Source: Royal Examiner
Publication Date: Oct 10, 2026
Medical Toxicologist(s): Christopher P. Holstege, MD
Keywords/Topics: orphines, opioids

Royal Examiner: UVA Poison Expert Warns of Emerging Synthetic Opioids That Fentanyl Tests May Miss

“Dr. Christopher P. Holstege, director of UVA Health’s Blue Ridge Poison Center and chief of the University of Virginia’s Division of Medical Toxicology, is warning about substances known informally as “orphines,” potent synthetic opioids that began appearing in the United States in 2019.

Orphines are synthetic opioids with chemical roots dating to the 1960s. Holstege said they currently have no legitimate medical use and are not approved by the U.S. Food and Drug Administration.

Like heroin, morphine and fentanyl, they can cause sedation, very small pupils and dangerously slowed breathing. In severe cases, a person can stop breathing and die.

[...]

One of Holstege’s biggest concerns is that detecting orphines isn’t easy. Fentanyl test strips do not detect them."