The war may be over in Syria, but pain of all kinds persists. With a shortage of doctors and therapists, people to turn to pills.
A man pours pills into his hand. (Photo by rattanakun)
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At noon, the bar where Ahmad works in Bab Sharqi, in Damascus’s old city, was empty. We met before customers arrived and his 12-hour shift grew busier. He spoke fast, his hands opening and closing as he moved from one thought to the next.
This energy he has is partly due to the drug Captagon, a synthetic stimulant used to treat depression and attention-deficit/hyperactivity disorder. Ahmad, whose surname is being withheld for his safety, said he has taken the drug regularly for six years. Without it he feels indifference and lack of motivation.
Captagon is sold illegally around the world and its production helped finance the government of former dictator Bashar al-Assad until it fell in 2024. The drug can be difficult or expensive for people to obtain. On some days, Ahmad takes four or five pills to stay alert and work through his shift. “Without it, I can’t work,” he said, shrugging.
He described losing his motivation and sense of meaning during years of economic hardship and insecurity. He dismissed a suggestion that he might have sought professional help for those feelings.
“I don’t trust the doctors in Syria,” he said. “I visited a psychiatrist once after a suicide attempt. Forced by my friends and family, I took the medication he prescribed and my symptoms got worse.”
Trafficking in addiction
Ahmad’s experience points to a less visible part of Syria’s drug crisis. Captagon is addictive. During Syria’s nearly 14-year civil war, the country became a major production centre for a multibillion-dollar Captagon trade.
Investigations linked production and trafficking networks to Assad’s government with much of the trade serving export markets, particularly in the Gulf. The pills also reached consumers inside Syria.
International attention has largely focused on Captagon factories, trafficking networks and their links to the Assad regime. Less attention has been paid to people inside Syria, who use the pills to work, remain awake or cope with distress, and to the care available when they become dependent.
Captagon was originally the brand name of a prescription stimulant containing fenethylline, introduced in the 1960s. The illicit tablets sold under that name today are different, commonly containing amphetamine and caffeine in varying combinations.
After Assad’s fall, the new authorities uncovered production sites, destroyed pills and announced seizures.
Panic and depression
Ahmad said he can still buy Captagon when he needs it even though it is more expensive now. It isn’t clear whether he has depression, but by his own account he suffers from emotional distress, exhausting working conditions. Distrust of medical care can become intertwined with drug use.
Psychiatrist Zeina Abdulrahman said that years of war, loss and economic hardship have left many young Syrians struggling to imagine a future. “The 2025 massacres on the coast may have reactivated earlier trauma, deepening fear, hopelessness and a sense that life no longer has meaning,” Abdulrahman said.
This distress can take the form of panic attacks or depressive symptoms. “Recovery requires both psychological support and a realistic chance to rebuild their lives,” she said.
There is no reliable national figure for the number of Syrians using Captagon or living with substance-use disorders. Stigma and fear make the problem difficult to measure, while years of war divided the country’s health and data-collection systems.
A study published in 2026, based on a survey of 480 people in northwest Syria, found that about 12% of respondents reported using substances themselves. Its authors cautioned that stigma may have discouraged disclosure. The findings cannot be generalised to all of Syria, and reported use does not necessarily indicate dependence. They nevertheless offer a limited view of an issue for which national evidence remains scarce.
A lack of healthcare
Since the conflict began in March 2011, Syrians have depended heavily on humanitarian assistance to meet basic needs. State institutions have largely failed to provide even minimum public services, particularly healthcare, and Euro-Med Monitor said this situation had not fundamentally changed following the fall of the former government in December 2024.
In the Latakia countryside near Jableh, I met Ali, a 30-year-old German-language teacher whose surname is also being withheld for his safety. His experience involved another substance: morphine.
Sitting in his modest rural home, Ali described nearly a decade of severe insomnia and repeated attempts to find relief.
“I have suffered from insomnia for nearly 10 years, and none of the doctors I consulted could help me,” he said. “I tried every sleeping pill and sedative until they stopped working, so I resorted to morphine injections.”
Ali’s eyes were sunken while he was telling his story with morphine and how the insomnia worsened after witnessing violence against his family and neighbours during the 2025 coastal massacres.
When there is no access to treatment
In March 2025, Alawite communities in Syria’s coastal region were subjected to acts of violence in which civilians were killed in their homes or taken away and executed. UN investigators documented the participation of members of military factions affiliated with the new government, finding that civilians were targeted because of their Alawite identity, which was also Assad’s.
“I witnessed the killing, the assaults and the humiliation,” he said. “And after that, nothing remained the same.”
Ali’s mother was initially hesitant to discuss her son’s dependence. She then said that the family had tried to find rehabilitation treatment but could not locate a specialised centre in Latakia.
Their search illustrates the difficulty of finding appropriate care. In 2025, the Financial Times reported that Syria had only four specialised addiction-treatment facilities. Hospitals could sometimes offer medication and supervision during withdrawal, it reported, while longer-term rehabilitation was much more limited.
According to media outlet Al-Ekhbariya, the Ministry of Health has described efforts to build a comprehensive system of mental-health and addiction services.
Building a mental health network
According to the ministry, these included establishing a Mental Health Directorate in February 2026 and subsequently forming a National Council for Mental Health and Addiction, bringing together ministries and organizations providing mental-health and psychosocial support.
For families such as Ali’s, the practical question is where those plans translate into treatment they can reach. For Dr. Abdulrahman, there are many obstacles facing young people from getting help, like the social stigma surrounding both mental illness and addiction which can make asking for help feel like an admission of personal or moral failure.
Pharmacists see another part of the problem. Reem Mahmoud, a pharmacist in Homs, said young customers were already seeking medications with the potential for dependence or misuse before Assad’s fall. These included pregabalin, prescribed for conditions including nerve pain; tramadol, an opioid painkiller; and the anxiety medication sold under the brand name Zolam.
“After the fall of the regime, the Ministry of Health instructed us to tighten controls on medications that can cause dependency or are commonly misused, including pregabalin, tramadol and Xanax,” she said.
The tension between preventing misuse and preserving legitimate medical access is not unique to Syria. The World Health Organization (WHO) has warned that regulations intended to control potentially addictive medicines can become so restrictive that patients are unable to obtain drugs needed to treat pain, neurological and mental health conditions and substance use disorders.
A shortage of pain medication
In 2025, the WHO issued new guidance urging governments to adopt policies that prevent non-medical use without interrupting affordable access for patients.
The global imbalance is particularly severe for opioid painkillers. According to the International Narcotics Control Board’s 2025 report, high-income regions in Europe, North America and Oceania accounted for more than 98% of the opioid analgesics available for consumption worldwide in 2024, leaving less than 2% for all other regions.
The disparity reflects more than limited supplies: the WHO identifies restrictive regulations, complicated procurement systems and fear among medical professionals of punishment if controlled medicines are diverted as barriers that can prevent appropriate prescribing and dispensing.
Mahmoud’s account raises the question of whether Syria can achieve that balance. Tighter pharmacy controls may prevent some medications from being sold or used without appropriate supervision.
But if restrictions are not accompanied by clear prescribing rules, reliable supplies and referrals to treatment, patients with legitimate medical needs may also struggle to obtain care. Syria must control diversion without turning necessary medicines into another service available only to those who know how to reach the illicit market.
Panic attacks
I experienced the consequences of these restrictions personally. A doctor had prescribed Xanax — the brand name for alprazolam, a benzodiazepine used to treat anxiety and panic disorders — to help me manage severe panic attacks.
Yet even when I presented the prescription, several pharmacies refused to dispense it. Tightened controls, widespread misuse and the circulation of forged prescriptions had created a climate of suspicion. Although no pharmacist directly accused me of anything, I felt I was being treated less as a patient than as someone who might be misusing the medication or presenting a false prescription.
I remained without the medication for a period of time. During that gap, my panic attacks became so severe that I sometimes fainted. Eventually, after failing to obtain Xanax through pharmacies, I began getting it through an intermediary who sourced it from illicit dealers.
The experience exposed the contradiction at the heart of poorly-designed restrictions. Measures intended to keep controlled medicines off the illicit market had not eliminated that market. Instead, they had blocked my access through the medical system and pushed me towards the very illicit supply chain the restrictions were intended to combat.
What I lost was not simply access to a pill, but the medical supervision that should have accompanied its use.
A war on drugs
Tighter controls address access to these drugs. Ahmad’s rejection of doctors and Ali’s unsuccessful attempts to obtain relief raise a further question: whether people will seek and trust the treatment available to them.
Back in the empty bar in Bab Sharqi, Ahmad measured his dependence against the demands of another working day. Captagon, he said, allowed him to keep going through shifts he felt unable to manage without it.
Asked what would happen if he stopped taking it, he laughed. “I will be clinically dead,” he said.
Syria may succeed in curbing the supply of Captagon and other drugs and opening addiction treatment centres. But unless young people can access mental health care they trust and live without the constant threat of violence because of their identity, removing the pills will not remove the distress that made them useful.
The factories may close, while the reasons people turned to their products remain.
Questions to consider:
1. Why is it hard for people in Syria to get medical and mental health treatment?
2. What does the author mean by a global imbalance of some painkillers?
3. Why might someone not seek medical or mental health they need?
Sarah Khazem is a Syrian freelance journalist based in Latakia, Syria. With over five years of experience covering Syria and Lebanon, her reporting focuses on human rights, gender, migration, social justice and the intersections of politics and everyday life. She produced this story as part of the Dalla Lana Fellowship in Journalism and Health Impact at the University of Toronto.