30 Apr NPS Frontline Alert: Medetomidine
Medetomidine is a non-opioid veterinary anesthetic that acts as a synthetic agonist at alpha-2-adrenergic receptors. It belongs to the same drug class as xylazine but is approximately 200 times more potent.1 While it does not have any approved human use, the active form of dexmedetomidine is utilized for sedation during various procedures. Increasingly, medetomidine is detected alongside illicitly manufactured fentanyl, xylazine, heroin, and other street drugs in several parts of the U.S.1-3 Novel Psychoactive Substances (NPS) are compounds designed to mimic common illicit or prescription drugs while evading regulation and routine testing methods. They are also known as “designer drugs” or “research chemicals.” NPS testing also often includes substances that have been utilized as adulterants in the drug supply (e.g., xylazine, BTMPS).
Class/Drug Co-Positivity
(Samples positive for medetomidine: 2,585)
This table includes the top 10 classes of substance with misuse potential based on their co-positivity
with Medetomidine. Medications prescribed for Medication Assisted Treatment were excluded.
Samples were received for testing between 10/1/2023-3/31/2025. Specimens were tested based on
provider request, and all specimens did not received testing for the same drug classes.
States with Medetomidine Detected Q4 2023 – Q1 2025
States in Dark Blue – Medetomidine detected
States in Teal – Medetomidine Tested and Not Detected
States in Light Blue – Medetomidine Not Tested
About Medetomidine
- Medetomidine, an alpha-2 adrenergic agonist, is increasingly found as an adulterant in illicit opioids. Its potent sedative effects can exacerbate
respiratory depression, bradycardia, and hypotension, complicating overdose management.1 - Medetomidine may produce longer-lasting sedation as it has approximately 200-fold higher potency than xylazine.1,2
- Reported adverse effects include analgesia, sedation, anxiolysis, hallucinations, muscle relaxation, hypotension, and bradycardia.3,4
- Medetomidine may enhance the effects and duration of other illicit substances, increasing the adverse risk to those exposed.3,4
- Unlike opioids, medetomidine’s effects are not reversed by naloxone. Patients with prolonged sedation or respiratory distress despite adequate
naloxone administration may require alternative interventions, such as ventilatory support.3,4
Reference:
1. Scheinin H, Virtanen R, et al. Medetomidine—a novel alpha 2-adrenoceptor agonist: a review of its pharmacodynamic effects. Prog Neuropsychopharmacol Biol Psychiatry.1989;13(5):635-51
2. Medetomidine rapidly proliferating across USA — implicated in recreational opioid drug supply & causing overdose outbreaks. Center for Forensic Science Research and Education. May 20, 2024. Accessed January 17, 2025. https://www.cfsre.org/nps-discovery/public-alerts/medetomidine-rapidly-proliferating-across-usa-implicated-in-recreational-opioid-drug-supplycausing-overdose-outbreaks
3. Medetomidine – an emerging adulterant of concern. Center for Forensic Science Research and Education. July 11, 2024. Accessed January 17, 2025. https://www.cfsre.org/images/Presentations/Medetomidine_NPSD_Webinar_Series_Walton_and_Krotulski.pdf
4. Toxic adulterant alert: medetomidine/dexmedetomidine. Center for Forensic Science Research and Education. December 8, 2023. Accessed January 17, 2025. https://www.cfsre.org/images/content/reports/public_alerts/Medetomidine_Public_Health_Alert__Final.pdf
For further information about NPS, including recorded presentations and national trends, please visit here.
