Over the last five years, illicit trade in the amphetamine-type stimulant Captagon has expanded considerably, both in size and scope, posing new challenges to the rule of law, public health and even security dynamics. With its production hub anchored heavily in regime-held areas of Syria—with sponsorship from Syria’s Fourth Division and partnered Iran-aligned militias—the Captagon trade has been used as both an alternative revenue source for the cash-strapped and sanctioned Syrian regime and a tool for influence on the diplomatic stage. The Syrian regime has leveraged its agency over the trade, violent cross-border smuggling clashes and plausible deniability with affiliated actors to achieve its aims of the normalisation of relations with it regionally and the granting of concessions. However, these normalisation efforts have come under pressure as demands from regional neighbours to reduce the flow of Captagon and interdiction capacity have increased. Incentivised to retain their profits from Captagon, producers and traffickers aligned with the Syrian regime’s security apparatus have begun to identify new routes and markets outside its primary destinations in the Arab Gulf. As a result, criminal networks have carved out new transit routes across Iraq and Turkey and through African ports, and have even established nodes in southern and mainland Europe—all with the potential for pills to trickle into local consumer markets over time. With the Captagon challenge no longer confined to the Middle East, European countries and their partners are quickly beginning to focus on key aspects of the trade, implementing policies that address supply, demand and accountability for implicated actors.