Detection of Medetomidine in the Unregulated Drug Supply in the US

"Reports on the detection of medetomidine in biospecimens and drug supplies have emerged much more recently. In July 2022, the first identification of medetomidine in illicit drug packaging was reported in Maryland [16]. Medetomidine occurs in two enantiomeric forms: dexmedetomidine and levomedetomidine. Dexmedetomidine is approved for human medical use in procedural or general sedation, but racemic medetomidine (which includes the less active levomedetomidine enantiomer) is only approved for veterinary use [17].

"In May 2024, 38 confirmed or probable cases of medetomidine-involved overdose were reported in Chicago, with patients experiencing hypertension, bradycardia, and most showing no improvement in symptoms with naloxone administration [18]. Medetomidine most frequently co-occurs with IMF (and sometimes xylazine) but has also been detected in the absence of these drugs [3,4,16,19]. The geographical prevalence of medetomidine in the illicit drug supply appears to coincide with areas where xylazine is more prevalent. The prevalence of both medetomidine and xylazine is likely underestimated overall due to limited awareness and availability of testing for these drugs [7]."