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Introduction <p>Cychlorphine (also referred to as N-propionitrile chlorphine) is a non-fentanyl synthetic opioid that has been linked to the illicit drug supply and fatal overdoses in the United States since 2024.</p> Case Report <p>A female in her 20s presented to the emergency department (ED) following ingestion of what the patient reported was alprazolam. Unresponsiveness and respiratory depression prompted 6&#xa0;mg of intranasal naloxone administration by emergency medical services prior to arrival to the ED. Comprehensive toxicological testing of serum revealed the presence of cychlorphine. Additional substances found were bromazolam, carboxy-THC, acetaminophen, caffeine, citalopram, cotinine, naloxone, naproxen, nicotine, and trazodone and its metabolite.</p> Discussion <p>This rare case of clinical signs of opioid overdose with cychlorphine detected is the first to provide direct evidence linking a non-fatal overdose to cychlorphine exposure. A naloxone responsive opioid toxidrome is described with an opiate and fentanyl negative initial urine drug screen. Advanced analytical techniques were required to identify the presence of cychlorphine.</p>

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An Emerging Synthetic Opioid in the Drug Supply: A Case of Opioid Overdose with Biological Confirmation of Cychlorphine

  • 期刊论文

  • 发表日期：

    2026年7月21日

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  • Rebecca Kusko,
  • David Liss,
  • Stacey L. House,
  • Serena B. House,
  • Alex Krotulski,
  • Kim Aldy

摘要

Introduction

Cychlorphine (also referred to as N-propionitrile chlorphine) is a non-fentanyl synthetic opioid that has been linked to the illicit drug supply and fatal overdoses in the United States since 2024.

Case Report

A female in her 20s presented to the emergency department (ED) following ingestion of what the patient reported was alprazolam. Unresponsiveness and respiratory depression prompted 6 mg of intranasal naloxone administration by emergency medical services prior to arrival to the ED. Comprehensive toxicological testing of serum revealed the presence of cychlorphine. Additional substances found were bromazolam, carboxy-THC, acetaminophen, caffeine, citalopram, cotinine, naloxone, naproxen, nicotine, and trazodone and its metabolite.

Discussion

This rare case of clinical signs of opioid overdose with cychlorphine detected is the first to provide direct evidence linking a non-fatal overdose to cychlorphine exposure. A naloxone responsive opioid toxidrome is described with an opiate and fentanyl negative initial urine drug screen. Advanced analytical techniques were required to identify the presence of cychlorphine.