What is Medetomidine? Medetomidine, also known as "Domitor", is a highly potent alpha-2 adrenergic receptor agonist primarily used as a veterinary sedative and analgesic. Medetomidine has a rapid onset of action and produces significant sedative, amnestic, and analgesic effects.
 
What was found? According to a May 2024 public alert from the Center for Forensic Science Research and Education (CFSRE), medetomidine has been rapidly proliferating across the United States and Canada, being implicated in the recreational opioid drug supply and has been involved in outbreaks. The report notes that medetomidine has appeared as a fentanyl or heroin adulterant alongside other adulterants such as xylazine. The report notes that heightened sensation and profound bradycardia have been found as effects of recreational medetomidine use.
 
How is it being discussed? Online discussions on platforms like Reddit reveal that medetomidine is often used in combination with opioids for recreational purposes. Reddit users report that the drug's potent sedative effects are an order of magnitude greater than those of xylazine. Some users mention that medetomidine may have reduced peripheral vasoconstriction and hypertension compared to xylazine. The combined CNS depression of a fentanyl-medetomidine mixture is highlighted by commenters as a major danger, potentially leading to severe respiratory depression and overdose. The discussion also notes that the potency difference between medetomidine and other sedatives like xylazine may not be well understood, leading to unintentional overdoses.
 
Drug Terms: Medetomidine, Domitor
 
Methodological Note: Data was collected and analyzed by the NDEWS Web Monitoring Team, led by Dr. Elan Barenholtz and NIDA T32 predoctoral fellow Daniel Van Zant of the Machine Perception and Cognitive Robotics (MPCR) Lab at Florida Atlantic University. Metrics are based on post counts derived from algorithmic monitoring of all subreddits on Reddit. No personally identifiable or post-specific information is incorporated into this monitoring process. Due to modifications in our data collection protocols, the NDEWS Web Monitoring Team is currently unable to collect data for substances that generate high volumes of posts (e.g. xylazine or psilocybin). This temporary restriction, which is anticipated to persist until early June, reflects recent revisions to Reddit's Terms of Service on data gathering. For more methodological details, see our publication. 

This weekend, the NDEWS team will be traveling to attend the 86th College on Problems of Drug Dependence (CPDD) Annual Meeting in Montreal, Quebec Canada. CPDD is the oldest and largest organization in the US dedicated to advancing a scientific approach to substance use and addictive disorders. The NDEWS team will be presenting both an oral presentation and an invited symposium, showcasing our latest data. We invite you to join us for these presentations. Please find the presentation information below: 

Sunday, June 16, 2024
5:30-7:00pm Poster Session 1 (Agora & Centre-Ville, Lobby Level)
S30 - Assessing Xylazine Involvement in Non-Fatal Drug Overdoses Using EMS Data for 2023
Andrew McCabe, Linda Cottler

S110 - Patterns of Polysubstance Use Among Adults Who Use Opioids: Results from the NDEWS Rapid Street Reporting Study, 2021-2023
Anna Wang, Nae Won, Joseph Palamar, Linda Cottler

Monday, June 17, 2024
6:15-7:45pm Poster Session 2 (Agora & Centre-Ville, Lobby Level)
M67 - Predicting Fentanyl Related EMS Incidents Using the Hawkes Process
Daniel Van Zant, Belle Krubitski, Andrew McCabe, Elan Barenholtz, Linda Cottler

M150 - New Psychoactive Substances and Polysubstance Use Patterns Among Adults in 19 US Cities: A Latent Class Analysis
Nicole Fitzgerald, Joseph Palamar, Linda Cottler

M175 - Self Reported Past 12-Month Fentanyl Use: Results from an Anonymous Multi-City Intercept Survey
Nae Won, Andrew McCabe, Anna Wang, Joseph Palamar, Linda Cottler

Tuesday, June 18, 2024
8:00-9:00am Oral Session: Licit and Illicit Use of Psychedelics (Avenue Viger, 2nd Floor)
Prevalence of Use of Psilocybin and MDMA in Multiple US Cities
Tamara Millay, Nae Won, Anna Wang, Joseph Palamar, Linda Cottler

Wednesday, June 19, 2024
9:45-11:15am Invited Symposium (Place du Canada, 2nd Floor)
Sentinel Networks for Early Surveillance and Warning of Substance Use Trends in North America
Linda Cottler, Erin Parker, Doris Payer, Jaime Arredondo Sanchez Lira, Andrew McCabe, Tara Sabo-Attwood

A study recently published in Drug and Alcohol Dependence Reports, co-authored by NDEWS colleague Dr. Alex Krotulski, characterized xylazine awareness, desire, use, and exposure among people who use drugs in Rhode Island, US. Data were analyzed from an ongoing cohort study, and in 2023, 125 people who use drugs were enrolled and surveyed. One residual drug sample was tested from each participant and confirmed offsite at a laboratory. The results showed that virtually all participants wanted to avoid xylazine exposure. Half knew what xylazine was, and a quarter suspected previous exposure. Xylazine was detected in 14.5% of samples using FTIR-S and in 21.4% of samples using a dual laboratory approach. Read the study here.

A study recently published in Addiction described the spread of xylazine throughout the UK illicit drug supply. The results showed that by the end of August 2023, xylazine was detected in 35 cases from toxicology, drug testing, and drug seizure sources covering England, Scotland, and Wales. There were no cases reported from Northern Ireland. Xylazine was detected in biological samples from 16 people. In most cases where full toxicology results were provided, xylazine was detected with heroin and/or a potent opioid, but this polydrug use pattern was not evident in all cases. Supporting this claim, evidence from the Welsh Emerging Drugs and Identification of Novel Substances showed that all 14 drug samples submitted from across the UK contained xylazine; however, in none of these cases was heroin the purchase intent but rather counterfeit prescription medication tablets, THC vapes or white powder. The authors concluded that xylazine has penetrated the UK illicit drug market and is not limited to heroin supplies. Read the study here.

On Thursday, June 13, 2024, the Centers for Disease Control and Prevention (CDC) issued a Health Alert Network Health Advisory to inform public health officials, clinicians, and affected patients, their families, and caregivers about potential disrupted access to care among individuals taking prescription stimulant medications and possible increased risks for injury and overdose. This week the US Department of Justice announced a federal healthcare fraud indictment against a large subscription-based telehealth company that provides attention-deficit/hyperactivity (ADHD) disorder treatment to patients 18 years and older across the US. This indictment could impact as many as 30,000 to 50,000 patients. The alert notes that this disruption coincides with an ongoing prescription drug shortage involving several stimulant medications commonly prescribed to treat ADHD. Read the alert here.

🔸 NBC News
A dangerous new animal sedative is making its way into the illegal drug supply

🔸USA Today
The twisty, titillating, controversial history of gay sex drug poppers

This presentation will explore attempts to alter analytical and interpretive aspects of postmortem toxicology for expediency purposes.

Date: June 26th, 2024

Time: 2:00 p.m. ET

Register here.

Share your research, news, and events through our submission form.

Share your comments on our newsletter through our feedback form.

Follow NDEWS on Twitter: @NDEWSnews