Severe Fentanyl Withdrawal Associated With Medetomidine Adulteration: A Multicenter Study From Philadelphia, PASevere Fentanyl Withdrawal Associated With Medetomidine Adulteration: A Multicenter Study From Philadelphia, PA
Addiction Medicine: Beyond the Abstract
Clinicians from Philadelphia discuss severe fentanyl withdrawal linked to medetomidine adulteration, outlining its distinctive clinical picture, system pressures, and emerging treatment strategies. They also reflect on multidisciplinary care and offer advice for those entering addiction medicine.
23:36•14 May 2026
Severe Fentanyl Withdrawal and Medetomidine: Clinicians Confront a New ICU-Level Crisis
Episode Overview
- Medetomidine, a highly potent veterinary alpha‑2 agonist, has entered the fentanyl supply and is linked to a rapid, severe, and distinct withdrawal syndrome.
- Patients may present with extreme hypertension, tachycardia, severe vomiting, encephalopathy, and organ injury, with a high proportion requiring ICU admission.
- Previously effective protocols for opioid and xylazine withdrawal often fail in medetomidine-associated cases, demanding earlier and more aggressive treatment.
- Hospitals benefit from coordinated, multidisciplinary approaches, including shared protocols, order sets, and strong collaboration across nursing, pharmacy, and medical teams.
- For clinicians entering addiction medicine, building multidisciplinary teams and engaging in advocacy and systems-level work can be as crucial as bedside medical care.
“We were very ineffective at treating it. And it markedly worsened the hospital experience for patients, both because they were in agony and because all the healthcare workers… were ineffective.”
What can we learn from those who have battled addiction? This episode of Addiction Medicine: Beyond the Abstract zooms in on a fast-changing and frightening part of the opioid crisis: medetomidine turning up in the fentanyl supply. Journal Podcast Editor Shawn McNeil, MD chats with Dr. Corey London, an emergency physician and operations lead in Philadelphia, and Dr. Phil Durney, an internal medicine and addiction medicine specialist.
Together, they talk through their multicentre study, "Severe Fentanyl Withdrawal Associated With Medetomidine Adulteration," and share what they’re seeing on the ground. You’ll hear them explain what medetomidine is – an extremely potent veterinary alpha‑2 agonist – and why its arrival is such a problem.
Compared with earlier adulterants like xylazine, medetomidine is far stronger and triggers a withdrawal picture that is, in their words, “really a decompensated, kind of unprecedented novel withdrawal syndrome.” Patients can show blood pressures near 200, heart rates in the 140s–160s, severe vomiting, confusion, and signs of organ injury, with about 77% in their series needing ICU care.
They talk frankly about how standard pathways using opioids, ketamine, gabapentin and other alpha‑2 agonists “just stopped working,” forcing teams across Philadelphia hospitals to rapidly rethink protocols. There’s a strong focus on early recognition, aggressive treatment, and building hospital-wide systems – from order sets to nursing and pharmacy coordination – so care can happen quickly enough. Towards the end, the conversation shifts to career advice for budding addiction medicine clinicians.
Both guests highlight the value of multidisciplinary teams, community work, and the “wonderful and warm and welcoming” culture within addiction medicine. If you’re interested in how science, systems, and compassion intersect in the opioid crisis, this episode gives you a clear look at a new clinical challenge and how teams are responding. So, how might your own service prepare if medetomidine shows up in your local drug supply?
Do you want to link to this podcast?
Get the buttons here!
More From This Show
The latest episodes from the same podcast.
Related Episodes
Similar episodes from other shows in the catalogue.