Sovereign Health Group Blog

Uncovering U-4: The tip of the synthetic and psychoactive substance iceberg

01-05-17 Category: Addiction, Advocacy, Substance Abuse

Uncovering U-4: The tip of the synthetic and psychoactive substance iceberg

In the past, China was ravaged by the West through the Opium Wars. Today, Western countries appear to be the ones being targeted, as synthetic drugs pour over our borders from China and elsewhere. Sadly, these substances are taking the innocent lives of our youth, while leaving devastated families and communities in their wake. As the government remains powerless to do anything to curb the growing problem, Americans have no choice but to protect themselves.

The recent tragic loss of Orange County college student Natasha Heim has helped bring to light the dangers of U-47700 (also called U-4, Pink or Pinky) and other such substances. U-4 was also implicated in the death of two young boys from Utah as well as part of the drug cocktail that took the life of the music artist Prince. While nothing can bring back those who have already been lost, perhaps lives can be saved by spreading awareness into this dangerous new trend.

  • Read the full story of Natasha Heim here.

A few key points to know about U-4 and similar substances:

  • They are sometimes referred to as designer drugs
  • They may or may not be detectable on urine drug screens
  • They most often have not be tested for safety in humans or even animals
  • The manufacturing process is unregulated, so concentrations vary from very low to lethal levels
  • They may contain toxic additives

The chemical name for U-4 is 3,4-dichloro-N[2-(dimethtlamino)cyclohexyl]-N-methylbenzamide. It can be taken by mouth, taken rectally, inhaled, or injected. It has been aggressively promoted over the internet as a research chemical or as a substitute for prescription painkillers or heroin. Physical effects are dose-dependent, but can include pinpoint pupils, slow and shallow breathing, cyanosis (turning blue) and unresponsiveness.

As of Nov. 14, 2016, U-4 has been temporarily placed on Schedule I for 24 to 36 months, at which point it will be decided if it should be permanently categorized as such. The scheduling system of the Drug Enforcement Administration (DEA) consists of five categories into which various substances fall, with Schedule I substances having no known medicinal value and a high potential for causing physical dependency. Schedule I drugs are illegal to possess or sell. But even if the substance is permanently categorized as Schedule I, a slight modification to its molecular structure would allow a new, unscheduled drug to be born.

Legal loopholes have allowed the drug to be sold to Americans on the street, in nightclubs, and delivered directly to the door through online orders from China. By altering the chemical composition of a drug and packaging it as a prescription painkiller or heroin, drug dealers can skirt the laws banning such substances in the U.S. Because these ever-changing chemical compounds are untested in humans, sometimes their fatal effects are not known until it is too late.

In order to understand the magnitude of the problem, we asked Michael Lynch, M.D., about U-4 and the clinical and social implications of such substances. Dr. Lynch is the medical director at the Pittsburgh Poison Center and an assistant professor in the Division of Medical Toxicology, Department of Emergency Medicine Divisions of Adolescent and Pediatric Emergency Medicine and the Department of Pediatrics at the University Of Pittsburgh School Of Medicine.

Uncovering U-4: The tip of the synthetic and psychoactive substance iceberg

“We are seeing more and more of these novel synthetic opioid overdose cases lately. I believe our first documented case was last January, and they have been increasing ever since,” Dr. Lynch explained. “We recently have acquired the ability to test for U-4 in our toxicology laboratory, but most centers do not have that ability. Therefore, the actual number of U-4 overdose cases nationwide might be underestimated. We may only be seeing the tip of the iceberg.”

“Fortunately,” he added, “U-4 is similar enough to other opioids so that those who overdose can be treated with the same antidote, naloxone, if they are able to receive help in time. I urge anyone who has a friend or loved one who is taking opioids to ask their doctor for a prescription for a naloxone emergency kit and learn how to use it. It could mean the difference between life and death.”

Synthetic opioid substances are not the only dangerous so-called designer drugs on the market. Substances similar to barbiturates, benzodiazepines, stimulants, cannabinoids and hallucinogens are also being created and sold through similar avenues.

Other terrifying examples of these novel psychoactive substances are the synthetic cathinones. These drugs have a molecular structure similar to the stimulant found in the khat plant, except the synthetic versions tend to be much stronger and much more dangerous. Because these drugs can be manufactured to appear like bath products, they are sometimes called “bath salts.” Synthetic cathinones are notorious for causing paranoid and psychotic behavior, and possibly even violent behavior.

Whether or not psychoactive substances should be legal or illegal remains controversial. While the synthetic opiate U-47700 is no longer legal in the U.S., it is merely the tip of the novel-synthetic-psychoactive iceberg. These substances, such as U-4, can be created and distributed internationally faster than they can be identified and regulated. As a result, Americans are being slaughtered by these untested and highly toxic substances.

The dangers of taking novel synthetic psychedelics far outweigh the benefits. People who use them socially are literally risking their own lives and perhaps even the lives of those around them. Those who use them as a desperate attempt to ease the terrible discomfort from opioid withdrawal must understand that safe and comfortable detoxification is available. In the throes of addiction, getting more drugs may seem like the only available option, but such thoughts are merely the effects of the drugs themselves. People can and do recover. If you or a loved one is struggling with opioid addiction, alcohol or other drugs, know you are not alone. Things can begin to get better as soon as today.


Follow this series

If you missed it, be sure to read the first article in the series, “Uncovering U-4: O.C. local succumbs to opioid substance that’s skimming through legal loopholes” Finish the series by checking out the concluding article “Uncovering U-4: Synthetic drugs threaten youth, future.”

Check back regularly for developments in the story at, Facebook or LinkedIn. You can also follow us on Twitter and track the discussion by searching for hashtags #StopU4 and #SovTalk.

About us

Sovereign Health is a leader in the treatment of individuals with addiction, mental illness and co-occurring disorders in our many different specialized programs. We welcome adolescents and adults with opioid addiction who require detoxification or are already on medication-assisted therapy. Our experienced treatment teams provide comprehensive care and ongoing aftercare to help ensure lasting recovery. We also offer clinical professionals continuing education opportunities such as seminars, webinars and other events. To find out more about our programs, please call our 24/7 helpline.

About the author

Dana Connolly, Ph.D., is a senior staff writer for Sovereign Health, where she translates current research into practical information. She earned her Ph.D. in research and theory development from New York University and has decades of experience in clinical care, medical research and health education. Sovereign Health is a health information resource and Dr. Connolly helps to ensure excellence in our model. For more information and other inquiries about this article, contact the author at

We accept Most Private Insurance, reach out to us so we can help!

Call Now Button