Driven largely by the spread of illicit fentanyl into the drug supply, overdose deaths surged in Tennessee beginning in 2020, rising from 2,089 deaths in 2019 to more than 3,800 in 2021 and 2022. In 2023, Tennessee recorded more than 3,600 overdose deaths, with fentanyl involved in more than 75% of them.
Since then, the numbers have begun moving in the right direction. Tennessee overdose deaths fell sharply in 2024, part of a broader national decline that researchers have attributed to several factors, including increased access to the overdose-reversal drug naloxone, expanded treatment and harm-reduction efforts, and disruptions in the supply of illicit fentanyl and its precursor chemicals.
But the numbers remain devastatingly high, and the illicit drug supply continues to evolve. One of the newest threats is cychlorphine, a powerful synthetic opioid that emerged in the United States in 2025.
Researchers estimate cychlorphine to be approximately 10 times more potent than fentanyl. Like fentanyl, it can be mixed into other illicit drugs or counterfeit pills without the user’s knowledge. Between July 2025 and February 2026, cychlorphine was associated with 46 overdose deaths in Knox County and the surrounding 10-county East Tennessee region, according to research published in Environmental Science & Technology Letters, a journal of the American Chemical Society.
Cychlorphine presents additional challenges for people trying to protect themselves from overdose. Standard fentanyl test strips are not designed to detect it, and Tennessee health officials have warned that overdoses involving cychlorphine may require multiple doses of naloxone and rapid medical intervention.
Organizations like Johnson County’s A.C.T.I.O.N. Coalition are on the front lines of raising awareness about these emerging synthetic opioids and reducing the stigma surrounding substance use disorder.
According to Trish Burchette, executive director of the A.C.T.I.O.N. Coalition, facilitating open communication about drug use is key.
“Stigma has, for far too long, created secrecy and isolation for those battling addiction,” she says. “Our number one priority is reducing that stigma and changing the way our community views those with substance use disorder. I believe if we do that, it will open up doors for conversation, support and healing.”
For Burchette, communication also means educating people about what is actually in the illicit drug supply and ensuring that those at risk of an opioid overdose have access to naloxone, commonly sold under the brand name Narcan. Working with the Tennessee Department of Mental Health and Substance Abuse Services and Ballad Health, the A.C.T.I.O.N. Coalition provides free naloxone throughout a 10-county East Tennessee service area, including Johnson County.
On Friday, August 21, the A.C.T.I.O.N. Coalition will recognize International Overdose Awareness Day with an event at Ralph Stout Park. Beginning at 6 p.m., the all-ages event will feature door prizes, a bounce house for children and food trucks. Three speakers will also share their personal experiences with substance use disorder and overdose.
Burchette describes the event as “a celebration of lives that have made significant advancement in their recovery process and the strength that has been found by those in our community affected by such profound loss.”
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