A class of synthetic opioids known as orphines, some of which are estimated to be roughly 10 times more potent than fentanyl, has been detected in the illicit drug supply across 22 states, with detections increasing sharply since late 2025, Medscape reported Oct. 9.
Researchers from Richmond-based Virginia Commonwealth University School of Medicine analyzed 14,261 biospecimens collected through the Center for Forensic Science Research and Education’s NPS Discovery early-warning program from the third quarter of 2020 through the second quarter of 2026. The findings were published Oct. 7 in JAMA Psychiatry.
Here are five things to know:
1. Researchers identified 142 orphine-positive specimens, accounting for 1% of those tested. Cychlorphine was the most commonly detected analog, appearing in 102 specimens (72%), followed by brorphine in 38 (27%).
2. Detections occurred in two waves. The first began in the third quarter of 2020 and involved brorphine. A larger wave began in the fourth quarter of 2025, with cychlorphine detected in 100 of the 102 orphine-positive specimens identified (98%) through the second quarter of 2026.
3. Tennessee accounted for the largest share of positive specimens, with 50 (35%), followed by Illinois with 37 (26%), Texas with 14 (10%) and Minnesota with 10 (7%). Overall, 53% originated in the South and 37% in the Midwest.
4. Polysubstance involvement was common. Benzodiazepine-related compounds were detected in 37% of positive specimens, fentanyl-related compounds in 36% and methamphetamine or other amphetamines in 36%. Naloxone was present in 23%.
5. Orphines can cause opioid-induced respiratory depression but are not routinely included in clinical or forensic toxicology testing. Fentanyl and nitazene test strips do not reliably detect them, and no orphine-specific test strips are currently available. Researchers called for clinical guidance for managing orphine-involved overdoses, development of orphine-specific test strips, greater access to confirmatory testing, continued naloxone distribution and expanded surveillance for additional analogs.
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