BALTIMORE, MD (June 9, 2026) — Public health officials across Maryland are warning of an ongoing threat from medetomidine, a potent veterinary sedative detected in the illicit drug supply in the United States. It has been identified in the Maryland illicit drug supply since July 2022. According to the Maryland Department of Health’s Rapid Analysis of Drugs Quarter 4 Newsletter, medetomidine has been primarily seen in Cecil County due to its proximity to Philadelphia. But samples have also shown an increased presence in Baltimore City, Harford, St. Mary’s, and Wicomico Counties. Medetomidine was found in samples tested from the area of the overdose cluster in the Penn-North neighborhood of Baltimore City on October 8th.
Medetomidine is not approved for human use and poses significant health risks as it can result in prolonged sedation and severe withdrawal, especially when combined with opioids or other central nervous system depressants. Medetomidine exposure often requires hospitalization.
Background
Medetomidine is an alpha-2 adrenergic agonist primarily used in veterinary medicine for sedation and anesthesia. Its appearance in illicit drug samples — often mixed with fentanyl, xylazine, or other substances — raises concerns about increased risk of respiratory depression, bradycardia, hypotension, profound sedation, and death. Withdrawal from medetomidine can also be extremely severe, sometimes requiring hospitalization and care in an intensive care unit.
Standard doses of naloxone will reverse the effects of opioids that may be mixed into but will not counteract medetomidine’s sedative properties, complicating overdose response.
Medetomidine is not associated with xylazine-type necrotic wounds.
Health Risks and Clinical Considerations
Ingestion of medetomidine can cause:
- Severe sedation and unresponsiveness: Individuals exposed to medetomidine may present with deep sedation, hypotension, bradycardia, or respiratory compromise.
- Prolonged effects: Sedation may persist significantly longer than opioid effects, even after naloxone administration.
- Early and severe withdrawal syndrome: Reports from places such as Philadelphia have identified withdrawal from medetomidine as distinct from that of fentanyl or xylazine and associated with severe hypertension, tachycardia, and vomiting, often requiring intensive care unit management.
- Polysubstance risk: Co-administration with opioids, xylazine, or other depressants increases the likelihood of fatal outcomes.
Recommendations for Clinicians and First Responders
- Check for breathing, then responsiveness as medetomidine may leave people sedated but breathing adequately.
- Continue to administer naloxone during suspected overdoses, as opioids are often co-present. Use the lowest effective dose to restore breathing and expect persistent sedation even after reversal. Administration of naloxone is not expected to trigger medetomidine withdrawal given that medetomidine does not work on the opioid receptor.
- Monitor vital signs closely and prepare for supportive care, including airway management and advanced cardiac life support if needed.
- Communicate the potential for severe withdrawal from medetomidine and the prolonged sedation risks to patients and caregivers, even after overdose reversal.
- Consider additional toxicology testing in unexplained sedative presentations, particularly when xylazine or other non-opioid sedatives are suspected.
Maryland Addiction Consultation Services (MACS) will be hosting a training on Medetomidine Intoxication and Withdrawal on Monday, June 22 | 12 p.m. – 1:00 p.m. Click here to sign up.
What Community Partners Should Know
- Carry naloxone and use it for any suspected opioid overdose; expect sedation to linger and watch breathing.
- Avoid using alone; consider drug checking where available.
- Seek care early if severe vomiting, pounding headache, chest pain, confusion, or marked BP/HR changes appear after use.
- Wounds: Medetomidine has not been linked to xylazine-type wounds; decreasing wound presentations have been observed where medetomidine use rose
- Test Strips: Programs registered as Overdose Response Programs, ORPs, can order medetomidine test strips (MTS).
Reporting and Surveillance
The Maryland Rapid Analysis of Drugs (RAD) is a state-wide drug checking program available to Maryland Opioid–Associated Disease Prevention and Outreach Program (OADPOP) participants. RAD allows participants to have their routinely returned paraphernalia sampled and submitted to the National Institute of Standards and Technology (NIST). SSP staff provide the participant’s results back to them, typically within a week. This type of post-use drug checking achieves the following goals:
- Improve the understanding of the Maryland drug market landscape
- Empower people who use drugs with knowledge about the drug supply to help inform their decisions and reduce risk
- Provide critical information about new and emerging trends in the drug supply
To find a participating OADPOP near you, visit: https://health.maryland.gov/pha/NALOXONE/Pages/RAD.aspx
