Maryland’s Office of Overdose Response Warns of Medetomidine

From Maryland’s Office of Overdose Response:

The Philadelphia Department of Public Health recently distributed the attached health alert regarding medetomidine, a veterinary sedative that has increasingly been found in Philadelphia’s supply of illicit drugs.

Important takeaways from the health alert are summarized below.

Medetomidine Highlights

  • Medetomidine is a veterinary sedative (alpha-2 agonist) that is more potent than xylazine.
  • Medetomidine may be linked to symptoms of hypotension (low blood pressure), bradycardia (low heart rate), and prolonged sedation that is not reversed by naloxone.
  • All samples that were found to contain medetomidine in Philadelphia also contained xylazine and fentanyl.
  • It is not clear if medetomidine causes wounds similar to those associated with xylazine.

Overdose Response

  • Naloxone should always be administered as the first step when responding to a drug overdose.
  • However, similar to xylazine, medetomidine may cause prolonged sedation, which emphasizes the importance of rescue breathing, placing an individual in the rescue position, and monitoring breathing after administering naloxone.
  • Administer one dose of naloxone every two minutes. Once individuals are breathing on their own (taking a minimum of one breath every six seconds). they no longer require more naloxone.
  • Always call 911 for medical assistance when responding to an overdose.
  • Additional instructions on overdose response can be found here.


  • Individuals may report symptoms of withdrawal from medetomidine. These symptoms may be responsive to clonidine, a similar alpha-2 agonist.
  • Withdrawal management should prioritize treating opioid withdrawal with buprenorphine or methadone and add clonidine early for patients who are hemodynamically stable and have persistent symptoms.

Download the Full Report from the Philadelphia Department of Public Health

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