Background: Strox has become the most widely abused substance, evolving from a semi-synthetic product originally made from marjoram mixed with pain relievers and animal sedatives into a dangerous designer drug. Over time, cheaper and more hazardous chemicals like insecticides, acetone, rat poison, and ketamine replaced the original ingredients, allowing the drug to be smuggled into Egypt under the pretext of animal use. Despite its affordability, Strox addiction is driven more by the intense euphoria it offers than by wealth. Aim: to explore whether genetic polymorphism, rather than psychological or social factors, is the key driver behind Strox addiction. Methods: We used the ICD-10 and the Addiction Severity Index (ASI) to screen and select 44 addicts and an equal number of controls for the study. Blood samples were analyzed using real-time PCR, conventional PCR for sequencing, and granulocyte colony-stimulating factor (G-CSF) assessments. Results: showed reduced fatty acid amide hydrolase (FAAH) expression and increased cannabinoid receptor 1 (CNR1) expression in addicts, confirming their addictive state. G-CSF levels were notably lower in addicts, linking it to the addiction's progression. Sequencing revealed two significant single nucleotide polymorphisms (SNPs) in FAAH and CNR1. Conclusion: Our results support the hypothesis that genetic polymorphism plays a central role in addiction. This finding aligns with the presence of a family history of addiction, suggesting that genetic factors are the primary drivers of Strox addiction.