What is Cychlorphine?
Cychlorphine is a powerful synthetic opioid that has been found inside counterfeit prescription pills. It has been pressed into fake oxycodone and fake hydromorphone tablets that look exactly like real prescriptions from a pharmacy. It is approximately 10 times more potent than fentanyl and lasts longer in the body than fentanyl does.
It has no established street name because people who encounter it typically have no idea it's in the pill they took. It cannot be detected by sight, smell, or taste. It does not appear on the label. It looks and feels identical to a legitimate prescription tablet.
Cychlorphine appears to be emerging as a replacement or supplement to fentanyl in parts of the illicit drug supply. It has been confirmed in fatal overdoses across multiple U.S. states and Canadian provinces. Any pill that did not come from a licensed pharmacy must be considered potentially life-threatening.
Why This Matters for You
There are two things about cychlorphine that are critical to understand if you are in treatment or recovery:
Your drug test will not detect it. Standard urine drug tests used by treatment programs, drug courts, and probation offices cannot detect cychlorphine. Extended fentanyl immunoassay panels and point-of-care test strips will also miss it. A negative drug test does not mean cychlorphine was not in the pill you took.
Naloxone (Narcan) CAN reverse it, but you will likely need much more than usual. Cychlorphine is an opioid, so naloxone should work. However, because it is 10 times stronger than fentanyl, a single standard dose of Narcan is often not enough. If someone is overdosing, give the highest dose you have and keep giving doses every 2 to 3 minutes. Do not stop. Call 911 immediately and do not leave the person alone.
Signs Someone May Have Been Exposed
If someone has taken a counterfeit pill and cychlorphine was in it, you may see some or all of these signs. Because it is so much stronger than fentanyl, overdose can happen faster and be more severe:
Because cychlorphine is so potent, a single dose of Narcan may wear off before the drug does. This can look like the person is not responding to Narcan at all. Keep giving doses. The naloxone is likely helping, just not enough with one dose. Call 911 immediately so paramedics can give additional medication and monitoring.
If Someone Is Unresponsive — What to Do
If someone is unresponsive and you suspect a drug overdose involving a counterfeit pill, act immediately. With cychlorphine, time matters more than with most drugs because of how powerful it is.
What This Means for Your Drug Test
If you are in a treatment program, drug court, or on probation and you take a pill that was not dispensed by a licensed pharmacy, you may be exposed to cychlorphine without knowing it. This will not show up on your standard urine drug test. Not on the immunoassay screen, not on extended fentanyl panels, not on multi-panel point-of-care strips.
This matters in both directions. A negative test does not mean cychlorphine was not in your system. And if you did test positive for something else, your provider has no way to know cychlorphine was also involved unless specialized testing is ordered.
Unlike some other adulterants, there is currently no fentanyl test strip, lateral flow strip, or point-of-care device that can detect cychlorphine. Confirmatory identification requires a specialized laboratory test called LC-MS/MS. If you believe you may have been exposed, tell your care team so they can discuss whether specialized testing is appropriate.
What to Tell Your Treatment Team
Your counselor, doctor, or nurse needs to know about cychlorphine. Here are things worth saying: