The era of “tranq,” the powerful veterinary tranquilizer xylazine that has been prevalent in the illicit drug supply, may be coming to an end. However, a new dangerous sedative called medetomidine is quickly taking its place. Cities like Philadelphia, Pittsburgh, Chicago, and San Francisco have reported a rise in overdoses involving medetomidine in the past year.
In Philadelphia, reports of medetomidine have surged. Initially, when the city began testing for the substance in May 2024, it was found in 29% of fentanyl samples. Six months later, the prevalence of medetomidine had tripled to 87%, while xylazine had decreased from 100% to 42%.
For years, illegal drug suppliers in the U.S. have been cutting fentanyl with sedatives like xylazine to make it more cost-effective. Many drug users have unknowingly encountered xylazine in substances marketed as fentanyl, while others have actively sought it despite its powerful sedative effects. As law enforcement has cracked down on xylazine, medetomidine, a pharmacologically active form known as dexmedetomidine or “dex,” has swiftly taken its place.
Medetomidine is causing severe health complications among drug users, even more so than xylazine. Overdoses involving medetomidine result in low heart rates and profound sedation, making overdose reversals more challenging. Additionally, withdrawal symptoms from medetomidine can be life-threatening, with the sympathetic nervous system causing elevated heart rate and blood pressure that can harm vital organs like the heart and brain.
Unlike xylazine withdrawal, which is often mild, medetomidine withdrawal is characterized by heightened heart rate and blood pressure. Medetomidine belongs to the same family of medications as xylazine and clonidine, a common antihypertensive medication used to treat ADHD and pain.
Although formulations of medetomidine are used in veterinary settings, they are also used in humans under the brand name Precedex for sedation. The rapid spread of medetomidine in Pennsylvania’s drug supply occurred after the state cracked down on xylazine by classifying it as a Schedule III controlled substance.
Nabarun Dasgupta, a pharmacoepidemiologist at the University of North Carolina, believes the rise of dexmedetomidine was inevitable. Legislation targeting xylazine created a demand for a replacement with similar properties, leading to the emergence of medetomidine in the illicit drug market.
The presence of medetomidine in the drug supply adds a layer of uncertainty to the ongoing U.S. overdose epidemic. While overall trends show a decrease in the death toll from overdoses, medetomidine, like xylazine, does not respond to naloxone, the medication used to reverse opioid overdoses.
Efforts to crack down on medetomidine could potentially limit access to a medication critical for many healthcare providers’ daily responsibilities. As the drug landscape continues to evolve, addressing the rise of dangerous sedatives like medetomidine is crucial to preventing further harm in the ongoing opioid crisis. The increasing prevalence of medetomidine in the drug supply has posed new challenges for health providers and researchers alike. While the death rate may be decreasing, the presence of medetomidine has complicated treatment, overdose response, and post-overdose care.
Medetomidine withdrawal has proven to be particularly challenging, with potentially life-threatening symptoms that require medical intervention. In comparison to opiate withdrawal, medetomidine withdrawal often necessitates a higher level of care and specialized treatment. Treatment typically involves a combination of medications such as short-acting opioids for pain relief, alpha-2 agonists like clonidine, anti-nausea drugs, and sedatives to manage symptoms like high blood pressure.
Despite the difficulties associated with medetomidine withdrawal, there may be a silver lining in the form of reduced skin complications. Unlike xylazine, which is known to cause deep skin wounds and necrosis, medetomidine does not have the same reputation for causing such issues.
In response to the growing prevalence of medetomidine in the drug supply, public health officials, researchers, and harm reduction advocates have taken steps to address the challenges it presents. Forums and conferences have been held to discuss strategies for treating medetomidine withdrawal, and some states have issued warnings about its dangers. Companies like BTNX have also developed test strips to detect the presence of medetomidine in substances, providing a valuable tool for harm reduction efforts.
Dr. Dasgupta, a researcher at the University of North Carolina, emphasizes the heightened dangers posed by dexmedetomidine for drug users. Its powerful sedative properties increase the risk of overdoses and leave individuals vulnerable to dangerous situations while under its influence. The similarities between xylazine and dexmedetomidine in appearance highlight the importance of caution and awareness when dealing with these substances.
Overall, the rise of medetomidine in the drug supply underscores the need for continued vigilance and innovation in addressing the evolving challenges of substance use and addiction. By staying informed, collaborating with experts, and utilizing available resources, healthcare providers and communities can better respond to the complexities of medetomidine and other emerging substances in the drug landscape.
