Two years ago, Michael Samir (a pseudonym) enrolled in an addiction treatment program at the harm reduction unit in Abbasiya Psychiatric Hospital, aiming to recover from heroin addiction and regain his ability to lead a normal life and fulfill his professional duties. After a long struggle with addiction dating back to 2008, like thousands of others in the program, he signed a consent form to begin treatment with methadone, an opioid substitute used in Egypt for treating heroin and morphine addiction. The drug helped him overcome the physical and psychological withdrawal symptoms. He was dispensed carefully calculated daily or take-home doses based on his physical indicators and the duration of his enrollment in the program.

In early April, Michael and other patients in the Abbasiya harm reduction unit were shocked to be informed of a decision to halt the distribution of imported methadone, and that it would be replaced with Egyptian-made methadone, which they were told was a new drug produced by EIPICO Pharmaceuticals. They had never heard of this version before and were unaware of its pharmaceutical composition. Shortly afterward, their doses were significantly and unscientifically reduced, leading to severe withdrawal symptoms that endangered their lives due to sharp drops in their vital indicators and increased risk of suicide, according to Michael.

He told Zawia3: “I used to receive a daily take-home dose of 11 cm of internationally recognized imported methadone. Suddenly, I found myself forced to take the Egyptian version called Methadenthe, which I don’t even know if it has undergone proper clinical testing. Then my dose was reduced to 8 cm daily, and I felt no effect, so I took two doses in one day. They kept reducing it daily until my dose reached 2 cm. They also forced me to attend the hospital in Abbasiya every day to take my dose, even though I live in 6th of October City. I suffered from severe withdrawal symptoms—shortness of breath, intense headaches, body aches, crying spells, and low blood pressure.”

Under the weight of withdrawal, Michael relapsed, using heroin once. Though he reported feeling no euphoria or high like before, he is more concerned about the fact that most of his peers in the harm reduction program in Cairo also returned to drug use. This led to family and social crises such as divorce, estrangement, job loss, or involvement in violent behavior and crime, according to his account. Rumors circulated among patients about deaths due to withdrawal symptoms after the imported methadone was discontinued, though no official confirmation has been issued.

Michael told Zawia3 that he and fellow patients organized a sit-in inside the hospital to demand a solution, but were met with direct threats from staff and a police colonel, who was brought in to force them to back down.

Amid the ongoing crisis, participants were unexpectedly subjected to random drug testing. Anyone who tested positive was immediately expelled from the program without consideration of the withdrawal circumstances or reasons for relapse. Later, in early May, the expelled patients were reinstated after being told that the Ministry of Health had provided a new shipment of methadone at its own expense. However, the new doses ranged only between 1 and 3 centigrams per day, which, according to patients, was insufficient to alleviate the severe physical and psychological withdrawal symptoms they continued to experience.

Methadone was developed in Germany in the late 1930s by scientists Gustav Ehrhart and Max Bockmühl, and was later approved in the United States in 1947 as a pain reliever. Since the 1960s, it has been widely used in addiction treatment programs, especially for treating Opioid Use Disorder (OUD).

Methadone is listed among the World Health Organization’s essential medicines due to its effectiveness in easing withdrawal symptoms resulting from abrupt opioid cessation, either as long-term maintenance or short-term detox support. Its use in addiction treatment is subject to strict medical regulation in most countries due to its sensitivity and direct effect on the nervous system.

A 2009 scientific review by the Cochrane Collaboration found methadone to be one of the most effective treatments for retaining patients in treatment programs and for reducing—or completely stopping—long-term heroin use.

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The Black Market Mafia of Methadone

After 25 years of addiction and repeated attempts at recovery, Hani Mohamed (a pseudonym) joined the harm reduction program at the Heliopolis Psychiatric Hospital (commonly referred to as “El-Matar”) in 2013 to overcome heroin addiction. He received treatment using opioid substitutes such as methadone and buprenorphine, under medical supervision, which helped alleviate withdrawal symptoms and restore both his family and professional life.

But in the winter of last year, Hani discovered that the very drug used for recovery had started to become a commodity in a black market run by some patients inside harm reduction units. He told Zawia3 that several patients were selling their assigned doses to other users, and that methadone had even begun to appear in known drug dens (popularly referred to as “dawalib”) in the neighborhoods of Ain Shams and Imbaba.

The situation escalated when a friend of his—facing the threat of losing a limb due to heroin use—tried to enroll in the same program, but ended up stuck on a long waiting list, forcing him to buy methadone from the black market. During this time, Hani discovered that one of his peers in the harm reduction unit was selling his share of the medication, and had sold a 50 cm dose for 3,500 pounds ($70) to his friend.

Hani reported the incident to his treating physician—who also held an administrative position at the hospital—and provided detailed information about the transaction he had witnessed. However, the doctor dismissed the report and accused Hani of fabricating the story for personal reasons, even though, according to Hani, the methadone dose in question was being offered for sale inside the hospital.

Speaking to Zawia3, Hani said he noticed a sharp increase in the number of patients enrolled in the harm reduction program at El-Matar Hospital during the past winter, with participants rising from around 200 to between 700 and 800, including many individuals with criminal records. According to him, some of them were selling all or part of their doses to drug dealers.

He added that at the time, the price of one centimeter of methadone on the black market ranged between 100 and 200 pounds ($2–$4). He believes the sudden influx of patients was accompanied by unusual leniency in admission criteria, with many new patients being enrolled without the strict medical exams and tests that he and other earlier participants had undergone.

Hani recounted:
“Normally, the hospital doesn’t allow more than 35 cm of methadone to be dispensed as a combined supply. My daily dose was 10 cm, tailored to my case, so I was allowed only enough for four days. I had to return on the fourth day, which cost me job opportunities. When I couldn’t make it, I had to buy from the black market. One day, I saw a nurse carrying prescriptions covering up to a month or 40 days. Later, a fellow patient told me his relative who worked at the hospital could arrange extra doses for me—for a price.”

Hani believes that a corruption network exists within several psychiatric hospitals in Cairo, involved in smuggling methadone supplies outside the official system. According to his testimony, some staff members facilitated the enrollment of individuals from unlicensed private rehab centers, some of whom had criminal drug records and were still selling crystal meth, just to obtain methadone doses and resell them to these centers for a fee.

He also alleged that unnamed officials used their positions to obtain large methadone quantities for private addiction clinics they own or manage—without any medical oversight or legal accountability.

On the second day of Eid al-Fitr, Hani and his peers at El-Matar’s harm reduction unit were suddenly informed that their methadone doses would no longer be dispensed. They were told that the existing stock had expired, with no prior notice. Hani told Zawia3: “It was strange to suddenly discover that the expiration date of such a vital medication had passed. We requested it be dispensed under our personal responsibility since expiration only reduces effectiveness—not safety. But the doctors refused outright.”

Instead of methadone, an alternative treatment protocol was suddenly introduced, including paracetamol and antidepressants. According to patient testimonies, this led to severe withdrawal episodes, more intense than drug withdrawal itself, with suicidal thoughts reported by some. “One staff member told us to figure it out ourselves until the crisis ends,” Hani added. “Many had no choice but to relapse.”

He described the withdrawal symptoms:
“I felt like electricity was running through my body. I couldn’t speak, was constantly irritable, and thought about suicide multiple times.”
Within 20 days of forced methadone deprivation, Hani lost his job, was involved in a car accident, had to sell his computer, and entered serious conflicts with his wife that nearly ended in divorce. He also spent around 20,000 pounds ($400) on prescription painkillers like morphine from the black market.

During the crisis, Hani was told by other patients in harm reduction units that deaths had occurred due to the sudden methadone cutoff, although no official announcements were made. He said one of the victims was his colleague in the El-Matar unit, who died at his workplace, but the family chose not to disclose the cause of death due to social stigma, and the hospital issued no public statement.

Over time, Hani noticed that patient numbers declined in the unit, returning to nearly pre-winter levels. After 20 days without access to the drug, he and his peers were informed that imported methadone had returned, but in drastically reduced doses. Instead of the 10 cm daily he previously received, he was now given just 1 cm of oral solution per day.

Hani said this reduction kept him in a constant state of physical withdrawal, blaming poor management and suspected corruption for what he and his peers had suffered. He demanded accountability for those responsible before the crisis is quietly buried without consequences.

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Complaints Filed with the United Nations

In April, a number of patients—among them Michael and Hani—submitted complaints and urgent appeals to both international and domestic bodies, accusing Ghada Waly, Executive Director of the United Nations Office on Drugs and Crime (UNODC) and former Egyptian Minister of Social Solidarity, of misleading the international community regarding the status of the methadone program in Egypt.

According to the complaints—copies of which were obtained by Zawia3—Waly stated at the 68th session of the Commission on Narcotic Drugs held in Vienna on 14 March 2025 that the methadone program in Egypt was a success. Her remarks came just two weeks before the sudden suspension of methadone distribution in Egypt, which occurred without warning or alternatives. Patients said her statements ignored prior appeals and distress calls that had already been submitted before the date of her address.

In an individual complaint submitted by a program participant to the UN Ethics Office, the patient explained that his life, along with the lives of other patients, had been endangered by the unsafe suspension of the methadone program without medical oversight, despite it being officially implemented in cooperation with UNODC. The complaint stated that the decision led to severe withdrawal symptoms, psychological trauma, and an increased risk of death.

The complaint described the situation as potentially amounting to “misconduct, negligence, or abuse of authority,” calling for an independent UN investigation into the incident. It argued that Waly’s public statements and her direct involvement in the program could place her in a position of accountability.

In the same context, Zawia3 obtained a copy of an official collective complaint, sent on 27 April to four entities: the Office of the United Nations High Commissioner for Human Rights (OHCHR), the UN Office on Drugs and Crime (UNODC), the World Health Organization Regional Office for the Eastern Mediterranean, and the Egyptian National Council for Human Rights. The complaint carried a clear title:
“The Sudden Termination of the Methadone Treatment Program in Egypt Violates Human Rights.”

The complaint stated:
“We, the patients, families, and advocates harmed by the methadone treatment program, submit this urgent complaint against the Egyptian Ministry of Health for the sudden termination of the program, the forced dose reductions, surprise drug testing, and arbitrary patient dismissals—all without any medical or legal justification. These practices violate Egyptian law, international human rights standards, and medical ethics.”

The document highlighted what it called a stark contradiction: while Egypt promoted the program as a success story at the Vienna conference, state hospitals—such as Abbasiya Hospital—began reducing doses without prior notice or individualized medical assessment. Patients were subjected to undisclosed drug tests, and those who tested positive were expelled—even though some results may have been caused by acute withdrawal symptoms.

The complaint argued that this contradiction between official discourse and actual practice could point to unprofessional or politically motivated decisions, warranting urgent international investigation.

Zawia3 reached out to Dr. Ghada Waly in her capacity as UNODC Executive Director and Director-General of the UN Office in Vienna for comment on the methadone crisis in Egypt’s harm reduction units and in response to the patient complaints. However, at the time, the UN official and former minister was abroad and responded briefly, stating that the methadone treatment program is under the purview of Egypt’s Ministry of Health, and denying that UNODC is responsible for either the program’s implementation or the distribution of the medication.

A report issued by Egypt’s State Information Service in February 2024 presented by the Minister of Social Solidarity outlined the activities of the national anti-drug fund, including the completion and review of a draft national plan to reduce drug demand (2024–2028) in cooperation with UNODC. The report cited a national survey indicating that drug use rates in 2020 had declined compared to 2015.

According to the United Nations, UNODC collaborated with Egypt’s Ministry of Health and Population to launch opioid agonist therapy (OAT) in Egypt as part of the regional project “Prevention, Treatment, and Care Services for HIV/AIDS in Prisons,” funded by Germany. UNODC adopted a comprehensive approach to support the country’s provision of medication-assisted treatment, which included capacity building, training on up-to-date practices, and holistic methodologies for involved medical and social staff.

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Opioid Substitution Therapy in Egypt

On March 1, 2023, Egypt launched its opioid substitution therapy (OST) program using methadone, at Heliopolis Psychiatric Hospital (“El-Matar”), which is affiliated with the General Secretariat for Mental Health and Addiction Treatment. Patients receive their daily doses at the nearest harm reduction unit, alongside their required participation in psychotherapy sessions. Within a year, the number of units expanded to 13 across 10 governorates: Cairo, Alexandria, Sohag, Sharqia, Minya, Assiut, Qalyubia, Gharbia, Dakahlia, and Damietta. The Ministry of Health is preparing to launch the second phase of units in Giza, Port Said, Menoufia, and Beni Suef. In June 2024, the Ministry of Health and Population announced that 700 patients had responded positively to the program, while unofficial estimates suggest that 8,000 patients have joined harm reduction units.

Dr. Amr Osman, Director of the Anti-Addiction Fund, told Zawia3 that around 170,000 addiction patients visit public psychiatric and addiction hospitals annually—out of a total of 34 hospitals, 11 of which are operated by the fund, while 23 fall under either the Ministry of Health or the Armed Forces. He noted that these figures have remained largely consistent over the past five years. However, recently 40% of addiction cases involve patients addicted to shabu (crystal meth), ice, or synthetic cannabinoids like “strox.”

Dr. Wael Fouad, consultant psychiatrist and former director of Khanqah Psychiatric and Addiction Hospital, stated that methadone-based treatment is extremely costly, and ill-suited to a country struggling economically and facing drug shortages. He estimated the cost in the millions of pounds, due to the high price of the drug and the infrastructure it requires. He argued that methadone creates dependency, and patients experience withdrawal once the treatment stops. He emphasized that addiction is primarily a behavioral disorder, not merely biological, and thus requires behavioral therapy as the foundation of treatment.

Speaking to Zawia3, he said: “I consider the methadone treatment program in Egypt, and the introduction of other expensive medications like Invega, used for schizophrenia—with each ampoule costing 4,000 pounds ($80)—to be a waste of resources that should be criminalized. Instead of installing air conditioning in Khanqah Hospital when I was director, we were told to prepare a harm reduction unit with specific standards, including an ICU bed. Our input as field professionals wasn’t considered. Even if methadone is part of a foreign grant, that support won’t last forever. The foreign company succeeded in creating market demand, building dependency on its active substance. They offered psychiatrists incentives, including a training grant in France. A company representative once asked me for a recommendation letter for the drug, which I refused. Soon after, we received directives to promote and encourage methadone therapy.”

He added: “In April, harm reduction units across psychiatric hospitals faced a severe methadone shortage, after discovering that 15,000 bottles stored in the Ministry of Health’s warehouses had expired. Patients experienced intense withdrawal symptoms, similar to heroin withdrawal. There were rumors of deaths as a result, though I couldn’t confirm them. Methadone should only be used in a limited, short-term scope, for patients experiencing severe withdrawal—and only if they can afford it. The OST program in Egypt was based on continued methadone consumption, not on detox protocols to flush out toxins.”

Fouad pointed out that, by protocol, methadone should never be dispensed without medical supervision, nor should patients take it home. However, when the General Secretariat for Mental Health discovered a large stockpile nearing expiry, some officials began distributing unusually high doses to patients with addictive behavior to reduce inventory waste. This ultimately led to large volumes of opioid medication entering the street market, just before the crisis.

Available data shows that methadone is sold under brand names such as:

Methadose, Dolophine, Methadone Hydrochloride Intensol (UK), and Diskets (UK). One of the key manufacturers of DTF methadone formulations is Macarthys Lab T/A Martindale Pharma, based in the UK. Other companies include Hikma Pharmaceuticals (Jordan/US), Mallinckrodt Pharmaceuticals (Ireland/US), Mylan Institutional (US), SpecGx LLC (a Mallinckrodt subsidiary, Ireland/US), and Roxane Laboratories (US).

According to Drugs.com, the cost of oral methadone tablets (10 mg) is approximately $17 for 100 tablets, while 5 mg tablets start at $14.78 for 100 tablets.

• 10 mg tablets: $16.88 per 100

• Injectable solution (10 mg/mL): starts at $143.03 per 20 mL

• Concentrated oral solution (10 mg/mL): from $17.87 for 30 mL

• 5 mg/5 mL oral solution: $13.59 for 150 mL

• 500 mL bottle of the same solution: $58.35

These figures underscore the financial strain involved in methadone procurement and the challenges of sustaining such a program in resource-limited settings like Egypt.

Drug Substitution and Methadone Addiction

Dr. Gamal Farweez, consultant psychiatrist and addiction specialist, believes that addiction is a chronic, relapsing behavioral disorder that can be fatal, and therefore it is a mistake to rely solely on medication or to hospitalize the patient for more than two weeks. He explains that drug withdrawal typically takes 7 to 14 days, and medications play only a supportive role—helping with sleep, mood stabilization, seizure prevention, and anxiety reduction. Farweez notes that there are four personality types prone to addiction: psychopathic, borderline, neurotic (anxious-depressive), and dependent-passive. Treatment varies by personality, with psychopathic traits being the most challenging to treat. He stresses that psychotherapy is the most critical component of addiction treatment, lasting several months, and does not necessarily require inpatient care; patients can attend therapy sessions and take medications at home.

Farweez argues that the use of methadone in addiction treatment has failed, much like previous methods such as the so-called “three-pill regimen.” He now treats patients who have become addicted to methadone, the very drug prescribed to wean them off heroin. Although the prescription does not classify methadone as addictive, patients develop dependency on the active substance, as the drug attempts to substitute for endorphins—natural chemicals produced in the pituitary gland and hypothalamus that act as neurotransmitters for pain relief and comfort. He notes that methadone withdrawal symptoms include headaches, physical pain, eating and sleep disturbances, irritability, anxiety, and depressive episodes. Former heroin users, he adds, may experience seizures and severe headaches during withdrawal.

He told Zawia3:”Until recently, specific pharmacies used to purchase imported methadone and sell it to patients. Once authorities cracked down on them, the drug began circulating through illegal channels with no ties to the medical sector. Although methadone was once used in many developed countries, it has since proven ineffective. Several U.S. states have discontinued its use for addiction patients, as have Canada, Switzerland, Denmark, the Netherlands, and Finland. Some opted for stricter legal controls, while others gave addicts the freedom to choose whether to use or seek treatment. Methadone is a false cure that only delays heroin withdrawal symptoms.”

Administrative Changes at the General Secretariat

Mahmoud Fouad, Director of the Egyptian Center for the Right to Medicine and former board member at Khanqah Psychiatric Hospital, told Zawia3 that he received a complaint alleging the death of two addiction patients at one of the harm reduction units due to the suspension of methadone treatment. Methadone is a synthetic opioid used to treat severe pain and opioid dependence (e.g., heroin). It works by inhibiting pain receptors and reducing drug cravings. According to the complaint, the hospital never publicly acknowledged the deaths, and no concrete evidence was provided. Although Zawia3 obtained testimonies from patients in Cairo’s psychiatric hospitals reporting fatalities due to unsafe methadone withdrawal, the outlet was unable to verify these claims or confirm that families filed formal complaints regarding patient deaths caused by the suspension.

Fouad stated: “Former minister Ghada Waly introduced methadone into Egypt as a free donation. It later transitioned into imports from an international pharmaceutical company, which, as is standard, asked the Egyptian government to purchase and distribute the drug for a year-long contract, after which its branded version would be officially registered and priced under Egyptian regulations. These pricing laws often make companies uneasy. Through my contacts in mental health hospital administrations, I’ve learned that methadone is not the only drug in short supply in psychiatric and addiction hospitals like Khanqah. There’s also a shortage of critical medications, particularly those used in electroconvulsive therapy, causing treatment disruptions.”

Fouad speculates that the April suspension of methadone was part of an effort by the General Secretariat for Mental Health and the Ministry of Health to address its leakage into the black market, where some doses were reportedly ending up in the hands of drug dealers. The situation arose from instructions given to hospital directors to dispense weekly doses to harm reduction patients, which allowed some to sell off part of their supply. He noted that the Anti-Narcotics Department had reportedly alerted the Ministry of Health, linking this issue to recent administrative changes at the Secretariat.

On May 8, the Central Administration of the General Secretariat for Mental Health announced the resignation of Dr. Menan Abdel Maqsoud from her position as Secretary General—a role she held since October 17, 2017. The statement described her as a pivotal figure in developing mental health and addiction treatment programs, strengthening strategic partnerships, supporting scientific research, and building the capacity of healthcare professionals.

On May 9, the Secretariat appointed Dr. Wissam Abou El-Fotouh as head of the Central Administration. According to the Secretariat’s official website, Dr. Wissam Mohamed Abou El-Fotouh Ibrahim is a medical specialist and member of the Addiction Treatment Department, as well as the Patient Affairs Department. She is also a supervising administrator for the psychological support team and hotline service. Previously, she served as Head of the Addiction Department at Benha Psychiatric Hospital (2013–2018) and Head of the Patients’ Rights Committee at the same hospital (2011–2018).

Zawia3 attempted to contact Dr. Menan Abdel Maqsoud to understand the reasons behind her departure and verify information from internal hospital sources and harm reduction units suggesting that the methadone crisis was a key factor in her resignation. However, she did not respond to phone calls. Dr. Ashraf Hatem, Head of the Parliamentary Health Committee, said the committee had no knowledge of the crisis and had received no complaints or interpellations regarding the drug. He stated that his information indicates Dr. Menan had expressed her desire not to renew her term and to return to academia, having served as a professor of psychiatry at Ain Shams University before assuming her leadership role.

The Production of the First Locally-Made Methadone in Egypt

Several addiction patients enrolled in harm reduction units at psychiatric hospitals, along with sources working in the mental health sector, reported that during April, patients were administered doses of a new medication called “Methadensy”, which supervising physicians told them was the “Egyptian methadone” produced by EIPICO Pharmaceuticals. However, no information was available about the drug on the websites of the Ministry of Health, the General Secretariat for Mental Health, EIPICO, or any medical or news platform. Nevertheless, Zawia3 obtained an image of the drug’s packaging, labeled “methdensy”, identified as methadone hydrochloride with a concentration of 10 mg/mL, produced by EIPICO, though it is not listed on the formal pharmaceutical market.

Sources from two harm reduction units at psychiatric hospitals in Cairo told Zawia3 that these hospitals had stopped dispensing the Egyptian-made drug, and had resumed dispensing imported methadone, produced by several companies, most notably:

• Hikma Pharmaceuticals (Jordan/US)

• Mallinckrodt Pharmaceuticals (US)

• Molteni Farmaceutici S.p.A (Italy)

Zawia3 contacted Dr. Assem El-Okbawy, Head of Commercial Operations at EIPICO, by phone to inquire about the new drug. He confirmed that the Egyptian Drug Authority (EDA) requested the company last month to manufacture a limited quantity of methadone, which the company did and delivered to the EDA for distribution to a specific group of patients (addiction patients) under medical supervision. The move was part of a presidential initiative focused on mental health and addiction treatment, marking the first locally-produced methadone in Egypt.

El-Okbawy added that the company does not know whether the EDA will request another batch, and that EIPICO has no plans to release this unlisted medication to the market, as it is intended for a specific patient group and requires strict medical supervision for dosing. He emphasized that there is no difference in the chemical composition between the Egyptian methadone and the imported versions.

In November, Dr. Maya Morsy, Minister of Social Solidarity, attended the launch of the Presidential Mental Health Initiative “Your Health is Happiness”, part of the broader “100 Million Health” campaign. The event was attended by Dr. Khaled Abdel Ghaffar, Deputy Prime Minister and Minister of Health and Population, Dr. Iman Kareem, General Supervisor of the National Council for Persons with Disabilities, Herro Mustafa, the U.S. Ambassador to Egypt, along with several other ambassadors and former ministers.

While psychiatric specialists in Egypt remain divided over the effectiveness of opioid substitution therapy and the high financial cost of purchasing methadone, the suffering of thousands of addiction patients like Michael and Hani continues, particularly amid unsafe methadone withdrawals. Testimonies confirm that the drug has found its way into the black market, amounting to a waste of resources in a country already burdened by a severe economic crisis and shortages of key medications and medical supplies.

Both experts and patients agree that there is a lack of transparency, along with allegations of corruption, that have affected the General Secretariat for Mental Health in recent times—at the expense of the patients.