New Synthetic Opioid Threat: Cychlorphine

What EMS Should Know: Overdose Risk, Potency and Detection Challenges

The National Highway Traffic Safety Administration’s (NHTSA) Office of EMS would like to make EMS leadership and clinicians aware of a new emerging synthetic opioid threat: cychlorphine, which has been linked to at least 55 deaths nationally.

WHAT EMS SHOULD KNOW

Highlighted in the Office of National Drug Control Policy (ONDCP) Drug Threat Notice, cychlorphine’s overdose risk, potency and detection challenges pose several serious hazards to EMS clinicians and their patients. Important cychlorphine considerations for EMS include:

• Up to 10x more potent than fentanyl
• Overdose may require multiple doses of naloxone
• Not detected by standard drug test strips or routine screens
• It can be found mixed in with fentanyl or drugs such as methamphetamine, bromazolam, cocaine and others
• It has been detected on its own (not mixed with other substances)
• Potential to spread across the nation

WHERE HAS IT BEEN REPORTED?

There have been 106 reports of cychlorphine in the drug supply in 10 states across all four U.S. Census regions. Reports are most concentrated in the South, Midwest and Northeast regions, with at least 41 overdose deaths reported in Tennessee.

WHAT SHOULD EMS DO ABOUT THIS EMERGING THREAT?

EMS should be aware of the prevalence of cychlorphine in the illicit drug supply and EMS clinicians should be prepared to treat opioid overdoses with extra doses of naloxone. EMS leaders should help spread awareness in the EMS community about this new drug threat by sharing this information through your networks.