From the Philly Frontlines: Managing Medetomidine Intoxication & Withdrawal in the Fentanyl Era

In late 2024, clinicians in Philadelphia witnessed a dramatic change in the street drug supply: medetomidine, an alpha-2-agonist previously used as a veterinary sedative, had replaced xylazine as the most common additive in most fentanyl drug samples. This lecture explores the emergence of this new drug trend, presented by two physicians who care for these patients in both the emergency department and inpatient setting.
We examine the characteristics of the fall 2024 outbreak and its impact on Philadelphia hospitals given the high clinical needs of patients suffering from both the medetomidine toxidrome and its life-threatening withdrawal syndrome. Attendees will learn how to recognize the evolution of the medetomidine-exposed patient, from a toxidrome causing profound CNS depression and bradycardia to the withdrawal phase that may provoke hypertensive emergencies, myocardial infarction, and posterior reversible encephalopathy syndrome (PRES).
This talk will introduce emerging treatment protocols that have been created to address this outbreak, which rely on high doses of narcotics, sedatives, and adjunctive therapies previously tailored for opioid and xylazine withdrawal. Our goal is to familiarize the emergency medicine physician who may encounter this novel street drug and equip them with practical tools for safe and effective care in a rapidly changing drug landscape.