Addiction Society Releases First Guidance on Medetomidine Withdrawal
The American Society of Addiction Medicine this week issued the first national clinical guidance for recognising and treating patients exposed to medetomidine, a veterinary sedative detected in illicit drug supplies across at least 18 U.S. states by the end of 2025, according to STAT. Because larger studies have not yet validated clinicians' bedside observations, the document is technically framed as clinical considerations rather than formal guidelines, STAT reported.
Emergence and Severe Withdrawal Symptoms
Jeanmarie Perrone, an emergency medicine physician at Penn Medicine and co-author of the document, said patients first develop nausea and vomiting without the diarrhea typical of opioid withdrawal. Perrone said clinicians recommend the alpha-2 agonist clonidine first, while patients who do not respond or cannot keep oral medication down can develop very high blood pressure and rapid heart rates within hours, potentially requiring intravenous dexmedetomidine, known as Precedex.
ICU Demands and Research Gaps
Thomas Jefferson University addiction specialist and emergency physician Kory London said withdrawal from medetomidine can require intensive care unit admission and doses of clonidine and dexmedetomidine he would not have used five years ago for xylazine. Because medetomidine is nearly always mixed with illicit opioids, naloxone remains the first emergency step during an overdose even though patients may stay sedated once breathing resumes, while acute low heart rate and blood pressure can be managed with IV fluids, the guidance noted. Michael Lynch, a medical toxicologist at the University of Pittsburgh Medical Center and co-author, emphasised that doctors need to know whether medetomidine is in their local supply because symptoms can mimic conditions such as sepsis, noting that drug testing strips are available. London added that some patients on opioid use disorder medications continue experiencing cravings driven by medetomidine, calling for urgent research into alpha-2 agonist sedative addiction. ASAM's guidance states that patients stabilized in the hospital can transfer to an ASAM Criteria Level 3.7 Medically Managed Residential program and notes it is essential for Medicare, Medicaid, and other payers to cover this level of care, according to Psychiatric Times.
Background
ASAM scheduled a 60-minute live clinician webinar on the Medetomidine Intoxication and Withdrawal clinical considerations for December 1, 2026, according to American Society of Addiction Medicine.
During July–December 2025, 10 of 20 CDC OD2A and NIST RaDAR sentinel sites detected medetomidine in almost 35% of opioid-positive samples, according to Centers for Disease Control and Prevention (CDC HAN-00527).
By late July 2024, medetomidine had been detected in drug samples and biological specimens in at least 18 U.S. states and the District of Columbia, according to Centers for Disease Control and Prevention (CDC HAN-00527).