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Medetomidine, a highly potent veterinary alpha-2 adrenergic agonist, has recently emerged as a significant adulterant within the U.S. illicit opioid supply. This presentation entitled will review the introduction of medetomidine in the U.S. drug supply, the pharmacology and clinical effects of medetomidine, and the distinguishing features of medetomidine toxicity and withdrawal. We will outline emerging treatment strategies emphasizing early, aggressive alpha-2 agonist therapy; nuanced antiemetic approaches; when and how to escalate to IV dexmedetomidine; and approaches to concurrent opioid withdrawal management. Participants will gain insight into diagnostic challenges, observation and disposition considerations, and strategies for system-level preparedness.

1. Describe the emergence of medetomidine as an illicit drug adulterant and its impact on overdose toxicity and withdrawal presentations.
2. Recognize the clinical features of medetomidine toxicity and differentiate medetomidine withdrawal from withdrawal syndromes.
3. Apply evidence-informed strategies for early, aggressive management of medetomidine withdrawal, including the use of alpha-2 agonists and antiemetic therapies.
4. Identify system-level challenges posed by medetomidine and outline approaches to multidisciplinary coordination.

Michael Lynch, MD

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