Advisory: May 31, 2024

Another Potent Sedative, Medetomidine, Now Appearing in Illicit Drug Supply

This advisory is intended to make the public aware of a new threat entering the illegal drug supply in various parts of the United States, as reported by the Center for Forensic Science Research and Education (CFSRE).  The drug, medetomidine, has been used in veterinary medicine for many years as a sedative, analgesic, anxiolytic, and muscle relaxant and is a synthetic, alpha-2-agonist that is in the same class of medications as xylazine and clonidine.

In April and May 2024, “mass overdose outbreaks” in Philadelphia, Pittsburgh, and Chicago were associated with fentanyl or heroin containing medetomidine—as well as xylazine and/or other substances.  The serious adverse events associated with these overdoses included prolonged sedation and slowed breathing and slowed heart rate that is not reversed by the opioid antagonist, naloxone.

Although there have been no reports of medetomidine in community drug sample tests by the New York State Department of Health thus far, it is important that education about medetomidine and its effects be disseminated among treatment providers, harm reduction programs and people who use drugs to help prevent overdose.

In animals, the most significant side effect of medetomidine is slow and shallow breathing that becomes more pronounced when medetomidine is combined with other sedating medications.  Other effects mirror those of xylazine and clonidine and include slowed heart rates, high or low blood pressure, and heart failure leading to poorly circulated blood.

Medetomidine, however, is more potent than xylazine and may produce deeper and longer lasting sedation—especially when combined with opioids.

In addition to administering naloxone and providing rescue breathing, emergency systems should be alerted as soon as possible when encountering an individual with profound sedation and a slow heart rate that is not responsive to naloxone. Like xylazine, medetomidine is a non-opioid sedative and its effects cannot be reversed by naloxone.

In a public alert issued by the CFSRE on May 20, 2024, medetomidine was described as an emergent and rapidly proliferating adulterant in the United States’ unregulated opioid drug supply that is contributing to overdoses in several states.

According to the CFSRE, the drug was first detected at the end of 2022 in Maryland, followed by Missouri, Colorado, Pennsylvania, and California in 2023.  

OASAS continues to offer free naloxone and fentanyl/xylazine test strips from our online ordering portal. As always, New Yorkers struggling with an addiction, or whose loved ones are struggling, can find help and hope by calling the state’s toll-free, 24-hour, 7-day-a-week HOPEline 1-877-8-HOPENY (1-877-846-7369) or by texting HOPENY (Short Code 467369).