MEDETOMIDINE: New 'Frankenstein Opiates' Found In Illegal Drug Supply Across America, Canada, and Europe
"Frankenstein Opiates" are emerging in major cities, sparking alarm within the medical community over how to address this growing epidemic claiming numerous lives.
Yet another synthetic drug is sweeping the country, said to be 100 times more potent than that of xylazine often referred to as the street drug Tranq. Medetomidine, an anesthetic and analgesic commonly used in veterinary surgeries has recently been found as an additive in drugs such as heroin, fentanyl, and occasionally even cocaine and methamphetamine. Medetomidine, like xylazine when married to illicit drugs is also nicknamed Tranq.
According to a recent article from NPR, “Mexican cartels and drug gangs inside the U.S. are mixing a dangerous chemical sedative called medetomidine into fentanyl and other drugs sold on the street. The combination triggered a new wave of overdoses that began in late April and have accelerated in May.”
These “Frankenstein Opiates” that contain medetomidine and xylazine share numerous similarities. Both medetomidine and xylazine enhance the effects of any illicit drug it is mixed with, leading to a more intense and prolonged high for the user.
Regular fentanyl and heroin users often remain unaware that their drugs are laced with these potent adulterants until they experience a notably more calming euphoria than usual. Opioids attach to receptors in the brain causing depression of the central nervous system which can result in respiratory depression and decreased heart rate. These effects can be deadly when combined with sedatives such as medetomidine or xylazine.
Xylazine and medetomidine are considered non-opiate sedatives used in a veterinary setting for surgical procedures on animals and are not meant for human consumption. Since medetomidine is from the same benzimidazole family as xylazine, they both can cause similar side effects such as hypotension, hyperglycemia, hallucinations, and bradycardia.
Due to the lack of documented human studies on the effects of these alpha-two agonists, there is very little data currently available. This presents a significant challenge for doctors treating patients who have unknowingly ingested the animal tranquilizers. There are instances where certain ER technicians lack awareness about the need to screen for medetomidine or xylazine when attending to a patient displaying overdose symptoms. Typical methods to reverse opiate overdoses are ineffective. Naloxone (Narcan) and other medications used to treat opioid overdoses target opioid consumption in patients but do not affect sedatives. As of now, there is no known reversal if one is experiencing an overdose due to one of the additives being present in the body.
Dexmedetomidine (brand name: PRECEDEX) is a medication distinct from medetomidine, though chemically related. It is used primarily in intensive care units (ICUs) for the sedation of patients, both for short-term procedures and long-term sedation needs. Dexmedetomidine is favored in these settings due to its sedative, anxiolytic, and analgesic (pain-relieving) properties, and has a unique ability to provide sedation without significant respiratory depression. This makes it particularly useful for patients requiring mechanical ventilation or are at risk of respiratory complications.
Another similarity between medetomidine and xylazine is the areas in which the “designer drug” is appearing across the nation, Kensington Beach in Philadelphia, Chicago, Pittsburgh, Skid Row, Miami, and San Francisco. Alex Krotulski, PhD told NPR, “The numbers reported out of Philadelphia were 160 hospitalizations over a 3 or 4-day period.”
Krotulski is the Director of the Center for Forensic Science Research and Education (CFSRE), specializing in forensic toxicology and forensic chemistry. He also serves as the Program Manager for NPS Discovery, CFSRE's flagship program dedicated to the early identification and characterization of new and emerging synthetic drugs. With a background in chemistry, Dr. Krotulski practices as a forensic toxicologist.
In 2020, xylazine was found in 25.8% of fatal overdoses in Philadelphia alone. Unfortunately, medetomidine is now adding to the number of recent overdoses and has become a concern for the CFSRE.
Just a few months ago, in January, cases of medetomidine toxicity by fentanyl and heroin users spiked in Toronto, Canada. According to Toronto's Drug Checking Service (TDCS) manager Hayley Thompson, it was first detected in the area on December 29th, 2023.
The CBC reported: “In total, the service detected the substance in 15 out of 140 samples it tested between Dec. 29 and Jan. 23. All of the samples were taken in downtown or the west end and were thought to be fentanyl. The two anesthetic drugs have very similar chemical structures and are being reported together because the service can't currently differentiate between them, TDCS said.”
Also in January 2024, the DEA released a report that reads in part: “According to DEA’s National Forensic Laboratory Information System (NFLIS) Drug database, which collects scientifically verified data on drug items and cases submitted to and analyzed by federal, state, and local forensic laboratories, reports of benzimidazole-opioids began to re-emerge in 2019, after several reports of clonitazene and etonitazene in 1999-2004. Since 2019, there have been over 4,300 reports of benzimidazole-opioids to NFLIS-Drug.”
Beginning in July 2022, medetomidine was detected in numerous seized drug samples in the state of Maryland and detected in overdoses in St. Louis the same year.
Much like xylazine, medetomidine can be purchased online. However, medetomidine is much more expensive at $43.20 per 5 mg compared to $6.00-$20.00 for a kilogram of xylazine. Medetomidine was first developed by Orion Pharma, distributed by Pfizer Animal Health, and in Canada distributed by Novartis Animal Health.
Supervisor Matt Dorsey who represents San Francisco's District 6 recently sent a letter of inquiry to the city voicing his concerns about the recent uptick of medetomidine being found in the street-level drug supply. In this inquiry, Dorsey asks whether or not medetomidine is being tested for in drug supplies, toxicology, and coroner reports, as well as from overdose victims. Dorsey wrote a similar inquiry in 2023 on the dangers of xylazine as it became more prevalent.
Intensifying the relatively new "Frankenstein Opiate" crisis is the recent emergence of nitazenes in various street drugs across the country. These substances are appearing in some of the same cities where xylazine and medetomidine have been detected. Because the drug is relatively unknown to the medical and scientific community it is being considered an “emerging drug”. Nitazene does not show up on the standard urine screening for illicit drugs and is often not specifically tested for in overdose patients due to so little being known about the drug itself and its occurrence in the drug supply.
Isotonitazene “ISO,” also known as nitazene is a potent synthetic opioid twenty times stronger than fentanyl that was first developed as an analgesic candidate in the 1950s but quickly shelved and never approved to go to market. This decision was made decades ago because it was found to be too strong for clinical or pharmaceutical use in humans.
The DEA Washington D.C. Division warned the public in a 2022 release: “In powder form, ISO can appear yellow, brown, or off-white in color. DEA regional forensic laboratories have seen this drug mixed into heroin and/or fentanyl (and marketed as common street drugs) with deadly consequences. However, in other parts of the country, ISO has already been seen pressed into counterfeit pills and falsely marketed as pharmaceutical medication (like Dilaudid ‘M-8’ tablets and oxycodone ‘M30’ tablets).”
Nitazenes are often compared to fentanyl though structurally very different from one another. Largely overlooked by the medical community, nitazene re-emerged in 2019 in Canada’s unregulated illegal drug supply. Since then, nitazene has steadily been found in both street drug supplies and toxicology reports in coroners’ offices around the country. Due to the lack of quality control on the black market, users cannot determine the quantity of additives they may be consuming and often have no idea their illicit drug of choice has been adulterated.
Additionally, coroners found the drug in the blood and urine of 18 patients in the United States between August 2019 and January 2020, nine of whom had previously tested negative for any opioids. All 18 cases originated from the Midwest with 9 in Illinois, 7 in Indiana, 1 in Minnesota, and 1 in Wisconsin, with the majority being male with a median age of 41.
According to a paper published in February 2020 in the Oxford Academic Journal of Analytical Toxicology, “Isotonitazene was first reported in seized drug casework in Belgium (Europe) and toxicology casework in Alberta (Canada) in August 2019; however, the toxicology case from Alberta was collected in March 2019, marking the earliest date associated with the appearance of this new opioid. In the United States, isotonitazene was first reported by NPS Discovery in November 2019 based on sample-mining results from biological samples collected and submitted to NMS Labs (Horsham, PA, USA) in August 2019.”
The NIH National Library of Medicine explains:
“Nitazenes are µ-opioid receptor agonists with psychoactive effects comparable to those of other µ-opioid receptor agonists, such as morphine, oxycodone, heroin, and so on. The best known of the street agents is isotonitazene (street names ‘ISO’ and ‘Tony’), a 5-nitro-2-benzylbenzimidazole opioid that was identified among street drugs in Europe in 2019. Structurally, isotonitazene is an analog of etonitazene, one of earliest nitazenes.”
Drugs such as medetomidine, xylazine, nitazene, and others are causing widespread devastation in communities throughout the United States, Canada, and Europe, leading to numerous overdoses and fatalities. Research must be significantly expanded to address the fentanyl crisis we are facing today. With new additives in the illegal drug supply emerging rapidly and frequently, causing overdoses and deaths at an increasing rate, we urgently need more knowledge about these substances and effective strategies to combat addiction and treat overdose victims who may have unknowingly consumed them.
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