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    Medetomidine in overdose cases is linked to a higher risk of bradycardia, but not increased sedation or need for intensive care. This highlights the importance of toxico-surveillance for emerging drug trends.

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    Area of Science:

    • Toxicology
    • Emergency Medicine
    • Pharmacology

    Background:

    • Medetomidine, an alpha-2 adrenoreceptor agonist, is approved for veterinary use and has been detected in the US illicit drug supply since 2022.
    • Emerging drugs in the illicit supply pose a significant public health risk, necessitating surveillance for associated clinical effects.

    Purpose of the Study:

    • To determine the prevalence of medetomidine exposure in emergency department (ED) patients presenting with opioid and/or stimulant overdoses.
    • To identify clinical characteristics associated with medetomidine exposure in this patient population.

    Main Methods:

    • Utilized the Toxicology Investigators Consortium (ToxIC) Drug Overdose Toxico-Surveillance (DOTS) Reporting Program across 17 US medical centers.
    • Enrolled ED patients with acute opioid and/or stimulant overdose between April 2023 and September 2024, collecting blood for toxicological analysis.
    • Conducted chart reviews and structured patient interviews to gather clinical data.

    Main Results:

    • Medetomidine was detected in 2.8% (n=27) of 964 overdose cases.
    • Medetomidine exposure was associated with a fourfold increased odds of bradycardia (<50 bpm) within 24 hours (OR: 4.03; 95% CI: 1.35, 10.58).
    • Patients with medetomidine exposure showed higher rates of bag-valve-mask (BVM) use (20.5% vs 3.7%) but did not require more intubation, BiPAP/CPAP, or naloxone.

    Conclusions:

    • Medetomidine exposure in overdose patients is linked to increased bradycardia but not greater sedation or need for advanced respiratory support.
    • Sentinel toxico-surveillance effectively identifies emerging drug trends missed by routine clinical data.
    • No patients interviewed reported intentional medetomidine use, suggesting its presence in the illicit supply is often unrecognized by users.