Medetomidine Infiltrates the US Illicit Opioid Market

The opioid crisis, driven by synthetic opioid use, has continued to lead to tens of thousands of deaths per year.¹ Although deaths appear to have begun to level off or slightly decline, the crisis has become increasingly complicated due to the emergence of comixtures of synthetic opioids (primarily fentanyl) with other central nervous system depressants, including animal tranquilizers. The recent addition of xylazine, a veterinary sedative, complicated the fentanyl overdose situation, making overdoses difficult to reverse²; and in recent months, rashes of opioid overdoses involving a new tranquilizer have been increasing.³ This new addition to illicit opioid concoctions is medetomidine, a potent α₂-adrenergic receptor agonist. Medetomidine, a racemic mixture of dexmedetomidine and levomedetomidine, is commonly used to produce sedation and analgesia in veterinary medicine, whereas dexmedetomidine is a Food and Drug Administration–approved drug for human administration and is commonly used in hospital settings.⁴