Cychlorphine: The New Synthetic Opioid Hawaiʻi Families Should Know About

I was scrolling through medical news when a story about a 16-year-old in San Francisco stopped me. The teenager died after taking a counterfeit pill, and the autopsy identified a newer synthetic opioid called cychlorphine.

As a healthcare provider and as a mom, that is the part I keep thinking about: we spend years teaching families about one threat, while the illicit drug supply keeps changing underneath us.

What is cychlorphine?

Cychlorphine, also called N-propionitrile chlorphine, is an emerging synthetic opioid in the “orphine” family. Federal public-safety agencies have warned that it is showing up in the illicit drug supply, including in mixtures with fentanyl and in counterfeit pills.

The exact potency estimates reported by laboratories have varied, so I would not focus on memorizing a number. The practical point is simpler: it is a very potent opioid, the dose in an illicit pill is unpredictable, and severe respiratory depression can happen quickly.

Does it have a street name?

Not a reliable one. Cychlorphine itself does not yet have one consistently recognized street name that parents can listen for.

What you may hear instead are names for the counterfeit pills that can contain it. Terms such as “blues,” “M30s,” “M-boxes,” or “Mexican blues” have been used for counterfeit oxycodone-style pills. Those names do not mean the pill contains only oxycodone, fentanyl, cychlorphine, or any other single drug. They describe what the pill is being sold as, not what is actually inside it.

What does it look like?

There is no dependable visual way to identify cychlorphine. It may be a powder, or it may be pressed into a tablet designed to look like a legitimate prescription medication.

Crime-laboratory reports have identified cychlorphine in counterfeit tablets stamped to resemble several prescription pills, including blue M30 tablets, green M15 tablets, pink K56 tablets, yellow T259 tablets, white M367 tablets, and Xanax-style tablets.

That does not mean every pill with one of those markings contains cychlorphine. It means the marking cannot tell you what is really in an illicit pill.

A counterfeit tablet can have the same color, shape, and imprint as something a person recognizes from a pharmacy. The safest rule is still the easiest one to remember: if a medication was not prescribed to you and dispensed to you by a licensed pharmacy, you do not know what is inside it.

What about fentanyl test strips?

Fentanyl test strips are still an important harm-reduction tool, but they are not an all-drug safety test. A negative fentanyl result does not prove that a pill or powder is safe, because an illicit product may contain other synthetic opioids or other substances that the strip is not designed to identify.

That distinction matters as the drug supply becomes more complicated. Testing can reduce risk, but it cannot turn an unknown street pill into a known medication.

What would an opioid overdose look like?

Cychlorphine is an opioid, so the emergency signs are similar to other opioid poisonings. Someone may be extremely difficult or impossible to wake, breathe very slowly or irregularly, have pinpoint pupils, become limp, develop blue or gray lips or fingertips, or make unusual choking, gurgling, or snoring sounds.

If you suspect an opioid overdose: call 911, give naloxone if it is available, and give another dose if the person does not respond and additional naloxone is available. Federal guidance notes that some potent synthetic opioids, including cychlorphine, may require several doses of naloxone.

Why this matters in Hawaiʻi

Whether or not a particular emerging opioid has already made a Hawaiʻi headline, the lesson is relevant here now. Hawaiʻi is not isolated from the national counterfeit-pill market, and fentanyl has already changed the overdose landscape in our state.

Hawaiʻi has expanded free naloxone distribution and access to fentanyl test strips through statewide overdose-prevention efforts. Those are useful tools, but prevention also starts much earlier: with families understanding that a pill offered by a friend, bought online, or purchased on the street may not contain what anyone thinks it contains.

What I would tell my own kids

You do not need to memorize the word cychlorphine. You do not need to know every new synthetic opioid that appears next.

Remember this instead: if the pill did not come from a pharmacy for you, you cannot know what is inside it.

And if someone takes something and will not wake up, is breathing strangely, or looks like they may be overdosing, get help immediately. Call 911. Use naloxone if you have it. Tell the adults or first responders what you know. We can sort everything else out afterward.

The bigger lesson

I hope cychlorphine never becomes a familiar word in Hawaiʻi. But the warning is bigger than one drug name.

The illicit drug supply can change faster than public awareness does. Counterfeit pills can look familiar while containing something completely different. A negative fentanyl test is not a guarantee. And naloxone is something more families should know how to use before they ever need it.

Sometimes living on an island gives us a chance to see a wave forming somewhere else before it reaches our shore. We should use that time to teach, prepare, and protect our families.

Sources and further reading

U.S. Drug Enforcement Administration — Public Safety Advisory: Heightened Threat, Fentanyl Mixed with Emerging Synthetic Drugs, May 12, 2026.

U.S. Drug Enforcement Administration — Fake Prescription Pills fact sheet and One Pill Can Kill resources.

U.S. Department of Justice / National Institute of Justice — Increase in Fatal Overdoses Linked to Novel Synthetic Opioid N-Propionitrile Chlorphine (Cychlorphine), January 2026.

Hawaiʻi Department of Health — Hawaiʻi Opioid Settlement Project reporting on statewide naloxone distribution, fentanyl-test-strip access, prevention, and treatment efforts.

North Louisiana Criminalistics Laboratory public warnings and laboratory reporting on cychlorphine in counterfeit prescription-style tablets.