Last fall, a 36-year-old man in southwest Ohio snorted what he thought was Xanax. He was found on a bathroom floor, unconscious and not breathing. The Narcan police gave him only partly brought him back, so paramedics gave him more.
The drug in his system wasn't Xanax. Analysis of the powder he bought showed that it was mostly cychlorphine, a synthetic opioid that barely existed in the U.S. drug supply two years ago. In 2024, federal drug labs recorded one report of it. In 2025, they recorded 106, across 10 states. Ohio is one of the places it's showing up most.
Here's what cychlorphine is, why it's so hard to detect, and what the few documented survivor cases tell us.
What is cychlorphine?
Cychlorphine, also called N-propionitrile chlorphine, is a lab-made opioid. It belongs to a group of drugs sometimes called "orphines," which also includes brorphine. We covered brorphine earlier this year in Brorphine: A New Synthetic Opioid with Familiar Risks.
According to the Center for Forensic Science Research and Education (CFSRE), this family of chemicals goes back to pharmaceutical research in the 1960s and '70s. None of it was ever approved as a medicine. CFSRE first detected cychlorphine in mid-2024, and it has shown up more often in fatal overdoses since mid-2025.
Chemically, cychlorphine is different from fentanyl and from nitazenes, another group of synthetic opioids. In the body, though, it acts like any other opioid, and like any other opioid it can slow or stop breathing.
Is cychlorphine stronger than fentanyl?
Probably, but how much stronger isn't settled. You'll often see it described as about 10 times stronger than fentanyl. That figure comes from early lab testing on cells, not people. CFSRE cites it as unpublished data, and no published human study has confirmed it yet. The real figure may turn out higher or lower.
The UN Office on Drugs and Crime (UNODC) reports that in studies on mice, cychlorphine caused severe breathing and heart problems at lower doses than fentanyl.
Two cychlorphine survivors who thought they took Xanax
Most of what's known about cychlorphine comes from autopsies. Very few people who survived an overdose have been confirmed to have taken it. Two cases have now been published in medical journals, and in both, the person believed they were taking alprazolam (Xanax).
| Ohio case | ER surveillance case | |
|---|---|---|
| Who | Man, 36 | Woman in her 20s |
| What they thought they took | Xanax, snorted as a powder | Xanax |
| What was actually in it | Mostly cychlorphine, plus fentanyl and xylazine | Cychlorphine and bromazolam (an unapproved benzodiazepine), among other substances |
| Naloxone given | 4 mg nasal by police (partial response), then 1 mg more by EMS | 6 mg nasal by EMS before reaching the hospital |
| Outcome | Survived | Survived. Routine hospital tests were negative for opioids. |
The Ohio case was published in Clinical Toxicology by researchers from Bowling Green State University, the Ohio Attorney General's Bureau of Criminal Investigation (BCI), and Mercy Health. One of the authors, toxicologist Dr. Jon Sprague, told WOIO that the man was from Hamilton County, and that cychlorphine was the main ingredient in the bag lab analysts tested.
The second case was published in the Journal of Medical Toxicology in July 2026. It came from a multi-hospital study that runs detailed lab tests on ER patients with suspected opioid overdoses. According to the American College of Medical Toxicology, the hospital's standard drug tests came back negative for fentanyl and other opioids, even though she clearly had opioid overdose symptoms. Only the study's advanced testing found cychlorphine. Researchers say it's the first case to confirm cychlorphine in a living overdose patient's blood.
What these cases tell families
For comparison, a standard Narcan nasal spray contains 4 mg. Both of these patients needed more than one spray's worth.
Both cases also involve people who were reaching for a benzodiazepine, not an opioid. Someone who doesn't use opioids has no tolerance to them, which makes an unexpected dose of a strong opioid especially dangerous. If someone you love uses pills for anxiety or sleep that didn't come from a pharmacy, they're at risk, even if they've never used heroin or fentanyl. Reliance on street Xanax is its own problem too, and one we treat through our benzodiazepine addiction program in Ohio.
And when the hospital's first round of tests misses the drug, families can be left without answers, or unaware that the person was exposed to an opioid at all.
Is cychlorphine in Ohio?
Yes. In April 2026, the White House Office of National Drug Control Policy (ONDCP) issued a Drug Threat Notice on cychlorphine. It named Ohio, Texas and Tennessee as the states where it's most common.
Ohio BCI told WOIO in July 2026 that orphine drugs had been found in Ohio 36 times since October 2025. Several of those were in Northeast Ohio: two in Elyria (December 2025 and January 2026) and one in Summit County (February 2026).
Ohio moved early on the legal side. According to Sprague, cychlorphine was already a Schedule I drug in Ohio under a state rule, called the pharmacophore rule, that covers drugs sharing a core chemical structure with fentanyl. Federal law has since caught up. The DEA temporarily placed cychlorphine in Schedule I nationwide, effective August 27, 2026.
Where else has cychlorphine been found?
Across the U.S. and in at least 10 countries. ONDCP's notice linked cychlorphine to at least 55 deaths nationwide between 2025 and 2026. A later FDA notice counts 225 law enforcement seizures of cychlorphine across 19 U.S. jurisdictions. In East Tennessee alone, the Knox County Regional Forensic Center linked it to at least 41 overdose deaths between July 2025 and February 2026.
In September 2026, it made national news after it was found in the autopsy of a 16-year-old who died of an overdose in San Francisco. Police there have since arrested four people and seized more than 20,000 counterfeit pills, which are being tested for the drug.
Worldwide, the UNODC reports that 10 countries have detected cychlorphine, including in 182 drug seizures and 78 fatal overdoses. It has been found in several forms:
- Pressed into fake prescription pills made to look like Xanax, Percocet, Dilaudid and OxyContin
- Mixed into fentanyl, methamphetamine, cocaine and bromazolam
- On its own
Do fentanyl test strips detect cychlorphine?
No. Fentanyl test strips look for fentanyl, and cychlorphine isn't fentanyl. ONDCP says it also doesn't show up on routine hospital opioid urine screens, which is exactly what happened in the ER case above.
A pill can test "clean" for fentanyl and still contain something just as dangerous.
Does Narcan work on cychlorphine?
Yes. Naloxone (Narcan) is still the right thing to use, and both survivors above responded to it. But ONDCP warns that a cychlorphine overdose may need more than one dose, and researchers are still studying how well naloxone works on this family of drugs. Sprague's advice is to keep giving it, since it may work after several doses.
If you think someone is overdosing
These are standard steps for responding to any suspected opioid overdose. They aren't specific to cychlorphine.
- Call 911 first, or have someone call while you act. Don't wait to see if naloxone works.
- Give naloxone. If they don't respond in 2 to 3 minutes, give another dose.
- Stay with them. If they're breathing, roll them onto their side. Naloxone can wear off before the opioid does, so they need medical care even if they wake up.
Warning signs include very small pupils, slow or stopped breathing, gurgling or choking sounds, blue or gray lips and fingertips, and not waking up when you shout or rub their chest.
For more, read our guide: Naloxone 101: How It Works, When to Use It, and What Happens After an Overdose Reversal.
Why do new opioids like cychlorphine keep appearing?
Because when one drug gets banned, manufacturers switch to a close relative. After China placed nitazenes under broad control in July 2025, CFSRE found that nitazene detections went down and orphine detections went up, led by cychlorphine. Cychlorphine won't be the last.
For anyone buying pills or powder outside a pharmacy, there's no reliable way to know what's in them. Test strips, "trusted" sources and pill markings can't keep up. The only way to stop worrying about what's in the supply is to stop depending on it.
Getting help
If you or someone you love is using opioids, or taking pills that didn't come from a pharmacy, now is the time to talk to someone. Wellbrook Recovery offers full medical detox and residential treatment at our programs in Chardon, Ohio and Brookfield, Wisconsin. We aim for same-day admission, so you don't have to wait for a bed.
Call (866) 986-6126 Start admissions
In an emergency: if you're with someone who may be overdosing, call 911 now. For poisoning questions, call Poison Control at 1-800-222-1222.
