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LAC DPH Health Alert:
Fatal Overdose Associated with Cychlorphine in Los Angeles County
October 15, 2026
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This message is intended for emergency, urgent care, primary care, and behavioral health providers in Los Angeles County.
Please distribute as appropriate.
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- A fatal overdose in LA County has been linked to cychlorphine (chemical name N-propionitrile chlorphine), a highly potent synthetic opioid.
- This is the first confirmation of cychlorphine in the local illicit drug supply.
- Naloxone should be given for any suspected opioid overdose. Cychlorphine may require repeated and higher cumulative naloxone doses.
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Cychlorphine is being mixed into the illicit drug supply and is not detected by routine urine immunoassay drug screens or by fentanyl or nitazene test strips.
- Definitive identification requires specialized laboratory testing.
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The County of Los Angeles Medical Examiner has identified cychlorphine as a cause of death that occurred earlier this year. This is the first confirmation of cychlorphine’s presence in the local illicit drug supply. Cychlorphine has not otherwise been detected through the County’s drug surveillance system, which includes community drug checking and wastewater testing.
Cychlorphine belongs to a class of drugs called orphines, first discovered in the 1960s and determined to be unsafe for medical use due to the high risk of respiratory depression and misuse. In 2019, another orphine drug, called brorphine, appeared in the illicit US drug supply, but has not remained a significant part of the supply. Since 2024, cychlorphine has been detected in more than 19 states and in multiple other countries, including Canada, the United Kingdom, France, and Germany. It has been found in powders, counterfeit tablets (made to look like prescription medication), rocks or crystals, and liquids.
Cychlorphine is classified as a controlled substance in many countries, including the U.S. In August 2026, the Drug Enforcement Agency (DEA) designated cychlorphine as a Schedule I drug, making it illegal to possess or sell. Cychlorphine has never been approved by the U.S. Food and Drug Administration (FDA) for any medical use. In April of this year, the San Francisco Department of Public Health reported an overdose death in which cychlorphine was detected (see SF Health Alert).
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Actions Requested of Providers
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- Administer naloxone to patients with suspected drug overdose who have stopped breathing. Naloxone can reverse the effects of cychlorphine or other opioids and restore breathing. Do not assume a single standard dose will suffice. Be prepared for repeat and higher cumulative dosing.
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Report suspected or confirmed cychlorphine overdoses to Poison Control: 1-800-222-1222.
- Consider sending confirmatory laboratory testing for cychlorphine if patients present with signs or symptoms of an opioid overdose with negative drug screen testing results. Note: Definitive identification requires specialized laboratory testing.
- Offer naloxone to patients at risk for overdose:
- Emphasize that naloxone should be given for any suspected drug overdose, even if the substance is unknown.
- Explain that the goal is to restore breathing and save a life.
- Note that naloxone can be given intranasally or intramuscularly; both methods are equally effective.
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Provide education on how to use naloxone: Recover LA Naloxone Guide.
- Identify patients at risk for overdose and provide anticipatory risk reduction guidance:
- Screen all patients, including adolescents, for recreational drug use.
- Advise patients that cychlorphine and other dangerous substances are appearing in illicit drugs — including counterfeit pills made to look like prescription medications — and cannot be seen, smelled, or tasted. Fentanyl test strips do not detect cychlorphine, so a negative test does not rule it out.
- Educate patients who use drugs to:
- Never use alone. If you use alone, leave your naloxone next to you.
- Use small “tester” doses.
- If you are using in a group, take turns so someone is alert and able to reverse an overdose.
- Avoid mixing drugs.
- Carry naloxone.
- Continue to use fentanyl test strips to detect fentanyl and be aware that a negative result does not mean the drug is safe.
- Inform patients that medications and other forms of treatment for substance use are available through treatment programs, primary care services, and other health providers.
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- Los Angeles County Department of Public Health Overdose Prevention Webpage This Substance Abuse Prevention and Control (SAPC) website features information sheets and toolkits for the community relevant to overdose prevention. publichealth.lacounty.gov/sapc/public/overdose-prevention.htm
- Poison Control 1-800-222-1222
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Finding Substance Use Disorder Treatment In Los Angeles County, the general public, health care providers, and patients can find publicly funded substance use treatment services and bed availability using an online, filterable service locator known as the Services and Bed Availability Tool (SBAT), in the resource section of RecoverLA.org, or by calling the Substance Abuse Service Helpline (SASH). Services include outpatient and intensive outpatient treatment, residential treatment, withdrawal management, and Opioid Treatment Programs.
- Service and Bed Availability Tool: SUDHelpLA.org
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RecoverLA mobile-friendly platform: RecoverLA.org
- Substance Abuse Service Helpline (SASH): 800-854-7771
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This communication was sent by Brian Hurley, MD, Interim Director and Medical Director, Substance Abuse Prevention and Control, Los Angeles County Department of Public Health.
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To view this LAHAN in PDF format, view past communications, or sign-up to receive LAHANs, please visit ph.lacounty.gov/lahan.
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