A highly potent synthetic opioid has been detected in the Chicago-area drug supply, prompting warnings over accidental overdoses and the inability of standard fentanyl test strips to identify it.
Cychlorphine has been found mixed with cocaine, heroin and counterfeit prescription pills, according to Jon Schultz, an advanced practice provider at Rush University Medical Center. He said users were generally not seeking the substance out, but could be exposed to it without their knowledge.
The laboratory-made opioid is understood to be part of a newer group of synthetic drugs known as orphine analogues. Toxicology experts say it has emerged only recently in illicit markets, leaving limited evidence about its effects and treatment.
Cychlorphine can resemble a fentanyl overdose
Schultz said cychlorphine was “much more potent than other opioids, even more potent than fentanyl”. It can suppress breathing and heart rate, reduce a person’s responsiveness and cause a blue tinge around the lips or mouth.
Those signs may look similar to a fentanyl overdose, making it difficult for bystanders and clinicians to identify which substance is responsible. Cychlorphine was developed about 65 years ago but was never approved for use in humans.
Routine hospital opioid screens are not designed to detect the compound. Fentanyl and nitazene test strips are also not expected to flag cychlorphine, meaning a negative result could give people a false sense of security.
“It’s the unknown that is the scary thing here,” Schultz said.
Specialist toxicology testing, including laboratory analysis using mass spectrometry, is needed to confirm its presence. Researchers and public-health officials have warned that the lack of rapid testing could make it harder to track exposures and identify overdoses linked to the drug.
Schultz urged people to keep naloxone, also known by the brand name Narcan, available. He said it can reverse cychlorphine’s effects, although more than one dose may be required.
“Keep using Narcan. Keep it on hand,” he said. “In addition to administering Narcan, it’s really important to call 911.”
He also advised people not to take drugs alone and encouraged anyone seeking help with substance use to speak to a medical provider or treatment professional.
