(Fifth of five parts)
BETHLEHEM, Pa. — It took just over a year for medetomidine to dominate drug samples obtained by the drug-tracking organization PA Groundhogs.
One of the harm-reduction organization's recent public health alerts warns of medetomidine adulteration found April 27, 2024, to May 17, 2024, in Philadelphia and Allegheny counties.
By May of this year, the University of Pittsburgh Medical Center's emergency department had developed a webinar about the emerging adulterant — a veterinary sedative not approved for human use and used on the streets as a cutting agent with fentanyl.
In Philadelphia, Sarah Laurel sounded alarm bells at the outreach center she founded, Savage Sisters.
"So it does not look like it is just going to come in and then drift out. It looks like it is actually going to be part of the drug supply."Savage Sisters founder Sarah Laurel
Volunteers with the harm reduction nonprofit said they watched the switch in the drug supply from xylazine to medetomidine in real time.
Laurel said medetomidine has entered the supply "much more rapid" than xylazine, another veterinary sedative used with fentanyl to prolong highs.
In one week last August, Laurel said 27 of 46 drug samples taken by Savage Sisters had medetomidine in them.
"We've tested over 300 samples, and we have seen medetomidine increase in the amount that is in the supply and the number of samples as well, very dramatically," Laurel said then.
"So it does not look like it is just going to come in and then drift out. It looks like it is actually going to be part of the drug supply."
UPMC Medetomidine Webinar by LehighValley Newsdotcom on Scribd
Numbers shooting up
Data from PAGroundhogs distributed through the UPMC webinar only backs that up.
Numbers show medetomidine shooting up from no presence in drug samples being sold as fentanyl in the first quarter of 2024 to 95% in the second quarter of this year.
Xylazine presence presents a near flip-flop of medetomidine's numbers — 96% in early 2024 to 10% in the second quarter of 2025.
Laurel said that's cause for concern, as medetomidine is significantly more potent than xylazine. The DEA reports the tranquilizer's potency is "200-300 times greater than that of xylazine."
Like xylazine, medetomidine is a "synthetic alpha-2 adrenoreceptor," but also isn't approved for human use, according to a public health alert by the Philadelphia Department of Health on May 13, 2024.
Laurel said medetomidine poses the same deadly threats as xylazine: necrotizing tissue and immunity to Narcan or naloxone because it is not an opioid.
Laurel said medetomidine can cause heavier sedation, seizure-like movements and body tremors, psychosis, hallucinations and low heart rates for upward of an hour.
"We're reversing these overdoses street-side, and they are experiencing another overdose within about an hour," Laurel said.
'The next coming nightmare'
A presentation from the UPMC webinar says there's "limited data describing verified medetomidine toxicity."
In comparing studies about medetomidine withdrawal syndrome, about 90% of patients are admitted to the intensive care unit, according to the UPMC webinar. Withdrawal is rapid, "often within hours," it says.
"And it's just such an emerging thing that most of the questions that you would ask are — we don't know."Lehigh County Drug and Alcohol Assistant Administrator Molly Stanton
The hospital presentation reports that clinical findings show symptoms include severe nausea and vomiting, rapid heart rate, progressive severe hypertension, anxiety, diaphoresis, tremor, and delirium.
Even with a clinical background, Lehigh County Drug and Alcohol Assistant Administrator Molly Stanton said of the webinar, "a lot of it was over my head."
"And it's just such an emerging thing that most of the questions that you would ask are — we don't know," Stanton said. "So it's kind of like the next coming nightmare."
What's next?
PAGroundhogs says that medetomidine emerged in Pennsylvania's illicit drug supply around the time the Shapiro administration permanently classified xylazine as a Schedule III drug in 2024.
Last October, the U.S. Drug Enforcement Administration announced it "knows where this xylazine comes from" — China-based manufacturing companies. Medetomidine is following suit, available in powder form from Chinese manufacturers, the DEA said, with a similar price range to xylazine of $10 to $300 per kilogram.
Medetomidine product descriptions from some suppliers guarantee "100% safe custom clearance," and suitable uses include "for research," "animals," and "adults."
As a relatively new adulterant, rapid clinical medetomidine tests aren't available.
The UPMC webinar says comprehensive drug screening can identify medetomidine, but it's "unavailable in nearly all clinical settings."
Stanton said there aren't many reliable blood or urine tests for the veterinary tranquilizer, either.
Testing inadequate
Tracking and testing for the sedative is tricky.
"Part of it is it has a really short half-life," Stanton said.
Half-life is described as the amount of time for a substance to decrease to half of its amount in the body. The City of Philadelphia Department of health said that, when medetomidine is used alone, "peak plasma levels within 10-30 minutes of administration and the elimination half-life is 1.6 hours."
Medetomidine drug testing strips are available. Prices online typically cost around $2 per test, but aren't free through Pennsylvania's Overdose Prevention Program like some other drug testing strips.
Even without large-scale testing available, reports show and health care professionals say they know medetomidine is in the drug supply.
The DEA said medetomidine first emerged in the U.S. drug supply in 2021. Christopher Moraff, founder of PA Groundhogs, said his team found that medetomidine has been in Pennsylvania since 2022 "at least."
"But we discovered the latest push just before that law went into effect scheduling xylazine," Moraff said.
The Philadelphia Department of Health released the health alert about medetomidine adulteration right around that time.
By January of this year, Bill Carver received confirmation the substance made its way into the Lehigh Valley's illicit drug supply. Carver, a public health paramedicine specialist at the Allentown Health Bureau, said the agency sent at least four samples to PA Groundhogs.
In the first week of January, one sample came back positive for medetomidine, he said, and now, "we've had some drug tags come back for medetomidine deaths."
Both Moraff and Carver said they know users "come down and cop here" in Philadelphia and bring it back to the Valley.
"We know that drugs directly flow from Philadelphia to the Lehigh Valley," Carver said. "We know when bad batches hit Philadelphia and we generally have like three days to prepare for it. [Savage Sisters] let us know about [medetomidine] in June of '24 and that's when we started educating our field staff in it being around."
Much like Laurel and Moraff have expressed, of attempting to keep up with the ever-changing drug supply, Carver said: "I couldn't even venture an educated guess" to estimate medetomidine usage in this region.
But he knows it's here and says his team will continue "making an impact on the problem."
Officials, harm reductionists respond
Last month, PA Groundhogs released a joint statement with The PA Harm Reduction Network and The Everywhere Project regarding the potential scheduling of medetomidine.
On May 30, state Sen. Michele Brooks, R-Mercer and chair of the Health and Human Services Committee, announced plans to schedule medetomidine as a Schedule III controlled substance and criminalize possession of the veterinary tranquilizer.
The co-sponsorship memo says: "Medetomidine, a potent non-opioid drug used in veterinary anesthesia for cats and dogs, is up to 200 times more potent than xylazine...
"We must combat the illicit use of medetomidine, while also allowing veterinarians in the commonwealth to legally continue to use the drug for its intended purposes. We appreciate your consideration of cosponsoring this important legislation."
But the joint statement from PA Groundhogs says harm reduction groups "know from experience that scheduling one substance invariably leads to the introduction of new, often more dangerous alternatives to the supply."
The statement also warns that, alternatively, a blanket ban could have even worse consequences, creating a "medical crisis" from those who use and will likely experience "severe and potentially fatal withdrawal syndrome."
"It is our belief that any response to the medetomidine problem should be led by experts in the field, not state lawmakers," the release says.
"We appeal to the legislature to leave medetomidine withdrawal to the professionals with specialized expertise in alpha-2 agonist dependency rather than shifting the burden to a medical ecosystem that is unprepared to deal with the consequences.”
Lehigh County Drug and Alcohol's Stanton said she sees both sides.
While she's not immediately against scheduling an illicit substance, Stanton said it's important to understand how information will be used that comes from scheduling it. Are the intentions behind legislation punitive, or are they to direct more research or funding to address the substance, Stanton asked.
"...It's like that old story: the four blind people with the elephant in the room, and one person thinks it's a rope and the other thinks it's a wall and the other thinks it's a blanket, because they're all touching different parts of the elephant," Stanton said.
"I think that a lot of these perspectives are kind of summed up by that old story. But we need to see the bigger picture. We need to see the whole elephant that's in the room and not just our little slice of it."
OTHER STORIES IN THE SERIES
PART 1: Silent surge: Tranq's rapid rise in Pa. overdose deaths — and the lives it's taking
PART 2: How veterinary sedative xylazine transformed Pa.'s illicit drug supply
PART 3: With tranq, naloxone isn't the antidote it became amid the opioid crisis
PART 4: A step ahead: 'Emerging threat' of tranq pushes suppliers, users to other substances
