments for stimulant use disorders.

Interestingly, late last year the U.S. Drug Enforcement Administration did not increase the annual production quotas for several amphetamine-based prescription medications, including Adderall and Ritalin, although drugmakers had raised concerns about ongoing shortages. The agency’s response was due partly to concerns that aggressive marketing of these drugs could spark the next crisis. Recent studies suggest the use of ADHD medication by young adults does not necessarily lead to the use of illicit drugs in the future, but if shortages persist, will users turn to the black market as they did with prescription opioids?

The illicit drug trade is surprisingly regional, and preferences come and go. Just because a substance is popular in one region of the world doesn’t mean it will inevitably become popular in another. But Captagon displays all the hallmarks of the next big thing for the American public. Like fentanyl, it has a natural user base, is cheap and easy to make, and is highly addictive. It also avoids bizarre side effects (such as a notorious case of face-eating and other unusual behaviors) sometimes encountered with NPS.

It is difficult to predict what form the next drug crisis may take, but I believe one thing is certain: There will be another crisis. Early indications and warnings will be essential to identify the next threat and protect health and safety. Public health and law enforcement organizations must improve data collection and monitoring of emerging drug threats through intelligence collection, wastewater analysis, and forensic testing. They must also enhance information sharing and collaboration across the prevention, supply reduction, and treatment continuum. And the U.S. and its partners must act now to avoid repeating the mistakes of the past — before it’s too late.

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  1. Rob Urie

    The rat anecdote comes from an experiment conducted by Bruce Alexander in the 1970s nicknamed ‘Rat Park’ where Alexander reported that rats kept in isolation with little to do would take cocaine obsessively until they died, whereas rats that were free to socialize and live full rat lives had little interest in the cocaine.

    The conclusion drawn from the experiment and popularized by psychologist Gabor Mate, is that drug addiction is a function of psychological trauma, and not some intrinsic quality of the drug on offer.

    However, trauma is generally considered to be a psychological response to past events, whereas to the capacity to live fulfilling lives unfolds in real time.

    But from my recollection, Mate has had success in treating drug addiction through treating trauma, as he describes it, with psychological counseling.

    This shouldn’t be possible if standard models of drug addiction explained it robustly.

  2. Paul J-H

    In this Dutch article: https://nos.nl/artikel/2491368-protesten-oorlog-en-hyperinflatie-situatie-in-syrie-heel-complex

    it is said that Captagon is a lucrative contraband for the Syrian regime. So, will the USA activate its international war on drugs in Syria in this regard? The article does not say this drugs also ends up in the USA but it does say it spreads havoc in neighbouring regions, with Jordan killing a drug-lord in Sweida (in Syria, where there are protests now).

  3. furnace

    As per to the causes of addiction, Gabor Maté has the most convincing ones I have yet read. From The Myth of the Normal:

    Addiction is a complex psychological, emotional, physiological, neurobiological, social, and spiritual process. It manifests through any behavior in which a person finds temporary relief or pleasure and therefore craves, but that in the long term causes them or others negative consequences, and yet the person refuses or is unable to give it up. Accordingly, the three main hallmarks of addiction are

    – short-term relief or pleasure and therefore craving;
    – long-term suffering for oneself or others; and
    – an inability to stop. […] (p. 207)

    “It is commonly believed,” Felitti said, discussing his research, “that repeated use of many street drugs will in itself produce addiction. Our findings challenge those views . . . Addiction has relatively little to do with the supposed addictive properties of certain substances, other than their all providing a desirable psychoactive relief . . . In other words, this is an understandable attempt at self-treatment with something that almost works, thus creating a drive for further doses.”[2]

    Felitti’s childhood adversity findings lay further waste to the myth of genetic determinism that I began debunking in the chapter on epigenetics. No single addiction gene has ever been found—nor ever will be. There may exist some collection of genes that predisposes people to susceptibility, but a predisposition is not the same as a predetermination. What’s true of physical illness is just as true of addiction: genes are turned on and off by the environment, and we now know that early adversity affects genetic activity in ways that create a template for future dysfunction. Human and animal studies have both confirmed that any genetic risks for substance abuse can be offset by being reared in a nurturing environment.[3] (pp. 212–213)

    The studies cited in [3] are

    Gene H. Brody et al., “Parenting Moderates a Genetic Vulnerability Factor in Longitudinal
    Increases in Youths’ Substance Use,” Journal of Consulting and Clinical Psychology
    Association 77, no. 1 (February 2009): 1–11; among other studies, such as, for example,
    Marcello Solinas et al., “Prevention and Treatment of Drug Addiction by Environmental
    Enrichment,” Progress in Neurobiology 92, no. 4 (December 2010): 572–92

    So in this view addiction is not so much a property of the drug being consumed (given someone can get addicted to gambling, to sex, etc.) being in fact a response to unpleasant psychic states. It’s a form of (very unhealthy, but still funcional) self-medication. Thus to combat drug use punishment and banning is useless, whilst proper medical and psychological attention is far more effective. But those take time and money, so I guess it’s easier to just arrest people or let them die of overdoses.

    1. Koldmilk

      Thus to combat drug use punishment and banning is useless, whilst proper medical and psychological attention is far more effective.

      Worse than useless, prohibition creates a lucrative black market which leads to organized crime and corruption. There is increase in violent crime (gangs protecting/expanding their markets) and property crime (addicts stealing). From the point of law enforcement, this is an opportunity for increased funding and growth, and their incentives favour not solving the problem, creating the positive feedback of a self-licking ice-cream.

      1. Jake

        Even worse than prohibition is decriminalization. When cities decide that the drug war is bad and we are just going to stop fighting it, but never bother to legalize the drugs, you end up with the worst of both worlds. Drug addicts getting drugs from violent criminals who are no longer required to follow any laws unless they are blatantly killing many people. And the gangs of drug addicts start coming to the city to set up meth camps, and before you know it, an entire city has been transformed. This is something that the left doesn’t seem to understand. The more blue cities continue to follow this method, the more the right is going to be able to truthfully say “Looks, the democrats don’t understand how to govern!!! Look at all these blue cities that have become unlivable!!!!!!1” The scariest part is the activists and politicians who insist the method is actually working.

        1. furnace

          Have you sources for your statements? A quick search on Google Scholar yielded the following article, arguing that decriminalization is by no means worse than prohibition (at least for softer drugs such as cannabis):
          Drug Decriminalization in Portugal: Lessons for Creating Fair and Successful Drug Policies
          From the abstract:

          Although postdecriminalization usage rates have remained roughly the same or even decreased slightly when compared with other EU states, drug-related pathologies — such as sexually transmitted diseases and deaths due to drug usage — have decreased dramatically. Drug policy experts attribute those positive trends to the enhanced ability of the Portuguese government to offer treatment programs to its citizens — enhancements made possible, for numerous reasons, by decriminalization.

          That sounds like a win to me. That being said, there are disadvantages to decriminalization, as there are to legalization. To talk about it in such a reductive manner is counterproductive.

          1. Futility

            Yes, but decriminalization in Portugal is accompanied by actual services offered by the state (like handing out clean syringes, trying to find rooms for the homeless, medical services, etc.), nothing of which is offered by US authorities, partially explaining the vastly different outcomes.

    2. David in Friday Harbor

      Gabor Maté is quoting Dr. Joseph Felitti’s Adverse Childhood Experiences (ACE) studies conducted under the auspices of the Kaiser Permanente Medical Foundation nearly 30 years ago in Southern California. Felitti documented a strong evidentiary basis for the conclusion that some people become addicted to drugs as a coping mechanism to a matrix of adversity beginning in childhood and continuing into adulthood.

      I have personally known many drug users (and been one myself). None of these drugs, whether “ups” or “downs,” are particularly healthful and most will contribute to an early death. I support decriminalization but not legalization. However, until we address personal trauma and human need through psychological and economic safety nets, the demand will remain strong.

      Just this week, China Foreign Ministry spokeswoman Mao Ning pointed out that the U.S. has 5 percent of the world’s population yet 80 percent of the world’s opioid consumers, with over a million drug overdose deaths since 2000. Certainly other regions of the world experience economic and psychological adversity — but in America inequality makes this intolerable for many, who escape their physical and mental suffering through drugs.

      Thanks for the shout-out, Yves!

    3. digi_owl

      Sounds very much like the ones i have encountered in life indeed.

      It is by far about trying to escape, even if just temporary, internal demons.

      But once on start going down that path another problem develops, that over time the only “community” one has any connection with are fellow addicts and the dealers supplying them.

      Thus one likely have to uproot and move far away to be able to stay clean long term.

  4. caucus99percenter

    Story from 2015: Saudi prince Abdel Mohsen Bin Walid Bin Abdulaziz caught using his private jet to smuggle two tons of Captagon via Beirut airport:


    Saudi royals are probably so used to being allowed to flout non-kingdom law and do whatever they want wherever they want, it would not surprise me if they were up to their eyeballs in this international drug trade — while the U.S. Blob tries to pin it all on Syria.

  5. KLG

    A quick note on personal experience, so YMMV. Last year I had a surgical procedure for the first time since I was a toddler. The anesthetist used a combination of Versed and fentanyl. Despite to rather large incision in my upper right chest and the discomfort of what had been done that left about 12 large stitches covered in glue, I woke up feeling like Superman. That was due to the fentanyl. When it came time for surgical removal of what had been inserted, I insisted on Lidocaine only. But the experience was an eye-opener! In college in the 1970s everyone thought I was a narc, always passed the joint or the pipe. I just did not see the point (and it was a felony at the time). But I could see the point of fentanyl abuse after that one experience. Which means that if we were a serious nation we would listen to Gabor Maté. Hope springs eternal. Which reminds me, his book sits in the pile, waiting.

  6. ambrit

    I was on the edge of the drugs ‘scene’ back in the 1970s and 1980s. I noticed even then the two sorts of drugs ‘users.’ The Party Crowd, who were up for anything if it promised a “good time.” And the “junkies,” who depended on the drugs like the air they breathed.
    The two groups had sharply different views of the world. The Party Crowd felt that they were “On Top of the World.” They could do nothing wrong, and everyone else had better learn to get along with them, or else. The Junkies were sliding along, staying close to the shadows. To them, the World was ‘out to get them.’
    No amount of counseling is going to do any good when you feel that you are Superman. Likewise, no amount of counseling is going to help if you cannot afford to eat, much less experience a Middle Class existence.
    From these observations I determined that drugs addictions were a hellacious combination of Nature and Nurture. No simplistic solutions to such problems exist, unless you are an Eugenicist.
    Given the manifest rise in Eugenicists in positions of Power, I fear that addicts are going to be mainly given Neo-liberal Rule #2 as lifestyle advice: Go die.
    End of rant.
    Stay safe and hold your friends and family close.

    1. Duckyyy

      Perry Farrell, the lead singer of Jane’s Addictions said people do drugs for 2 reason, to explore or to escape. I’ve never heard a more succinct reasoning for doing drugs. Personally, I have done for both reasons.

  7. James

    I remember talking to a guy in Syria who told me he had a serious Captagon habit until, in Syrian fashion, his uncle beat the snot out of him and that got him off of it.

    I was young and stupid. When he told me it was in pill form I thought “Well it can’t be that bad – not like meth or cocaine.”

  8. Robert Hahl

    There is something more at play here than simple addiction. I know two people, one in my immediate family, who do not regularly get high but still suffer from a stimulant psychosis all the time, call it long cocaine. The symptoms are: inability to hold a job, to manage money, to pay bills even when there is enough money (“I don’t pay bills”) or avoid mortgage default, to keep appointments without an escort, to feed themselves decently (imagine living on ice cream), to sleep normal hours, or even to acknowledge that street drugs have changed their personality. They must inevitably loose everything without an intervention by family or friends. But they are not addicted, just crazy.

    1. digi_owl

      Not a psychologist or anything of the sort, but that sounds almost ADHD-ish. Note btw that the H there is frankly optional, and the ADD, or more correctly executive function disorder, is the major element. What it boils down to, iirc, is that the person suffers from an inability to ignore distraction and stick to long term plans or tasks. In particular “boring” tasks.

  9. Yeti

    Just received a call last week from a very close friend relaying to me that his 33 year old son had died from an overdose. Opioids were his drug of choice. That was the third young man that I have personally known to die of overdose in past 18 months. In B.C overdoses are set to break another record in deaths this year averaging almost 7/day. It is the fourth leading cause of death and ranks #2 in years lost. There doesn’t seem to be a end in sight, at least in this corner of the world. Deaths are up almost 50% since 2016 when the province called a state of emergency which I believe is still in effect.

  10. John Beech

    2nd paragraph, last sentence . . .

    Opioids, like Covid19, are here to stay

    should be . . . Opioids, like cocaine, are here to stay.

    And after correction, I suggest you just delete this post.

  11. Morongobill

    Not directly related but the street drug Tranq is wrecking havoc in the homeless areas. Lots of YouTube videos for the Zombie drug as some call it.

  12. Paradan

    Another big driver of stimulant abuse is low wages/lack of full-time employment. Having to work multiple part-time jobs is a killer, nothing sucks like getting off work and driving to your other job for another shift.

  13. swmnguy

    Another rarely-discussed aspect of addiction in America is the lack of availability, and effectiveness, of treatment for both addiction and for pain.

    The treatment techniques that work involve high levels of interpersonal contact over time. This involves high labor costs for qualified practitioners. At prices people can pay, effective treatment is not profitable.

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