A New Synthetic Opioid Is Raising Alarm

A new and highly potent synthetic opioid is raising alarm among addiction specialists, adding another layer of danger to an already unpredictable drug supply. In this interview, Megan Britton, M.D., national medical director at Groups Recover Together, breaks down what patients, families and caregivers need to know about cychlorphine, an emerging substance linked to a growing number of overdose deaths. As the opioid crisis continues to evolve, experts warn that newer, stronger drugs are entering the market faster than many people can keep up with.

Cychlorphine belongs to a class of powerful synthetic opioids and is estimated to be significantly more potent than fentanyl. What makes it especially dangerous is not just its strength but the fact that people are often exposed without knowing it, through counterfeit pills or contaminated drug supplies. Britton emphasizes that today’s opioid landscape is defined by uncertainty, making harm reduction, access to treatment and education more critical than ever for those in recovery and their loved ones.

Cychlorphine is a name most people haven’t heard yet, but the numbers are alarming. For someone who has a loved one struggling with opioid use disorder, or who is in recovery themselves, how would you describe what this drug is and why it represents a new level of danger?

Megan Britton, M.D.: Cychlorphine is an emerging synthetic opioid showing up in the unregulated drug supply. It belongs to a newer class of highly potent opioids sometimes called “orphine” analogues. What makes it especially dangerous is not just its strength but the uncertainty around it: People may be exposed without knowing it, including through counterfeit pills or mixed drug supplies. That means someone may think they are taking a familiar substance and instead encounter something far more potent and unpredictable. Early forensic alerts have linked cychlorphine to increasing fatal overdoses, and public health experts are concerned because it is arriving in a drug environment that is already saturated with fentanyl and other synthetic opioids.

Reports describe cychlorphine as roughly 10 times more potent than fentanyl — a drug that has already caused devastating loss across the country. What does that level of potency actually mean in practical terms for someone who may unknowingly encounter it, and how does it change the overdose risk?

MB: In practical terms, higher potency means a very small amount can suppress breathing very quickly. For patients and families, it dramatically narrows the margin for error — what looks like a “normal” amount may be far more than the body can tolerate.

This significantly increases overdose risk in a few key ways. First, the onset can be very rapid, leaving little time to recognize what’s happening or respond. Second, the depth of respiratory depression can be more severe, sometimes requiring multiple doses of naloxone. And importantly, people are often exposed unknowingly, as substances like this are mixed into the drug supply without their knowledge.

From a harm reduction perspective, the basics become even more critical: assume contamination, use fentanyl test strips when available, start with a small test dose and never use alone. These steps can’t eliminate risk — but they can help save lives.

We spent years learning how fentanyl infiltrated the drug supply and caught so many people off guard. Are we seeing a similar trajectory with cychlorphine, or is this spreading differently? What did we learn from fentanyl that we should be applying right now?

MB: There are similarities. As with fentanyl, cychlorphine appears to be entering an already unpredictable illicit market where drugs are often mislabeled, mixed or sold as something else. Public alerts have documented it in powders and counterfeit pharmaceutical-style tablets, which is exactly the kind of pattern that makes a new synthetic opioid so dangerous. One lesson from fentanyl is that we cannot wait for perfect national surveillance before acting. We need faster toxicology reporting, rapid public alerts, broader naloxone distribution, easier access to medications for opioid use disorder, and honest harm-reduction messaging that tells people the supply is unstable and increasingly unpredictable.

Does naloxone work against cychlorphine, and if so, how effectively? Are standard doses sufficient, or does the potency of this drug require a different response protocol that patients, families and bystanders should know about?

MB: The best current answer is: Naloxone should still be used, and it should be used immediately in any suspected cychlorphine overdose, because cychlorphine is an opioid. But direct human data specific to cychlorphine are still limited, so we should be careful not to overstate certainty. What we do know from opioid pharmacology, CDC guidance and experience with other potent synthetic opioids is that more than one dose of naloxone may be needed, and people still need emergency medical care even if they initially wake up. That is especially important because naloxone’s duration is shorter than many opioids, and recurrent sedation or slowed breathing can happen after the first response. Related evidence from the brorphine literature suggests naloxone can reverse respiratory effects, though higher or repeated dosing may be needed with potent novel opioids. At Groups, we provide naloxone (brand name Narcan) with every prescription to help prevent overdose and save lives.

What do you want people in recovery — and the family members supporting them — to know about protecting themselves in an environment where the drug supply is becoming increasingly unpredictable?

MB: First, the unpredictability itself is the danger. People should assume the illicit supply may contain fentanyl, nitazenes, cychlorphine or other unexpected substances. From a provider standpoint, the most important protections are: keep naloxone on hand and make sure the people around you know how to use it; avoid using alone; call 911 immediately if someone is hard to wake, breathing slowly, turning blue or making gurgling sounds; and seek treatment early, because medications like buprenorphine and methadone remain the most evidence-based tools we have for reducing overdose death. For families, I would stress this too: shame increases risk. Calm, practical preparation saves lives. Having naloxone in the house, knowing overdose signs and keeping the door open to treatment can make the difference in an emergency.

From your position leading one of the country’s largest addiction recovery programs, what systemic changes do you believe are most urgently needed to get ahead of drugs like this one?

MB: We need to treat emerging synthetic opioids as both a clinical emergency and a systems problem. The biggest priorities are faster surveillance; modernized toxicology; real-time communication between labs, public health and providers; and much wider access to evidence-based treatment. We also need naloxone everywhere, not just in clinics or ambulances, but with families, community groups, shelters, jails and people actively using drugs. And we have to remove barriers to medication treatment: same-day access, fewer administrative hurdles, stronger re-entry support after incarceration, and better continuity of care across emergency departments, outpatient programs, and community settings. New drugs will continue to emerge. The way we get ahead of them is not by chasing each one individually, but by building a faster, more connected response system.

Megan Britton has over 15 years of experience practicing addiction medicine. She trained in family medicine and completed a fellowship in integrative medicine through Maine Medical Center and the University of Arizona. Throughout her career, she has worked with MaineHealth, in private practice, and in Federally Qualified Health Center (FQHC) settings, providing both primary care and integrative medicine. She joined Groups eight years ago. Megan earned her bachelor’s degree from Bowdoin College and her medical degree from the University of Queensland.