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Cyclorphine instead of benzodiazepine / Life-threatening mix-up with online tablets

An interdisciplinary team of toxicologists from the Institute of Forensic Medicine and physicians from the Poisoning Information Center at the Medical Center - University of Freiburg has investigated a serious case of poisoning in which the ingestion of a tablet from the Internet almost ended fatally. Instead of the expected benzodiazepine prodrug, the tablet was found to contain the highly effective synthetic opioid cyclorphine. The person concerned had to be treated in intensive care.

"We identified cyclorphine in the examined tablet - a potent opioid that, unlike benzodiazepines, can lead to life-threatening conditions even at low doses," said Prof. Dr. Volker Auwärter, Head of Forensic Toxicology at the Institute of Forensic Medicine at the Medical Center - University of Freiburg. "We see this case as a sign of a worrying development. In recent years, there has been a significant increase in fatal incidents involving synthetic opioids in Germany."

Danger to life due to misleading labeling

The tablets in question were contained in a transparent zip bag labeled "Alprazolam Triazolobenzophenone Pellets I 1 mg". According to the declaration, they were supposed to contain a prodrug of the benzodiazepine alprazolam, which is sold in Switzerland and the USA under the trade name Xanax and is known for its high addictive potential. Instead, the tablets were found to contain cyclorphine - an active ingredient that, unlike the chemically and structurally related opioid brorphine, is not yet legally regulated. Similar to fentanyl, which has been responsible for a high number of drug-related deaths for many years, particularly in the USA, this active ingredient can be life-threatening even in very small quantities.

The current case is an example of a growing problem: in the recent past, the Medical Center - University of Freiburg has also investigated deaths in which falsely declared substances were consumed. Against this backdrop, the experts are renewing their appeal for rapid implementation of the legally possible "drug checking" in Baden-Württemberg. Although the Narcotics Act has already been amended at federal level, several federal states - including Baden-Württemberg - still lack the necessary state ordinance for implementation.

Caption: Two of the seized tablets from the current poisoning case: instead of a prodrug of the benzodiazepine alprazolam, they contained cyclorphine, which can be life-threatening even in small quantities.
Image source: Medical Center - University of Freiburg