Medetomidine, a highly potent veterinary alpha-2 adrenergic agonist, has recently emerged as a significant adulterant within the U.S. illicit opioid supply. This presentation will review the evolution of adulterants in the U.S. drug supply, the pharmacology and clinical effects of medetomidine, and the distinguishing features of medetomidine toxicity and withdrawal. We will outline emerging treatment strategies emphasizing early, aggressive alpha-2 agonist therapy; nuanced antiemetic approaches; when and how to escalate to IV dexmedetomidine; and approaches to concurrent opioid withdrawal management. Participants will gain insight into diagnostic challenges, observation and disposition considerations, and strategies for system-level preparedness. The target audience includes physicians, advance practice providers, behavioral health practitioners, nurses, pharmacists, and social workers.
Learning Objectives:
- Describe the emergence of medetomidine as an illicit drug adulterant and its impact on overdose toxicity and withdrawal presentations.
- Recognize the clinical features of medetomidine toxicity and differentiate medetomidine withdrawal from opioid, benzodiazepine, and other sedative withdrawal syndromes.
- Apply evidence-informed strategies for early, aggressive management of medetomidine withdrawal, including the use of alpha-2 agonists and antiemetic therapies.
Presenter:
Dr. Michael Lynch is an associate professor of Emergency Medicine, Toxicology, and Addiction Medicine at the University of Pittsburgh, where he works clinically in several UPMC hospitals. He is currently Senior Medical Director for Quality and Substance Use Disorder Services at UPMC Health Plan. He previously served as the first Medical Director of the PA Department of Drug and Alcohol Programs and was Medical Director of the Pittsburgh Poison Center for 10 years. He is the founder and director of the UPMC Medical Toxicology Telemedicine Bridge Clinic.
