By Dr. Michael Frost, Chief Medical Officer, Wayspring
A new trend is complicating the overdose crisis: the increasing appearance of medetomidine, a veterinary tranquilizer now appearing in illicit drug supplies across the U.S.
According to a 2024 CDC report, medetomidine was first detected in street opioids in 2022. It’s now appearing more frequently as a component of the illicit opioid supply, substantially increasing the risk of overdose and withdrawal. While xylazine received national attention for its role in overdose deaths and skin ulcerations, medetomidine is now more dominant in some regions as well as more potent and more sedating (PMC article).
For health plans, this emerging trend is more than a clinical curiosity. It represents a growing concern for member safety, care continuity, and progress toward better outcomes.
What Is Medetomidine, and Why Is It Dangerous?
Medetomidine is an alpha-2 adrenergic agonist, similar to xylazine. It causes profound sedation, bradycardia (extremely slow heart rate), and hypotension (low blood pressure). Unlike opioids, its effects are not reversed by naloxone, which makes overdose response more complex. That said, naloxone should still be administered to reverse the effects of fentanyl, which is commonly present. Respiratory support and emergency medical attention remain critical.
Because medetomidine is not federally scheduled, it is relatively easy to access and is now being used as a substitute for xylazine in fentanyl supplies. In Maryland, it was found in more than 8% of drug samples by late 2024 (Maryland Matters, 2025). In other states like Delaware and Pennsylvania, the prevalence is even higher.
In overdose situations, members may present with extreme sedation or unconsciousness even after naloxone is administered. Emergency departments have reported heart rates in the 20s among medetomidine-exposed patients. In one Philadelphia outbreak, over 160 hospitalizations occurred in just a few days due to fentanyl-medetomidine combinations (NPR, 2024).
Withdrawal also presents new challenges. Symptoms may develop more rapidly than fentanyl withdrawal, intensifying over 24–48 hours and lasting up to 7 days without treatment. If withdrawal symptoms appear within 48 hours of last opioid use, clinicians should suspect medetomidine or xylazine. Proactive management of withdrawal is essential: common medications like clonidine are helpful in managing symptoms. Withdrawal due to fentanyl will usually appear later and is effectively addressed with buprenorphine or methadone.
For health plans, ensuring provider networks are aware of and equipped to manage these scenarios is critical—especially in regions where prevalence is rising.
Implications for Vulnerable Populations
People with substance use disorder (SUD) are already at high risk for overdose, and the introduction of medetomidine into the illicit supply only amplifies that risk—particularly for Medicaid populations who often face significant barriers to care, such as lack of transportation and limited phone access.
Because withdrawal symptoms from medetomidine can escalate quickly, timely intervention is critical. But for members who struggle to stay connected to providers, even identifying and managing those symptoms becomes more difficult. This increases the likelihood of emergency department utilization, missed care opportunities, and disrupted recovery efforts.
How Wayspring Is Responding
Our model is designed to support individuals who fall through the cracks—and that includes responding to trends like this with speed and precision.
Here’s how we’re adapting:
- Member Education and Harm Reduction: We proactively educate members about the growing presence of medetomidine in the illicit drug supply its effects and what to do in overdose or withdrawal situations.
- Clinical Team Training: Our care teams are trained to recognize the signs of medetomidine-involved overdoses, including unresponsiveness after naloxone and dangerously low heart rates. They understand when to escalate to emergency services and how to support members through medetomidine-related withdrawal.
- Provider Education: We work closely with providers to raise awareness about medetomidine exposure, including how it presents in overdose and withdrawal. We emphasize the importance of early recognition, timely symptom management, and adapting care protocols to meet the needs of members exposed to non-opioid sedatives.
- Trend Monitoring and Early Detection: We monitor member data alongside local and national reports to track the prevalence of medetomidine. When signs of increased exposure emerge, we act quickly—adjusting outreach strategies, informing care teams, and collaborating with health plan partners to ensure system-wide awareness and readiness.
Why Health Plans Should Pay Attention
This isn’t just about a new drug. It’s about a changing overdose landscape that requires new strategies from all stakeholders—including payers.
- Increased complexity for facilities: Many facilities may find these cases more challenging to manage, requiring additional clinical expertise, longer observation periods, and greater resource allocation.
- Rising emergency care costs: Overdoses involving medetomidine can lead to more severe symptoms, extended hospitalizations, and greater downstream needs.
- Greater challenges for care continuity: When members don’t respond to expected interventions, trust and engagement can suffer.
The good news: health plans don’t have to address this alone.
Wayspring is built for the reality of SUD care. That means we’re prepared to navigate uncertainty, respond quickly, and adapt as new challenges emerge. We partner with health plans to close care gaps before they widen—and move swiftly when emerging threats like medetomidine put members at risk.
Moving Forward
The emergence of medetomidine is a wake-up call. As the drug supply changes, our collective approach to overdose prevention must change with it.
At Wayspring, we’re committed to sharing frontline insights, adapting our model to meet evolving risks, and helping our partners implement smarter, more responsive strategies. Because when the landscape shifts, staying ahead requires more than awareness—it demands action.