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January 28, 2026Emergency doctors in Baltimore are wary of a new additive to street fentanyl that can complicate overdose treatment and prompt severe withdrawal symptoms. A November article in the Journal of the American Medical Association says the veterinary sedative and painkiller medetomidine has become prevalent in drugs sold in Philadelphia and local doctors fear it will begin to spike in Baltimore next. It has already been seen in other cities throughout the Eastern and Midwestern United States. It has created a new type of drug crisis — one that is occasioned not by overdosing on the drug, but by withdrawing from it. It causes almost instantaneous blackouts and, if not used every few hours, brings on life-threatening withdrawal symptoms. “Reports out of Philadelphia are pretty bad,” an emergency physician at the University of Maryland Medical Center, told The Baltimore Sun. “They have developed and published treatment protocols we can use.” The problem is that additives like medetomidine and another veterinary tranquilizer, xylazine, have no antidotes. “When a patient comes in with an overdose, we don’t always know what we’re treating,” he said. “The signs of opiate overdose are pretty recognizable, and we have the reversal drug naloxone. There is no reversal drug for xylazine or medetomidine. All we can do is provide supportive care and hope they get better.” Medetomidine overrides the body’s survival instinct to keep breathing, as well as working on the brain and blood vessels to cause fluctuating blood pressure, further complicating treatment. There is no routine test for medetomidine, although test strips are available for xylazine. The drug also has extreme withdrawal symptoms, according to news reports, which can show up within a few hours. Symptoms include high heart rates and blood pressure, vomiting and nausea and tremors, which often returns the user to the emergency room. Since the middle of last year, Philadelphia’s hospitals have been strained by patients coming in with what doctors have identified as medetomidine withdrawal. Although the heart rate slows drastically right after use, in withdrawal the opposite occurs: The heart rate and blood pressure become catastrophically high. The very high blood pressure can cause brain damage. Patients experience tremors and unstoppable vomiting. Many require intensive care. From a drug dealer’s grimly economic perspective, medetomidine is a smart choice. It is mostly manufactured in China and can be purchased cheaply online from suppliers of veterinary medicine and research chemicals. It is so addictive that dealers don’t need to mix much into fentanyl. It has been detected in 91 percent of the city’s tested supplies of fentanyl. Here are the links: Horse sedative appearing in fentanyl brings severe withdrawalA Powerful New Drug Is Creating a ‘Withdrawal Crisis’ in Philadelphia - The New York Times