North Carolina health officials are warning providers about medetomidine, a veterinary tranquilizer that is increasingly appearing in the state’s illegal drug supply, NC Health News reported Aug. 17.
The North Carolina Department of Health and Human Services sent a provider alert June 8 flagging medetomidine and other emerging substances. Medetomidine overtook xylazine in prevalence in the illegal drug supply earlier this year, according to UNC Street Drug Analysis Lab data.
Here are five things to know:
1. Medetomidine is increasingly showing up in the drug supply. The substance first appeared in UNC Street Drug Analysis Lab data in 2022, with its prevalence beginning to climb in the summer of 2024. The North Carolina Harm Reduction Coalition is also seeing medetomidine in drug samples analyzed in the Triangle area, which includes Raleigh, Durham, and Chapel Hill.
2. Withdrawal can require hospital care. Medetomidine withdrawal symptoms can start within hours of last use and can trigger cardiac problems severe enough to require hospitalization. Nabarun Dasgupta, director of the UNC Street Drug Analysis Lab, called medetomidine withdrawal a “nightmare” that can lead to a weekslong stay in an intensive care unit during March 26, 2026, testimony before Congress.
3. The nation’s illegal drug supply is changing rapidly. The UNC Street Drug Analysis Lab has detected 536 unique substances from more than 23,000 submissions. Over the past three years, the lab began detecting a significant amount of xylazine in the illegal drug supply, but medetomidine overtook xylazine in prevalence earlier this year. The lab has detected medetomidine since 2022, with its prevalence beginning to climb in the summer of 2024.
4. Federal policy has shifted away from some harm reduction measures. The Substance Abuse and Mental Health Services Administration issued a letter earlier this year banning the use of SAMHSA grant funds for testing strips. The move is part of the Trump administration’s step back from harm reduction, according to the report. The administration has discouraged interventions such as test strips, arguing they enable illegal drug use. Medetomidine test strips cost about $200 for a box of 100, compared with about $35 for a box of 100 fentanyl test strips. The North Carolina Harm Reduction Coalition sees more than 5,000 people a year.
5. Scheduling medetomidine could complicate its medical use. Substance use experts warned against responding to medetomidine by placing it under tighter controlled-substance restrictions. Nabarun Dasgupta, director of the UNC Street Drug Lab, pointed to Precedex, the human medicine counterpart of medetomidine, which is used in hospitals for sedation. He said scheduling medetomidine too restrictively could be “massively disruptive to human medicine.” Dasgupta also noted that after Pennsylvania added xylazine as a Schedule III substance in May 2024, medetomidine began replacing xylazine in the illicit drug supply.
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