Possible New Illicit Drug

News outlets are describing a new illicit drug being sold on the street, often with fentanyl, named medetomidine, and its mirror-image molecule, dexmedetomidine, or “dex.”

Medetomidine is a synthetic medication that is an alpha-2-adrenergic agonist, meaning the medication stimulates the alpha-2-adrenergic receptors found in the brain. This produces effects of anesthesia, analgesia, and sedation. One form of medetomidine, called dexmedetomidine, is used in pediatric and adult medicine in the U.S. under the brand name Precedex. Medetomidine is also used in veterinary medicine.

Precedex is often used around the time of surgeries or medical procedures, to sedate patients. Product information from the drug company that makes Precedex says the medication can cause low blood pressure and slow heart rate, along with sedation, and recommends a patient receiving this medication have continuous monitoring of heart rate, blood pressure, and oxygen level. This information warns that opioids can intensify the sedation from dexmedetomidine.

Atipamezole is a medication that works as an antagonist at the alpha-2 receptors and is used to reverse the sedating effects of dexmedetomidine. It is unknown if this medication would serve as an antidote for overdoses of medetomidine and fentanyl or other opioids. Narcan does not reverse the effect of dexmedetomidine, because it has no action at any of the opioid receptor types.

Xylazine is also an alpha-2-adrenergic receptor agonist, but medetomidine is much more potent than xylazine. Xylazine has been found already in the nation’s illicit drug supply and is frequently found in drugs sold as fentanyl.

In the past I’ve been appalled by traditional news reports of new drug threats. Often, they exaggerate how severe or widespread the threat is. Non-scientific news outlets use lurid descriptions of the effects of new drugs. Does anyone remember descriptions of users of synthetic cathinones, also known as bath salts, or “flacca”? Eight or so years ago, reports blamed the drug for causing a user in Florida to eat the faces of several people, calling it the “cannibal” drug. Xylazine, also an alpha-2-adrenergic agonist, has been called the “zombie” drug. So has desomorphine, also known as Krokadil, which seemed to have been mostly limited to Russia, despite frightening reports from news outlets in the U.S.

We don’t need exaggerated or lurid claims about any drug of use. This dilutes credibility at a time when we need accurate data to help keep people alive.

To get the best and most up-to-date information for my state of North Carolina, I contacted UNC’s Street Drug Analysis Lab. Their website is: https://www.streetsafe.supply/results

This wonderful organization is a public service of UNC Chapel Hill and offers testing of street drugs. They serve drug users unions, harm reduction organizations, clinics, and health departments. Law enforcement is NOT allowed to use their services. The tests are free to some non-profit organizations but agencies or individuals who send in larger volumes of samples for testing may be charged a fee.

This is high-quality testing, using GC/MS (gas chromatography/mass spectrophotometry). One of their goals is to inform people about what is in the drug supply now. Samples sent to this organization are assigned a code, and the person sending the sample can go to the website, input their code, and results of their sample are on the website.

So much data in the field of addiction medicine takes time to collect and analyze, so it’s valuable to have data available so quickly.

I invite readers to go to UNC’s Street Safe website and click on the sample analyses sent in anonymously, to get an idea of what’s presently being sold on the streets.

I communicated with Dr. Nabarun Dasgupta, UNC Street Safe’s senior scientist, and asked how many drug samples he’s found that contain medetomidine. He said he’s found it in only a handful of samples.  It was first detected in October of 2022, in a sample that also contained fentanyl, methamphetamine, and xylazine. He has a grant to continue monitoring for medetomidine and other new drugs in the future.

The bottom line for our patients and for people using drugs is that what’s being sold as fentanyl may also contain sedatives like the alpha-2-adrenergic agonists xylazine or medetomidine, and possibly some other stuff like methamphetamines. The drugs may be more sedating than expected, which emphasizes the importance of NOT using alone and having Narcan available. Though Narcan won’t reverse medetomidine, it will reverse fentanyl or other opioids.

This class of drugs, the alpha-2-adrenergic agonists, may cause bigger problems in the future. I plan to stay tuned to scientists like Dr. Dasgupta to get accurate and up to date information.