A new class of synthetic opioids known as orphines is emerging in the U.S., raising concerns for public health officials and clinicians, The New York Times reported May 5.
Orphines began appearing in the U.S. drug supply in the fall, following shifts in global synthetic opioid production.
Here are four things to know:
- Orphines are synthetic opioids first developed in the 1960s, when researchers sought rapid pain relievers for surgery. These researchers also developed fentanyl. Research was stopped due to severe side effects, including respiratory depression and high addiction risk.
- Researchers estimate the drug to be 10 times more potent than fentanyl, with lethal effects possible from only small quantities. The Drug Enforcement Administration in 2018 issued a temporary ban on fentanyl-related substances, or analogs. A fentanyl analog is a “substance intended for human consumption that is substantially similar in its chemical makeup and effects to fentanyls already listed in Schedule I,” according to the Drug Enforcement Administration.
- One common analog, cychlorphine, is circulating in counterfeit pills and powders, often mixed with fentanyl or other drugs — at times without the user’s knowledge — and has been detected in the U.S. and Europe.
- The drugs have been identified in 14 states, primarily in the South and Midwest, and are spreading. Standard toxicology tests often cannot detect orphines, complicating overdose identification and surveillance efforts. Overdoses may respond to naloxone, but multiple doses are often required, exceeding typical fentanyl reversal protocols.
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