Cychlorphine Is in Arkansas: The New Opioid Fentanyl Test Strips Can't Catch

Last week a national toxicology lab confirmed something I had been expecting and hoping not to see. A synthetic opioid called cychlorphine has been detected in Arkansas.

Aegis Sciences, one of the large labs that tests samples for hospitals and treatment programs, reported cychlorphine in 18 states as of September 21. Arkansas is on that list. So is Missouri, a short drive north of here, along with Tennessee, Texas and Louisiana.

Most people reading this have never heard the word. That is exactly the problem.

What cychlorphine is

Cychlorphine is a lab-made opioid from a newer family chemists call the orphines. It is not fentanyl and it is not a nitazene. It hits the same opioid receptors in the brain that fentanyl does, and it does the same thing when there is too much of it: it slows breathing until breathing stops.

Aegis reports that laboratory data puts it at roughly ten times the potency of fentanyl. I want to be careful with that number. It comes from test-tube pharmacology, and it does not translate neatly into a human dose. But the United Nations Office on Drugs and Crime reports that in mouse studies cychlorphine caused profound respiratory and cardiovascular depression at lower doses than fentanyl, and that it has now been tied to 78 deaths in postmortem cases from the United States and the United Kingdom.

Nobody sells it by name. It shows up inside something else.

Where it hides

According to the UNODC, cychlorphine has been found mixed into fentanyl, heroin and cocaine. It has also turned up in counterfeit pills pressed to look like Xanax, Percocet, Dilaudid and OxyContin.

Read that list again if you have a teenager or a college student in your house. The most common way a young person meets a drug like this is not by seeking it out. It is by taking what they believe is a Xanax from a friend, or a Percocet bought online, and never finding out what was actually in it.

It also rarely travels alone. Aegis describes it as usually part of a complex mixture, alongside other opioids, stimulants or benzodiazepines. Each of those layers adds risk.

Why fentanyl test strips will not save you here

Fentanyl test strips have saved lives, and I still want people to use them. But they test for fentanyl. That is all they test for.

The UNODC states that cychlorphine is not expected to be detected by standard drug test strips, and not by routine opioid urine screens either. A pill can come back negative for fentanyl and still contain something stronger. A strip can come back positive for fentanyl because fentanyl is in the mix, and tell you nothing about what else is.

So a negative strip is not a green light. It never really was, and now it is less of one than ever.

The same goes for a drug screen at an emergency room or a job. If someone overdoses on cychlorphine and the standard screen comes back clean, that does not mean opioids were not involved. It means the test was not built to see this one.

Naloxone still works, and you may need more than one

This is the good news, and it is important. Cychlorphine is an opioid, so naloxone, the medicine in Narcan, can reverse it.

But Aegis warns that multiple doses of naloxone may be required, along with emergency airway support. A DEA official said the same about the newer synthetic opioids generally last week: it can take several doses to bring someone back.

What that means in practical terms:

• Keep at least two doses of naloxone wherever you keep one. A box of Narcan contains two.
• If someone is not breathing normally, call 911 first, then give a dose.
• If they are not responding after two or three minutes, give the second dose.
• Stay with them. Naloxone can wear off before a strong opioid does, and people can stop breathing again after they wake up.

Naloxone is sold over the counter at any pharmacy, no prescription needed. The Fayetteville Fire Department made a point of reminding people about Narcan just this week. They are right to. It is the single cheapest thing you can buy that can keep someone alive long enough to get help.

Know the signs

The Substance Abuse and Mental Health Services Administration lists these as the signs to call 911 for:

• Face extremely pale or clammy to the touch
• Body goes limp
• Lips or fingernails turn blue or purple
• Vomiting or gurgling sounds
• Cannot be woken up or cannot speak
• Breathing or heartbeat slows or stops

You do not need to be sure it is an overdose. If you see these, act as though it is.

Why this matters for people already on opioids

Every time the street supply changes, the math changes for the people using it. A dose that was survivable last month can be lethal this month, and there is no way to know from the outside. A person can be careful, use the same amount from the same source, even test it, and still be caught by this.

That is the strongest argument I know for getting off the street supply entirely.

Buprenorphine, the medicine in Suboxone, is a prescription made in a regulated factory. You know exactly what is in it and exactly how much. It controls withdrawal and cravings, and people who stay on it die at a far lower rate than people who do not. A large review in the BMJ found that people on buprenorphine died of overdose at 1.4 per 1,000 person-years while in treatment, versus 4.6 per 1,000 once they were out of it.

No test strip, no careful dosing and no trusted dealer can offer that. A pharmacy can.

If you are the one using

Call me. 479-856-1505. I answer my own phone at any hour, including nights, weekends and holidays, and if you need to be seen tonight I will come in. A scheduled visit is $200. An unscheduled after-hours visit is $300. I do not bill insurance, so nothing about your treatment goes to an insurer or an employer's plan.

You do not have to be at the bottom of anything to call. You just have to be tired of gambling on what is in the next pill.

If you are the one worried about someone

Buy the naloxone today. Put it where the people in your house know to find it. Tell your kids, plainly, that a pill from anyone other than a pharmacy can kill them, test strip or not.

And you can call me about someone else, without them knowing you called. Families do it every week.

More on this: Starting Suboxone after fentanyl · 7-OH, kratom and fentanyl: what NWA families need to know · Recognizing opioid use disorder in someone you love · What the first visit looks like · What it costs