Strox drug in Egypt: what voodoo is and why it is more dangerous than hashish

What is the strox drug, and what are voodoo and joker?

Strox is neither a plant nor a kind of hashish. It is a group of chemicals made in unlicensed labs, known scientifically as synthetic cannabinoids, which are sprayed onto cheap dried herbs so they look like hashish and are sold in small bags. These substances do not exist in nature, and their make-up changes from batch to batch, so nobody, neither the seller nor the user, knows what is really in the bag.

The names change from country to country: strox and voodoo in Egypt, joker in Jordan, chemical (kimikal) in Kuwait, and spice or K2, well-known international product names, in the Gulf and elsewhere. Different names, one family. If you hear your son or one of his friends mention any of them, he is not talking about hashish, even if he believes he is.

What makes them "cannabinoids" is what they do, not one shared formula: they act on the same brain receptors as cannabis, while their chemical structures vary from one compound to another. The US National Institute on Drug Abuse (NIDA) notes that they often produce effects very different from those of cannabis, and that their use is linked to severe, potentially life-threatening health problems. In other words, "synthetic" here does not mean milder or cleaner. It means unknown.

Hashish vs strox: why are synthetic cannabinoids more dangerous?

Synthetic cannabinoids act on the same brain receptors as THC, the active substance in hashish. But a systematic review published in 2025 in a peer-reviewed medical journal describes them as powerful substances that activate these receptors fully and bind to them far more strongly than THC does, producing strong and often unpredictable effects on the mind.

• Strength: tighter binding to brain receptors, so a harsher and less predictable effect.
• Full activation: they switch these receptors on fully, so their effect on the brain can be far stronger than that of hashish.
• Changing make-up: hashish is resin from the cannabis plant, and its strength is not fixed either, but its main active substance is THC; strox is many lab-made compounds whose type and strength keep changing.
• More hallucinations: an Egyptian study cited an earlier small study of teenagers suggesting that hallucinations were five times more common after these substances than after natural cannabis.
• Unknown mixtures: one product may combine more than one substance, and may interact with other drugs that neither the user nor the emergency doctor knows about.

Why doesn't the person know what they are taking?

This is the most dangerous point of all. FRANK explains that the strength of these substances differs between batches and between packs, and that the chemical make-up of these mixtures changes all the time, so no one can be sure what they are taking or how strong it is. That is why testing and medical knowledge are often one step behind.

In its World Drug Report 2017, the United Nations Office on Drugs and Crime (UNODC) notes that the use of products containing synthetic cannabinoids has been linked to severe health events, including hospital admissions and deaths, and that other poisonings and deaths may have gone undetected because of limited scientific knowledge of new compounds and their interactions with other substances. Put simply: even the recorded figures may be lower than the reality.

Acute strox symptoms: what happens in the first hours?

A cross-sectional Egyptian study published in 2022 included 50 male patients who used strox and voodoo in Assiut, Upper Egypt; 68% were aged from 15 to under 35. The study recorded these symptoms among them:

• Red eyes and blurred vision: 88%.
• Palpitations and a racing heart: 76%.
• Dizziness or drowsiness: 68%.
• Hallucinations: 62%.
• Panic attacks: 26%.
• Headache: 22%, and nausea or vomiting: 24%.
• Chest pain: 12%, and seizures: 8%.

Another study published in 2025 from the poison control center at Tanta University reviewed poisoning cases over five years (2019 to 2023) and recorded four cases of acute strox poisoning, all adult men. All four arrived with a racing heart and low blood oxygen, three had seizures and high blood pressure, and all needed to stay in hospital for between 21 and 30 hours. The number is small, but the picture is clear: this is not a "herbal cigarette".

Psychosis and aggression: how can the family respond safely?

What frightens families most is the sudden psychological change: morbid suspicion of the closest people, strange ideas, hallucinations, and agitation that can reach violence. The 2025 systematic review, which pooled 35 studies covering about 4,600 cases, describes acute episodes with delusions, severe agitation and aggression, and sometimes frozen movement or a sense of detachment from reality that may be more marked than with hashish. The good news is that about 90% of these episodes improved within one to four days with treatment. But in some cases psychosis persisted or returned for weeks or months, and this was almost always linked to continued use or to a pre-existing psychotic disorder. In some studies of emergency department patients, between 5% and 25% needed intensive care because of heart rhythm and blood pressure problems or seizures. The authors point out that most of this evidence comes from case reports and small studies, so these figures are a guide, not a precise forecast.

What to do during an episode

• Keep yourself safe first, then stay calm; your calm voice is part of the treatment.
• Don't argue or try to prove that what they see is not real; arguing increases agitation. Use short, reassuring sentences.
• If possible, move them somewhere quiet, away from crowds, bright light and noise, and keep children and anyone who might get worked up away.
• Don't approach suddenly or restrain them by force, and keep a clear way out of the room for yourself.
• Remove anything that could hurt: sharp tools and anything that could be used in a moment of anger.
• Ask for help early: the ambulance on 123 at once for any danger, and the center's line for advice alongside it, not instead of it, without waiting for things to get worse.
• Don't punish or threaten during the episode; medical care comes first, and talking comes after they calm down.

If you have read before about psychosis after hashish, know that two studies included in the same review found that people who used only synthetic cannabinoids needed more antipsychotic medication and longer hospital stays than people who used cannabis. Symptoms settling does not mean follow-up is no longer needed, because psychosis returning is usually linked to returning to use.

How big is the problem in Egypt and the region?

An Egyptian study published in 2021 included 2,380 male and female students at one Egyptian university between July and October 2020, and 4.9% of them (116 students) reported using drugs. Among them, hashish was the most common at 96.5%, followed by strox at 41.3%, then bango (local herbal cannabis) and voodoo at 34.4% each, then tramadol at 31.1%. In other words, strox came second only to hashish among the students in this sample who used drugs.

On a screening questionnaire (not a medical diagnosis), the same study found symptoms of depression in about a third of the students who used drugs and symptoms of anxiety in roughly a quarter. This does not necessarily mean one caused the other, but it reminds us that psychological distress often comes with substance use, which is why stopping the substance alone is not enough.

In Jordan, where these substances are known as "joker", a study published in 2021 included 1,789 university students between November 2017 and March 2018: 92.5% had heard of them, 11.4% said they knew someone who used them, and 63.3% did not know that they are not herbal products (they either thought they were herbal or were unsure). The names change between countries, but the same misunderstanding repeats: many think of them as "herbs" when they are not.

When should you get help? Signs not to ignore

Don't wait for things to hit "rock bottom". Book an urgent appointment with a specialist doctor if you notice any of the following persisting or recurring:

• A clear change in personality and mood: irritability, outbursts of anger and suspicion of family.
• Withdrawing from family and old friends, and new friends you know nothing about.
• Falling behind at school or work, and repeated absences without a convincing reason.
• Frequently red eyes, blurred vision and complaints of palpitations.
• Disturbed sleep, loss of appetite and weight loss.
• Money or belongings disappearing from home.
• Talk of hopelessness or death, or a wish to harm themselves.

What to do until the ambulance arrives

• Don't leave them alone, and stay calm and reassuring.
• If they are unresponsive but breathing normally, lay them on their side in the recovery position, stay beside them and keep checking their breathing; if they are not breathing, or are only gasping, they need CPR (cardiopulmonary resuscitation) urgently: tell the ambulance call handler at once and follow their instructions.
• If they are drowsy, keep them sitting up if possible and talk to them to keep them awake, without startling them; don't give them coffee or put them in a cold bath.
• Tell the paramedics everything you know: what they took and when, and whether they took other substances with it.

If there is talk of self-harm, don't avoid the question. Ask directly and calmly whether they are thinking of ending their life, listen without blame or lectures, don't promise to keep it secret from everyone, and stay with them until a doctor sees them. Asking directly does not plant the idea; it opens a door that was closed. If the danger is immediate, call the ambulance on 123 straight away or go to the nearest emergency department, and don't leave them alone. Without immediate danger, you can also get support from the mental-health hotline 16328 or the center's 24/7 emergencies line +20 100 006 6752; these lines do not replace the ambulance. Help is available and things can get better.

How does treatment for strox addiction begin?

There is no "single medicine" for strox. Treatment rests on two things together: keeping the body safe while stopping, and treating what is happening in the mind. Because psychosis, anxiety and depression are common with these substances, it takes an addiction treatment service and psychiatry at the same time, not just one of them.

1. A medical and psychiatric assessment first: an appointment that establishes the physical and mental state and whether other substances are involved.
2. Stopping under medical supervision: this may come with insomnia, irritability, mood swings, strong cravings and physical symptoms, and some people need observation in hospital. Details in strox withdrawal symptoms and treatment.
3. Treating psychological symptoms: a doctor may decide on medicines to calm agitation or treat psychotic symptoms, and only the doctor decides which, for how long and when to stop.
4. Regular psychotherapy sessions to deal with cravings, triggers and ways to prevent relapse.
5. The family's role: most people who use these substances are young, so training the family to support without confrontation helps; teenagers aged 15 and over can be seen at an appointment with a psychiatrist (under 18 with a parent or guardian's consent), and there is more in our guide to signs of teen drug use.

The reassuring message is that people get better. The 2025 systematic review reports that about 90% of acute psychotic episodes improved within a few days with treatment, and that psychosis coming back was almost always linked to returning to use. In other words, staying stopped is half the treatment, and follow-up is the other half. To book or ask a question, you can contact us or call the center's line on +20 101 687 0711.