Commenters debate overdose response involving cychlorphine

Other posts stigmatized drug test strips.

Cychlorpine continues to dominate online conversation about substance use as more states report identifying the potent opioid in illicit drug supplies. Meanwhile, the Substance Abuse and Mental Health Services Administration sent a letter revoking federal funding for certain harm reduction tools, including drug test strips, sparking discussion about whether people who use drugs should have access to these services. Social media users also debated the safety of “gas station drugs” like tianeptine, an unregulated antidepressant with opioid-like effects, and kratom.

In light of these conversations, communicators may recirculate information about cychlorphine, outline the benefits of harm reduction tools, and highlight the dangers of tianeptine and kratom.

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What’s trending nationally in conversations about substance use

Over the past two weeks, cychlorpine has been identified in additional states. On April 30, the White House Office of National Drug Control Policy shared a social media post warning about the drug, fueling growing concern online. Some posts discussing cychlorphine garnered hundreds of thousands of views as of May 5. When many commenters encouraged people to carry naloxone, others falsely claimed that naloxone cannot reverse a cychlorphine overdose.

On April 27, SAMHSA sent a letter to state health departments and grant recipients stating that federal funding will no longer cover drug test strips or overdose hotlines that provide “a virtual or telephonic companion” for people using illicit drugs. The letter also reiterated that federal funding will not cover other harm reduction tools for safer drug use, like syringes. Most social media posts responding to the letter expressed alarm, emphasizing that drug test strips can help prevent overdose deaths. Others expressed stigmatizing attitudes toward people who use drugs and suggested that people who engage in “risky” behavior don’t deserve access to lifesaving tools.

On April 28, a Pennsylvania coroner reported that a woman had died from an overdose involving tianeptine, an unregulated drug with opioid-like effects that is sometimes sold in gas stations and vape shops. Many social media users responding to the news expressed concern about tianeptine and other easily accessible and dangerous “gas station drugs,” like kratom. Others falsely claimed that these substances are not dangerous and alleged, without evidence, that they improve brain function and treat chronic pain, anxiety, depression, and opioid use disorder.

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Recommendations for public health professionals

The Infodemiology.com team will provide messaging recommendations in response to some of the trending narratives outlined above. These helpful tips can be used when creating content, updating web and FAQ pages, and developing strategy for messaging about substance use.

Conversations about cychlorphine show ongoing confusion about whether naloxone is effective against the opioid. Messaging may continue to emphasize that naloxone is effective against opioids, including potent opioids like cychlorphine, though multiple doses may be required and administered every two to three minutes. Communicators may outline the signs of an overdose and appropriate response steps. Messaging may also direct people to community programs that offer free naloxone and training on its use.

In response to debate about harm reduction, communicators may explain that tools like drug test strips, sterile syringes, and naloxone help people who use drugs live healthier lives and access treatment when they are ready. As much of the online conversation focused on drug test strips, messaging may stress that these tools—which can detect substances like fentanyl and xylazine—help prevent overdose deaths by enabling more informed decisions. Because these tools are not legal in all states, communicators should ensure that messaging aligns with state laws related to drug checking equipment. Directing people to local harm reduction programs that provide drug test strips and other lifesaving tools like naloxone is recommended.

Given conversation about “gas station drugs,” communicators may explain that neither tianeptine nor kratom are approved by the FDA for any medical use. Both drugs are linked to serious health risks, including confusion, seizures, liver damage, and substance use disorder. People seeking support for chronic pain, mental health conditions, or opioid withdrawal symptoms should be encouraged to consult a health care provider about appropriate treatment options.