An effort to criminalize possession of medetomidine, a powerful veterinary sedative increasingly adulterating the fentanyl being sold on the streets of Philadelphia, is getting underway in Harrisburg. But critics such a law may cause more harm than good.
State Sens. Michele Brooks (R-50) and Doug Mastriano (R-33) plan to introduce legislation that would make medetomidine a controlled substance, just like Pennsylvania did last year with xylazine – another veterinary sedative used to cut illicit drugs.
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Efforts to regulate chemicals used in street drugs cause cartels and drug suppliers to experiment with substitutes – and often more harmful ones, critics say. And with so many people now dependent on medetomidine in Philadelphia – and because of the often rapid onset and severity of its withdrawal symptoms – scheduling the chemical would have "ominous consequences," said a joint-statement Tuesday from leaders of PA Groundhogs, a statewide street-to-lab drug checking program, the PA Harm Reduction Network and The Everywhere Project.
"The sudden disappearance of medetomidine from the fentanyl supply has the potential to cause a widespread medical crisis as consumers of illicit opioids are forced to detox from medetomidine cold turkey, or under the care of physicians who are only now becoming aware of just how dangerous that can be," the statement read.
The Philadelphia Department of Public Health issued an alert in May 2024 about the detection of medetomidine in illicit drugs and the medical complications posed by the veterinary tranquilizer, which is about 200 times more potent than xylazine.
Last month, the Centers for Disease Control and Prevention published a report by researchers from Penn Medicine, Jefferson Health and Temple Health stating that medetomidine has replaced xylazine as the most common drug adulterant in Philadelphia. The report described the "life-threatening withdrawal syndrome" that medetomidine causes, requiring "substantial escalations in care compared with the typical opioid and xylazine withdrawal syndromes."
In recent weeks, Thomas Jefferson University Hospital's emergency department has seen a significant increase in the volume of patients presenting for complications due to opioid withdrawal involving medetomidine. The severity of withdrawal symptoms has worsened to include intractable vomiting, severe cardiac symptoms, full-body tremors and crippling anxiety, said Dr. Phil Durney, an internal and addiction medicine doctor and the in-patient lead of Jefferson's addiction consult team.
Clinicians at Jefferson Health, Penn Medicine and Temple Health have been meeting regularly to share information about what they are seeing in their emergency departments and what is helping patients who seem to be in medetomidine withdrawal. For some patients, even "maximal doses of infusions of medicines that would put somebody three times their size into a profound coma" aren't easing severe withdrawal symptoms, said Dr. Kory London, an emergency medicine physician at Jefferson Health.
Other patients are catatonic, so clinicians are having to make treatment plans without being able to have conversations with them. And because of the shifting and poly-chemical nature of the city's street drugs, people who use them often don't know what they are getting, Durney said.
Jefferson clinicians, along with members of Jefferson University's chemistry department, have developed a test that picks up metabolites of medetomidine broken down and excreted in urine. They have been using the urine test to detect the presence of medetomidine in people's systems and will be publishing their research, London said.
PA Groundhogs first detected medetomidine in street samples of fentanyl in Philadelphia and Pittsburgh in April 2024, one month before Gov. Josh Shapiro signed legislation making xylazine a schedule III drug under the Controlled Substances Act. Over the next nine months, medetomidine "all but replaced xylazine as the cutting agent of choice by drug sellers," according to the joint statement from PA Groundhogs and others.
Medetomidine has been detected in 89% of illicit fentanyl samples PA Groundhogs has tested since January, the statement said.
"At best, reactionary scheduling amounts to an endless game of 'whack-a-mole' that fails to account for the historic resiliency of illicit drug markets and creates a more hostile environment for people who use drugs, and individuals who work in the field of substance use — including researchers, doctors, treatment providers, and other professionals," the statement said.
