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Overdoses Involving Medetomidine Mixed with Opioids - Chicago, Illinois, May 2024.

Amy Nham, John N Le, Shawn A Thomas

    MMWR. Morbidity and Mortality Weekly Report
    |May 1, 2025
    PubMed
    Summary

    Medetomidine, an animal sedative, was found mixed with fentanyl in Chicago opioid overdoses, causing severe symptoms and poor response to naloxone. This marks the largest reported cluster of medetomidine-involved overdoses, highlighting the need for broad public health surveillance.

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    Published on: November 8, 2024

    Area of Science:

    • Public Health
    • Toxicology
    • Emergency Medicine

    Background:

    • Medetomidine, a nonopioid sedative, has been detected in illicit opioids in North America since 2022.
    • Atypical overdose symptoms prompted an investigation into a cluster of cases in Chicago.

    Purpose of the Study:

    • To investigate and characterize an outbreak of suspected opioid-involved overdoses involving medetomidine in Chicago.
    • To identify the drug adulterant and patient demographics associated with the overdose cluster.

    Main Methods:

    • Multisector surveillance involving hospitals, the Illinois Poison Center, and public health departments.
    • Case investigation and data collection for confirmed, probable, and suspected overdoses.
    • Toxicological analysis of drug samples and blood specimens.

    Main Results:

    • 12 confirmed, 26 probable, and 140 suspected medetomidine-involved overdoses were identified in Chicago.
    • Medetomidine was mixed with fentanyl in all tested samples; it was a new adulterant in Chicago's drug supply.
    • Confirmed cases predominantly affected males, non-Hispanic Black or African Americans aged 45-64, presenting with bradycardia and poor naloxone response.

    Conclusions:

    • This outbreak represents the largest reported cluster of medetomidine-involved overdoses.
    • Multisector surveillance is critical for detecting novel adulterants in the illicit drug supply.
    • Continued administration of naloxone for all suspected opioid overdoses is essential due to the frequent co-occurrence with opioids.