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Qualitative medetomidine detection in ante- and post-mortem samples via toxicology surveillance testing, Michigan
Varun Vohra1, Matthew P Levitas2, Chris S Thomas3
1Michigan Poison & Drug Information Center, Department of Emergency Medicine, Wayne State University School of Medicine, 550 East Canfield Street, Suite 354, Detroit, MI 48201, United States.
Introduction:
Medetomidine is a non-opioid sedative with an increasing presence as an adulterant in the North American illicit drug supply. This study's purpose was to characterize the prevalence of medetomidine-positive cases in both ante- and post-mortem samples across Michigan.
Methods:
Post-mortem blood samples were submitted to the Swift Toxicology of Overdose-Related Mortalities (STORM) project between March 1, 2024, and May 16, 2025. Ante-mortem oral fluid samples were submitted to Forensic Fluids Laboratories Inc. between August 6, 2024, and May 27, 2025. All ante- and post-mortem samples were screened for common drugs of abuse. Medetomidine was qualitatively identified in both matrices using liquid chromatography-tandem mass spectrometry.
Results:
4290 post-mortem blood samples were tested with medetomidine detection in 17 (0.4 %) specimens. Fentanyl was co-detected with medetomidine in 16/17 (94.1 %) cases while xylazine was co-detected in 8/17 (47.1 %) cases. Positive co-detection of both xylazine and fentanyl occurred in 8/17 cases (47.1 %) cases. 20,736 ante-mortem oral fluid samples were tested with medetomidine detection occurring in 129 (0.6 %) specimens. Fentanyl was detected in 126/129 (97.7 %) cases while 59/129 (45.7 %) samples involved co-detection of both fentanyl and xylazine.
Conclusions:
Our findings support recent evidence of frequent co-detection of medetomidine in mixtures containing fentanyl and xylazine. Post-mortem blood and ante-mortem oral fluid data may reflect different inflection points related to market saturation of emerging drugs and adulterants. The prevalence of medetomidine in street-level opioids highlights the significance of increasing awareness and education directed to people who use drugs and health information exchange across health sector entities to mitigate morbidity and mortality.
Insights
Medetomidine, a sedative adulterant, was detected in Michigan drug samples. It frequently co-occurred with fentanyl and xylazine in both post-mortem and ante-mortem cases, indicating its growing presence in the illicit drug supply.
Area of Science:
- Forensic Toxicology
- Pharmacology
- Public Health
Background:
- Medetomidine is an emerging adulterant in the North American illicit drug supply.
- Its presence poses a significant risk due to its sedative properties and potential for overdose.
Purpose of the Study:
- To determine the prevalence of medetomidine in ante-mortem and post-mortem samples in Michigan.
- To characterize co-detections of medetomidine with other substances like fentanyl and xylazine.
Main Methods:
- Analysis of post-mortem blood samples (n=4290) and ante-mortem oral fluid samples (n=20,736).
- Screening for common drugs of abuse.
- Qualitative identification of medetomidine using liquid chromatography-tandem mass spectrometry (LC-MS/MS).
Main Results:
- Medetomidine was detected in 0.4% of post-mortem samples and 0.6% of ante-mortem samples.
- High rates of co-detection with fentanyl (94.1% post-mortem, 97.7% ante-mortem) and xylazine (47.1% post-mortem, 45.7% ante-mortem) were observed.
- Co-detection of fentanyl and xylazine with medetomidine was also frequent.
Conclusions:
- Medetomidine is frequently co-detected with fentanyl and xylazine in illicit drug samples.
- Findings highlight the need for increased awareness and education for drug users and healthcare providers.
- Monitoring emerging adulterants like medetomidine is crucial for public health surveillance and harm reduction efforts.
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