Laurel DeiCas
October 16, 2026
Throughout the past two years, the United States has seen the emergence of several synthetic opioids that are even more potent than fentanyl. These drugs, called nitazenes and cychlorphine, have the potential to be just as deadly, if not deadlier, than heroin and fentanyl. Policymakers must act now to mitigate the effects of a potential fourth wave of the opioid crisis. The United States’ ongoing opioid addiction crisis has long been the subject of intense policy debate. The fentanyl crisis has dominated the news for the past decade, and while it seems to finally be coming to an end as overdose-related deaths are on a decline, policymakers cannot afford to become complacent. The US can learn from other countries’ policy approaches and should move past its strict “War on Drugs” approach to drug policy in order to deal with the threat of emerging narcotics.
The opioid crisis in the United States has gone through three phases, those being prescription drugs, street drugs, and synthetic drugs. In the 1990s, prescription medications like OxyContin hit the market, and pharmaceutical companies pushed them to healthcare providers as a solution for pain management [1]. Many people became addicted to opioids after being prescribed them for pain, and from 1999 to 2010, opioid-involved overdose deaths doubled [1]. In 2010, as opioid deaths rose, prices for heroin began to decline, and in 2015 the street drug eventually surpassed prescription drugs as the leading substance involved in opioid-related deaths [1]. Alongside heroin, deaths involving synthetic opioids such as fentanyl also increased [2]. In 2016, synthetic opioids, particularly fentanyl, surpassed heroin as the leading cause of opioid-involved overdose deaths with the rate of deaths for every 100,000 once again doubling [1]. The COVID-19 pandemic was also likely responsible for an increase in overdose deaths [3]. Opioid-related overdose deaths have decreased each year since 2022 [2] but rates of overdose still remain higher than they were pre-pandemic [3].
Recently, a new synthetic drug called cychlorphine began circulating in the US. This drug is a synthetic opioid that was developed as an experimental painkiller, but it was never approved for human consumption [4]. The recipe for cychlorphine is publicly available online, so illicit labs can produce the drug with relative ease [4]. Cychlorphine overdoses are reversible with naloxone (Narcan), but the drug is ten times more potent than fentanyl, so there is a high risk for overdose and it can take multiple doses of naloxone to reverse an overdose [5]. Also on the rise are nitazenes, a class of synthetic opioids that can be up to 43 times as potent as fentanyl [6].Cychlorphine and nitazenes are both unable to be detected by fentanyl test strips, making even those who are cautious enough to test for fentanyl vulnerable to overdoses.
One major issue with nitazenes specifically is the difficulty in regulating them. Under the Controlled Substances Act, drugs are classified into 5 categories or schedules, with Schedule I substances being drugs with no accepted medical use and a high risk for abuse and Schedule V substances being drugs with a low potential for abuse [7]. Substances are classified by their specific chemical compounds, so when one nitazene is regulated, if underground laboratories can slightly alter the chemical composition, they can create a new drug that is outside the Controlled Substances Act [8]. The Drug Enforcement Administration notes that substances intended for human consumption that are pharmacologically similar to Schedule I substances will be treated as such [7], but nitazenes have no approved medical use, so they cannot be treated as Schedule I analogues [8].
Synthetic opioids may only be emerging in the US now, but they are not new. Estonia was one of the first countries to face a fentanyl crisis, but they were able to effectively deal with it, decreasing deaths by 70% from 2002 to 2018 [9]. Authorities thought that they had actually solved the issue of opioid overdoses, but then nitazenes began emerging rapidly, once again raising opioid-related deaths [9]. Estonia so far has implemented a dual-track response to nitazenes similar to their approach to fentanyl in the 2000s, placing relatively equal emphasis on supply-side control and harm reduction strategies. [10]. Policies include monitoring borders and trade routes, scheduling nitazenes on a case-by-case basis, and implementing harm reduction strategies such as naloxone distribution and needle exchanges [10].
Senators Dave McCormick and Ruben Gallego have introduced the bipartisan Nitazene Control Act, which would make it easier to make arrests related to dealing with nitazenes by permanently scheduling all nitazenes as Schedule 1 substances [11]. Some drug policy experts refer to the race to schedule substances as “drug whack-a-mole,” [12] because it seems that when one drug is scheduled, dealers of illicit substances are incentivised to create new ones that are often more potent and are unpredictable to deal with. The scheduling of fentanyl has contributed to the rise of nitazenes and other synthetic opioids [12], so there is no reason to assume that scheduling nitazenes will not result in the emergence of other synthetic opioids similar to cychlorphine.
Some countries, like Portugal, have decriminalized possession of all typically illegal drugs and moved towards addressing drug use and possession with a commission separate from the criminal justice system [13]. When someone is caught using or possessing drugs, they are referred to a Dissuasion Commission who can choose to dismiss the case or to impose fines, group therapy, or a referral to addiction treatment [14]. General trends in Portugal suggest an increase in “lifetime use” of drugs, but a decrease in “problematic use” of drugs, meaning that people are more likely to try drugs, but less likely to use them in a way that causes harm to themselves or others [13]. Reports also indicate that more people sought out pharmacotherapy treatments after decriminalization [13], and that overdose rates fell by over 80% after decriminalization [14]. Portugal’s drug policy is not without its issues, but their decriminalization and harm reduction measures have succeeded in reducing harmful drug use.
The idea of drug decriminalization seems completely outlandish in the U.S., but it has been tried before with Oregon’s measure 110, which decriminalized possession of small amounts of drugs [15]. Instead of arresting people, police were supposed to hand out a fine which would be waived if they attended a screening for drug services, but there was no penalty for not paying the fine, so most people who received a fine did not pay it and did not attend the screening [15]. Oregon repealed the measure in 2024, and re-criminalized drug possession as a misdemeanor [15]. This case study brings up questions of whether drug decriminalization can even work in the U.S.; Portugal has universal healthcare that covers addiction treatment, and Portugal never experienced the level of mass criminalization that exists in the U.S. [14]. Meanwhile, Oregon tried to implement this policy when reports showed that 49% of needed drug treatment services were missing [15]. The U.S. just may not be prepared to implement such a sweeping policy change.
It is incredibly unlikely that the U.S. will move towards an approach of complete decriminalization, but that doesn’t mean policymakers’ only option is to continue playing the “drug whack-a-mole” game forever. Estonia’s dual-track model, with supply-side crackdowns and harm reduction, proved to be effective at curbing their fentanyl crisis. Thus, a similar policy approach could work to deal with synthetic opioids in the U.S. The Oregon case should also not completely deter policymakers from considering decriminalization, but should instead demonstrate what needs to be done to make decriminalization successful. If Oregon had invested in drug treatment services and created a better incentive for people to seek treatment, they may have seen better results.
As of right now, nitazenes and cychlorphine have not infiltrated the U.S.’s illicit drug market in the same way they have in countries like Estonia, but this does not mean that policymakers should ignore these emerging drugs. As fentanyl-related death rates continue to decrease each year, U.S. policymakers must anticipate what may come next in the ongoing fight against the opioid epidemic.
Works Cited
[1] Ritchel, Matt. “The Ruthless Efficiency of Ultrapotent Street Drugs – The New York Times.” New York Times, August 31, 2026. https://www.nytimes.com/2026/08/24/science/drugs-opioids-fentanyl-baltimore.html.
[2] The opioid crisis in the United States: A brief history | congress.gov | Library of Congress, 2022. https://www.congress.gov/crs-product/IF12260.
[3] “Understanding the Opioid Overdose Epidemic.” Centers for Disease Control and Prevention. Accessed September 16, 2026. https://www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html.
[4] Stobbe, Mike. “U.S. Overdose Deaths Fell Again in 2025, but Some Worry about Policy and Drug Supply Changes.” PBS, May 13, 2026. https://www.pbs.org/newshour/health/u-s-overdose-deaths-fell-again-in-2025-but-some-worry-about-policy-and-drug-supply-changes.
[5] Cychlorphine, explained: 10 Things to Know About the New Synthetic Opioid – Becker’s Behavioral Health. Accessed September 16, 2026. https://www.beckersbehavioralhealth.com/pharmacy/cychlorphine-explained-10-things-to-know-about-the-new-synthetic-opioid/.
[6] Namm, Adam E., Information bulletin: The emergence of Nitazenes in the Americas § (2024).
[7] “Drug Scheduling.” DEA, 2026. https://www.dea.gov/drug-information/drug-scheduling.
[8] Schwarz, Evan S, Frank Dicker, Emilie Lothet, Hannah Spungen, and Michael Levine. “Nitazenes: An Old Drug Class Causing New Problems.” Missouri Medicine, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12331301/.
[9] Ahmed, Azam. Estonia Won the War on Fentanyl.What Came Next Was Even Worse. – The New York Times, July 7, 2026. https://www.nytimes.com/2026/07/07/world/europe/estonia-fentanyl-new-drugs.html.
[10] Abel-Ollo, Katri, Mailis Tõnisson, Peep Rausberg, et al. “The Nitazene Epidemic in Estonia: A First Report.” European Journal of Public Health 35, no. 6 (2025): 1233–40. https://doi.org/10.1093/eurpub/ckaf160.
[11] Nitazene control act. Bill (2025).
[12] “Facts About Nitazenes.” drugpolicy.org, April 2026. https://drugpolicy.org/wp-content/uploads/2026/04/DPA-NitazenesFactSheet_InDesign.pdf
[13] “International Models.” International Models – Alcohol and Drug Foundation, October 23, 2025. https://adf.org.au/talking-about-drugs/law/decriminalisation/international-models/.
[14] “Drug Decriminalization in Portugal Learning From a Health and Human-Centered Approach .” drugpolicy.org, 2019. https://drugpolicy.org/wp-content/uploads/2023/08/dpa-drug-decriminalization-portugal-health-human-centered-approach_0.pdf.
[15] Wasinger , Jake. “The Failures of Oregon’s Measure 110.” BJCL, February 23, 2026. https://www.bjcl.org/blog/the-failures-of-oregons-measure-110.