Evidence map›Paper›PMID 42481906›Full record

ArticleJournal of medical toxicology : official journal of the American College of Medical Toxicology2026

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

Rebecca Kusko, David Liss, Stacey L House, Serena B House, Alex Krotulski, Kim Aldy, Toxicology Investigators Consortium (ToxIC) Fentalog Study Group

Abstract readCase Reports
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of medical toxicology : official journal of the American College of Medical Toxicology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Rebecca KuskoDepartment of Emergency Medicine, Division of Medical Toxicology, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA, 52242, USA. Rebecca-kusko@uiowa.edu.ORCID http://orcid.org/0000-0001-5331-5119
David LissDepartment of Emergency Medicine, Division of Medical Toxicology, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
Stacey L HouseDepartment of Emergency Medicine, Division of Medical Toxicology, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
Serena B HouseDepartment of Emergency Medicine, Division of Medical Toxicology, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
Alex KrotulskiCenter for Forensic Science Research and Education, Fredric Rieders Family Foundation, 206 Welsh Rd, Horsham, PA, 19044, USA.
Kim AldyAmerican College of Medical Toxicology, 10645 N. Tatum Blvd Suite 200-111, Phoenix, AZ, 85028, USA.
Toxicology Investigators Consortium (ToxIC) Fentalog Study Group

Funding

National Institute on Drug Abuse of the National Institutes of Health R01DA048009
6 · The paper itself

Abstract

introductionCychlorphine (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.

Indexed as

Analgesics, OpioidDrug OverdoseIllicit DrugsOpiate OverdoseFemaleHumansNaloxoneNarcotic AntagonistsSubstance Abuse DetectionAnalgesics, OpioidIllicit DrugsNaloxoneNarcotic AntagonistsCychlorphineN-propionitrile chlorphineOpioidOrphineOverdose

Identifiers

PMID42481906
PMCPMC13633184

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.