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Clandestine drug production, use, and exploitation present a social issue afflicting millions across the globe. "Designer opioids," some known to the street as "China White" for their alleged purity, have been unveiled in the past years; noted to possess properties that can compromise well-being in a remarkably novel way. This class of designer opioids, the 4-phenylpiperidines, seems to be generating significant medical concerns due to its deadly clinical manifestations; which may be further complicated by the ease of access and its potent addictive properties. The potential drug adulteration with other chemical formulations further complicates the medical scenario, posing a serious challenge in the management of presumed overdoses. Furthermore, if the key clinical manifestations are overlooked due to the presence confounding signs and symptoms to medical practitioners, patient's mortality may potentially increase even stronger. Thus, the purpose of this communication is to create awareness about these novel agents and their potentially devastating clinical complications. We strongly support the empiric treatment with naloxone per the currently established guidelines. In addition, we urge practitioners to carefully document findings relating to recovery time and historical data to aid in early detection, and precise decision-making in suspected intoxications cases.

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