A synthetic opioid up to 40 times more potent than fentanyl has killed a woman in Richland County. The drug, called cychlorphine, is the first confirmed case of the substance in South Carolina, according to the Fort Mill Sun.

Standard drug tests miss it.

Forensic investigators identified cychlorphine only after using advanced mass spectrometry during the death investigation. Standard hospital drug screens and rapid urine tests cannot detect the compound because its chemical structure differs from fentanyl and other common opioids. Confirmation requires specialized liquid chromatography-mass spectrometry, or LC-MS.

Attorney General Alan Wilson issued a public safety advisory on April 8 calling cychlorphine poison and urging parents to talk to their children about the danger. Wilson said one mistake or one exposure can be fatal. His office said the drug is often manufactured overseas and trafficked into the United States, then mixed into other substances without a user's knowledge.

Cychlorphine is rarely sold under its own name. It is laced into street powders and counterfeit prescription pills made to look like Percocet or Xanax, according to the report.

Richland County Coroner Naida Rutherford said the discovery caught officials off guard.

"When we saw Cychlorphine and they called us, we were just in shock," Rutherford said, according to the Fort Mill Sun. "Expect that pills if they're not from a prescribed source, not from a pharmacy … expect that they are counterfeit."

The problem extends well beyond South Carolina. Health officials in Tennessee have confirmed more than 41 fatal overdoses linked to cychlorphine. Clusters of fatal poisonings and hospitalizations have been recorded in Louisiana, Ohio and Oklahoma. South Carolina officials are expanding toxicology protocols to check whether unexplained deaths from recent months may have involved the drug.

Overdose signs and response

Because of cychlorphine's potency, reversing an overdose often requires multiple doses of naloxone, sold as Narcan. Signs of overdose include shallow or stopped breathing, blue or pale lips and fingertips, unresponsiveness and gurgling sounds.

If an overdose is suspected, call 911 immediately. Administer one dose of Narcan into a nostril. If there is no response within two to three minutes, give a second dose. Cychlorphine overdoses may require three or more doses.

Fort Mill treatment resources

For Fort Mill and York County residents, the New Season/York County Treatment Center at 377 Rubin Center Drive, Suite 101, offers outpatient opioid treatment. Services include medication-assisted treatment, or MAT, and counseling. The center is also a Narcan distribution site. Hours are Monday through Friday, 5 a.m. to 1:30 p.m.

Keystone Substance Abuse Services in Rock Hill provides prevention, intervention and treatment services in York County.

The South Carolina Department of Mental Health support line is available around the clock at 844-724-6737. The SC Statewide Crisis Response Line can be reached at 833-364-2274.