If you didn’t already know, makers of illicit drugs include “additives and contaminants” in the opioid drugs they produce to “intensify the euphoric effects.” This, of course, adds to the risk involved with taking illicit drugs by causing sedation and worsening withdrawal symptoms. Until recently, the additive of choice was xylazine, a veterinary sedative. In 2024, xylazine was replaced by medetomidine, another, more potent veterinary sedative. Actually medetomidine “is up to 300 times more potent and is implicated in overdoses and complicated withdrawals in several major U.S. cities.
Medetomidine intoxication causes low blood pressure, slow heart rate, and prolonged sedation. It is rapidly absorbed after ingestion, and metabolized by the liver. It’s sedative effects can last several hours. As yet, it is not included in “standard urine drug testing.”
Narcan (naloxone) is the antidote of choice. It is available in IV, oral, and nasal formulations for use in emergency situations, but the concerns over sedation and respiratory suppression with medetomidine demand watchful care.
Withdrawal symptoms can be serious and start as soon as a few hours after ingestion of medetomidine. Severe rapid heart rate, high blood pressure, vomiting, and delirium are the main issues in withdrawal. They give way to low BP and slow heart rate, so hospitalization can be needed. Severe nausea and vomiting are a big part of withdrawal, as well.
Treatment requires oral or intravenous medications depending on the patient’s symptoms. A clonidine patch is one fairly reliable treatment. But withdrawal of the opioid, to which medetomidine has been added, makes treatment just one level more difficult.
Physicians who practice in high drug abuse areas should become knowledgeable of the drugs and additives more often used in their locale. If you have a good idea what’s coming through your door, your treatment efforts are going to be more fruitful and less frustrating. The whole idea that we even have to discuss this problem is upsetting and a sad commentary on our society.
Reference: Chertok J, Roder N. What Family Doctors Should Know About Medetomidine, a New Contaminant in the Illicit Drug Supply. Am Ram Phys 2026 March;113(3):211-212.
