People gather in front of the Savage Sisters community outreach storefront in the Kensington neighborhood of Philadelphia. The region is hit hard by medetomidine and xylazine, powerful sedatives most often used by veterinarians that pass through the illicit drug supply, triggering “mass overdoses” and causing horrific skin injuries.
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Public health officials say Mexican cartels and drug gangs in the United States are mixing a dangerous sedative chemical called medetomidine with fentanyl and other drugs sold on the streets. This combination triggered a new wave of overdoses that began in late April and accelerated in May.
“The numbers reported in Philadelphia were 160 hospitalizations over a 3 or 4 day period,” said Alex Krotulski, who runs an organization called NPS Discovery that studies illicit drugs sold in the United States.
Medetomidine, most often used by veterinarians as an animal tranquilizer but also formulated for use in human patients, has also been linked to recent “mass overdose outbreaks” in Chicago and Pittsburgh.
Experts say the chemical, mixed with counterfeit pills and powders sold on the streets, slows human heart rates to dangerous levels. It is impossible for drug addicts to detect it.
Public health advisories have been issued in Illinois and Pennsylvania.
Dr. Brendan Hart of Temple University in Philadelphia says he began hearing reports of street drug users being exposed to the fentanyl-medetomidine mixture in April.
“Some of our emergency doctors started stopping me in the hallway,” Hart told NPR.
“They said, ‘Something funny is happening with overdoses.'” Patients were coming in with very low heart rates, as low as the 20s. A normal heart rate is sixty to one hundred. [beats per minute] so 20 seconds is extremely low.
Laboratory tests of illicit drug samples have come back positive for this powerful sedative, used in some formulations by doctors with human patients, but only in carefully controlled medical settings.
Medetomidine had already been detected in the illicit drug supply as early as 2022, but only rarely and in small quantities. This time, experts say the virus appears to be spreading quickly, with large-scale overdoses also reported earlier this year in Toronto, Canada.
The drug supply in the United States is becoming increasingly toxic
Last year, the Biden administration issued a warning that street fentanyl was being mixed with another tranquilizer used by veterinarians called xylazine. This mix of drugs has led to more overdoses, and many users also suffer terrible bodily injuries that can linger for months or even years.
Medetomidine is even more potent than xylazine, experts told NPR. As it spreads, Krotulski said no one knows what long-term effects this new cocktail of chemicals will have on the health of the human body.
“Patients are being taken care of as we speak in emergency rooms,” he said. “These are very complex drug products. You have fentanyl adulterated with xylazine that now also contains medetomidine.”
Registered nurse Kathy Lalli treats Ellwood Warren’s wounds in the Kensington Hospital wound care van parked in the Kensington neighborhood of Philadelphia, May 23, 2023. In humans, xylazine can cause decreased breathing and heart rate. It is also linked to serious skin ulcers and abscesses, which can lead to infections, tissue rot and amputations. Experts disagree on the exact cause of the injuries, which are much deeper than those seen with other injection drugs.
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The presence of these chemical additives greatly complicates the medical response to high-risk overdoses.
Xylazine and medetomidine do not respond to naloxone, the drug used to reverse most fentanyl overdoses. There is currently no way for street users to know if their drugs contain this chemical.
Dr. Bertha Madras, a drug researcher at Harvard Medical School and McLean Hospital, said it’s unclear why drug gangs are mixing these new chemicals with fentanyl. Some experts believe sedatives can prolong the effect of opioids, making the drugs more desirable on the streets.
According to Madras, there is an urgent need for first responders and emergency services to be prepared to treat overdoses complicated by heart conditions triggered by medetomidine.
She also thinks drug users need to be warned that illicit pills and powders are more dangerous than ever.
“It is essential to alert street users,” Madras said. “They are now playing Russian roulette with the drug supply.”
Madras said experts are also working to understand where medetomidine appearing on U.S. streets is coming from.
It is not yet clear whether the sedative is illegally diverted from veterinary supplies or medications intended for use in hospitals and clinics.
It is also possible that drug gangs are manufacturing their own medetomidine compounds from illegally acquired precursor chemicals.
Evolution of street drug supply goes beyond public health and law enforcement
Madras said Mexican cartels and U.S. drug gangs are moving quickly to create new combinations of powerful synthetic drugs, often using chemicals like medetomidine that are not yet regulated or closely controlled by U.S. law.
She said it was nearly impossible for U.S. law enforcement and public health to keep up.
“There is an almost infinite supply of new psychoactive substances and there are literally thousands and thousands of drugs that can be manufactured,” she said.
Experts say the decision to experiment with xylazine, medetomidine or other chemicals in illicit combinations of illicit drugs likely reflects the cheap, poorly regulated and readily available substances.
Some critics, including Dr. Jeffrey Singer, a drug policy analyst at the libertarian Cato Institute, believe that law enforcement efforts to regulate chemicals used in illicit drugs actually encourage cartels to experiment with more readily available and potentially more harmful substances, including medetomidine.
“Law enforcement is increasingly working to crack down on xylazine,” Singer said. “If drug trafficking organizations want to add a sedative [to their street drug mixes] They can always add medetomidine. »
Singer believes that banning synthetic drugs is so difficult that U.S. policymakers should focus resources on helping drug users find medical treatment instead of funding more law enforcement efforts.
Efforts to tightly regulate medetomidine could be complicated by the fact that a version of the sedative called dexmedetomidine is widely used by doctors as well as veterinarians.
“This medicine is used everywhere throughout life, since [neonatal intensive care units] to put babies to sleep who need to be on a ventilator, for elderly patients who can’t breathe on their own,” said Dr. Nabarun Dasgupta, a street drug expert at the University of North Carolina at Chapel Hill.
“[Restricting access to] Medetomidine like xylazine or even fentanyl will have a major impact on every hospital in the country,” he said.
Fatal overdoses in the United States fell 3 percent last year, but about 107,000 people still died in the United States after using illicit drugs.
Drug addiction experts fear that modest progress in saving lives of drug users could be reversed as more toxic chemicals like medetomidine and xylazine hit the streets.