Medetomidine: A Worsening Illicit Substance-use Epidemic?

For more than a decade, cities struck with substance-use disorder have experienced the brunt of clandestinely adulterated drugs circulating the streets, culminating in the tragic death of over 107,000 individuals by drug-overdose in the United States in 2022. Recently, those cities, particularly Philadelphia, have witnessed a new “wave” of drug-adulterants entering the illicit drug supply. In May 2024, medetomidine, a non-opioid sedative employed in veterinary medicine, was identified as a new drug-contaminant in Philadelphia, with most identified medetomidine being co-detected with either fentanyl or xylazine. Medetomidine’s long-term effects on humans remain unknown, as concerns of a worsening illicit substance-use epidemic grow. Given such fears, this article serves to briefly educate readers on the current pharmacological and medical knowledge of medetomidine and its possible ramifications on the illicit substance-use epidemic, to offer recommendations to combat the early spread of the drug, and to ground our recommendations in ethics.