New Synthetic Opioids Raise SF Overdose Risk

San Francisco health officials issued an alert this week after a fatal overdose was tied to two novel synthetic opioids not previously reported in the city. (sf.gov) (sfist.com) The San Francisco Department of Public Health said the drugs were cychlorphine and N-desethyl isotonitazene, identified in the toxicology report of a person who died earlier in April. Fentanyl was not detected in that screening. (sfist.com) (kron4.com) City officials said the victim is believed to have swallowed counterfeit pills that also contained ethyl bromazolam, a benzodiazepine not approved in the United States. The department warned that even a fraction of a counterfeit pill can be lethal. (kron4.com) (sfist.com) Cychlorphine is estimated by officials to be about 10 times more potent than fentanyl, and the city said standard fentanyl test strips do not detect it. That changes the usual overdose-risk playbook for people who rely on fentanyl strips to check street drugs. (kron4.com) (sfist.com) Nitazenes are a class of synthetic opioids with no approved medical use in the United States. The Centers for Disease Control and Prevention has said some nitazene analogs exceed fentanyl in potency and that naloxone can reverse overdoses, though multiple doses may be needed. (cdc.gov) (dea.gov) The Drug Enforcement Administration says these drugs also show up in tablets made to mimic prescription opioids, leaving buyers unable to verify identity, purity, or dose. San Francisco’s warning described the recent case as the first reported overdose in the city involving the two newly identified opioids. (dea.gov) (sfist.com) The alert arrives as overdose deaths remain high even after recent declines. San Francisco recorded 635 unintentional overdose deaths in 2024, 621 preliminary deaths in 2025, and 148 preliminary deaths from January through March 2026. (sf.gov 1) (sf.gov 2) (media.api.sf.gov) The city’s medical examiner has already been tracking other additives and analogs in overdose deaths, including fluoro fentanyl, xylazine, bromazolam, medetomidine, and ethyl bromazolam. That list has grown as San Francisco’s overdose response shifted from fentanyl alone to a more mixed and less predictable street supply. (media.api.sf.gov 1) (media.api.sf.gov 2) Public health guidance did not change on the main emergency step: give naloxone right away for a suspected opioid overdose and call 911. The Centers for Disease Control and Prevention says naloxone works against opioids including fentanyl, and San Francisco directed people seeking treatment to its behavioral health line at (888) 246-3333. (cdc.gov) (kron4.com) The city’s warning is less about one isolated death than a new kind of uncertainty in the drug supply. Pills sold as familiar medications are now carrying opioids that can outmatch fentanyl and slip past fentanyl-only checks. (sfist.com) (dea.gov)