Identifying the Local Emergence of Medetomidine Through Prehospital Collaborations

Medetomidine, an alpha-two receptor agonist, has been recently detected as an adulterant of the illicit opioid supply in multiple states and observed to complicate clinical management of opioid overdoses through sedation, hypotension, and/or bradycardia. Our goal is to describe the process through which a novel adulterant of illicit opioids was identified in our community, and describe the process through which this information was disseminated to key stakeholders, including emergency medical services, emergency medicine and internal medicine providers, local and state departments of health, harm reduction advocates, people who drugs, and lay media.

After a paramedic from Worcester Emergency Medical Services described an increase in overdose alert activity, we were able to obtain blood specimens from two patients during a cluster of overdoses. These blood specimens were sent to a research laboratory for analytical toxicology testing.

Analyses of the two patient blood samples identified the presence of fentanyl, xylazine, and medetomidine. These patients were noted to be bradycardic and hypotensive on presentation to care, an observation that did not reflect the use of fentanyl alone. We subsequently reviewed our findings with local and state departments of health, local harm reduction agencies lay media, and patients presenting to our mobile addiction clinic.

Medetomidine, an emerging adulterant, further complicates the clinical care of exposed patients in overdose and magnifies features of xylazine exposure. In this case, prehospital data and clinical observation led to the identification of medetomidine in our community. With appropriate analytical toxicology resources, pre-hospital providers can translate clinical observation into new drug or adulterant identification, improving clinical care and public health.