People gather outside the Savage Sisters Community Outreach store in Philadelphia’s Kensington neighborhood. The region has been hit hard by medetomidine and xylazine, two powerful sedatives most commonly used by vets, which trigger “mass overdoses” and cause horrific skin wounds through the illicit drug supply.
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Public health officials say Mexican cartels and drug cartels in the United States are mixing a dangerous chemical sedative called medetomidine into fentanyl and other drugs sold on the street. The combination triggered a new wave of overdoses that began in late April and accelerated in May.
“Philadelphia reported 160 hospitalizations over three to four days,” said Alex Krotulski, a group that studies illegal drugs sold in the United States. NPS Discovery
Medetomidine is most commonly used by veterinarians as an animal tranquilizer but has also been formulated for use in human patients and has been linked to recent “mass overdose outbreaks” in Chicago and Pittsburgh.
Experts say the chemical, which is mixed into counterfeit pills and powders sold on the street, can slow a person’s heart rate to dangerous levels. It’s impossible for a drug addict to notice.
Illinois and Pennsylvania have issued public health advisories.
Dr. Brendan Hart of Temple University in Philadelphia said they began hearing reports of street drug users being exposed to fentanyl-medetomidine mixtures for the first time in April.
“Some of our emergency physicians started stopping me in the hallway,” Hart told NPR.
“They said ‘Something funny happened with the overdose.’ The patient came in with a very low heart rate, a normal heart rate is 60 to 100. [beats per minute] So mid-20s is very low.
Laboratory tests of street drug samples came back positive for the powerful sedative, which doctors use in certain formulations to treat human patients, but only in tightly controlled medical settings.
As early as 2022, medetomidine was discovered in the illicit drug supply, but in low and low quantities. Experts say it appears to be spreading rapidly this time, with mass overdoses also reported in Toronto, Canada, earlier this year.
America’s drug supply becomes more toxic
Last year, the Biden administration issued a warning that street fentanyl was being mixed with another tranquilizer called xylazine used by veterinarians. This combination of drugs led to more overdoses, and many users also experienced horrific flesh wounds that could last for months or years.
Experts tell NPR that medetomidine is more effective than xylazine. As it spreads, no one knows what long-term health effects the new chemical cocktail will have on humans, Kroturski said.
“As we speak in the emergency room, patients are being treated,” he said. “These are very complex drugs. Fentanyl is laced with xylazine and now medetomidine.”
Registered nurse Kathy Lalli treats Ellwood Warren’s injuries on a Kensington Hospital wound care outreach truck parked in the Kensington neighborhood of Philadelphia on May 23, 2023. . It is also associated with severe skin ulcers and abscesses, leading to infection, tissue decay, and amputation. Experts disagree on the exact cause of the wounds, which are deeper than those seen with other injectable drugs.
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The presence of these chemical additives seriously complicates the medical response to high-risk overdoses.
Xylazine and medetomidine do not respond to naloxone, the drug used to reverse most fentanyl overdoses. Currently, street users have no way of knowing when their drugs contain the chemical.
Dr. Bertha Madras, a drug researcher at Harvard Medical School and McLean Hospital, said it’s unclear why drug cartels mixed these new chemicals with fentanyl. Some experts believe sedatives may prolong the high period of opioids, making the drugs more popular on the streets.
Madras said first responders and emergency rooms must be prepared to treat overdoses complicated by heart attacks caused by medetomidine.
She also believes drug users need to be warned that illicit pills and powders are more dangerous than ever.
“Alerting street users is critical,” Madras said. “They are now playing Russian roulette with the drug supply.”
Madras said experts are still working to understand the origins of medetomidine on U.S. streets.
It is unclear whether the sedative was illegally diverted from veterinary supplies or drugs used in hospitals and clinics.
It is also possible that drug cartels formulate their own medetomidine compounds from illegally obtained precursor chemicals.
Changes in street drug supply outpace public health and law enforcement
Madras said Mexican cartels and U.S. drug cartels are moving quickly to create new combinations of powerful synthetic drugs, often using chemicals such as medetomidine that are not yet regulated or tightly controlled by U.S. law.
She said it would be nearly impossible for U.S. law enforcement and public health to keep up.
“The supply of new psychoactive substances is almost endless, and literally thousands of drugs can be made,” she said.
Experts say the decision to experiment with xylazine, medetomidine or other chemicals in the illicit street drug mix may reflect which substances are cheap, poorly regulated and easily available.
Some critics, including Dr. Jeffrey Singer, a drug policy analyst at the libertarian Cato Institute, argue that law enforcement efforts aimed at regulating chemicals used in street drugs actually encourage drug cartels to try to make them more readily available substances, but these may be more harmful, including medetomidine.
“Law enforcement is working increasingly hard to combat xylazine,” Singer said. “If a drug trafficking organization is interested in adding sedatives [to their street drug mixes] They can always add medetomidine.
Singer argued that intercepting synthetic drugs is difficult and that U.S. policymakers should focus resources on helping drug users seek medical treatment rather than funding more law enforcement efforts.
Efforts to strictly regulate medetomidine may be complicated by the widespread use of a sedative called dexmedetomidine by doctors and veterinarians.
“This drug is used throughout a person’s life, from [neonatal intensive care units] “Sedatives are given to infants who require respirators and to elderly patients who cannot 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 and even fentanyl are going to have a significant impact on every hospital across the country,” he said.
Drug overdose deaths in the United States fell 3 percent last year, but about 107,000 people still died from street drug use.
Addiction experts worry that modest gains in saving the lives of addicts could be reversed as more toxic chemicals like medetomidine and xylazine hit the streets.
