Besides traditionally abused substances, the use of novel synthetic cannabinoids (SCs) emerged in Egypt a few years ago. Strox is a popular synthetic cannabis in Egypt that consists of smokable herbal products laced with unidentified synthetic cannabinoids. Unfortunately, threats from the escalating use of Strox in Egypt are increasing, which is a challenge for medical and legal systems. Acute Strox intoxication manifested by acute toxic psychosis and severe cases could develop cardiovascular instability and fatal coma. Strox-related toxicity could be attributed to THC analogs and anticholinergic agents along with the presence of additives such as ketamine. Limited knowledge considering exact Strox ingredients makes its identification in biological samples using standard toxicology impossible. In 2018, Egyptian law criminalized the usage of five THC analogs that are rapidly followed by alteration of Strox constituents by its manufacturer using non-prohibited cannabinoids to escape legal prohibition. Therefore, comprehensive studies are needed to identify common Strox constituents with subsequent successful detection. Moreover, the amendment of the law is essential to include any substances that have cannabis-like actions in the schedules of a prohibited substance.
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