ASAM Releases Clinical Guide for Managing Medetomidine Exposure

The American Society of Addiction Medicine (ASAM) has released the first national clinical guide for managing the intoxication and withdrawal effects of medetomidine, a veterinary sedative now appearing in the illicit opioid supply, Psychiatric Times reported.

This new guidance arrives as medical professionals struggle to treat patients exposed to the animal tranquilizer, which is being used as an adulterant in unregulated drugs. The substance presents a unique clinical profile that differs significantly from standard opioid exposure.

Medetomidine intoxication is typically characterized by persistent sedation and bradycardia, or a slowed heart rate. However, the withdrawal phase presents a much more volatile set of risks for the patient.

According to ASAM, medetomidine withdrawal can develop rapidly and manifest through severe symptoms, including extreme tachycardia and elevated blood pressure. These physiological shifts are often unresponsive to the standard medications used to manage withdrawal from other substances.

Because these symptoms can become life-threatening, patients experiencing severe withdrawal may require escalation to critical care more frequently than those experiencing withdrawal from opioids alone.

ASAM Releases Clinical Guide for Managing Medetomidine Exposure — Photo: Inquirer.com

“The unpredictable illicit drug supply continues to pose a significant health risk to people and communities across America,” said Stephen M. Taylor, MD, MPH, DFAPA, DFASAM, the president of ASAM.

The emergence of medetomidine follows a pattern seen with xylazine, another veterinary sedative. As Inquirer.com reported, Philadelphia health officials observed how xylazine—often called “tranq” on the street—led to severe skin wounds and infections that could reach the bone, sometimes resulting in amputations.

In Philadelphia, emergency room doctors began noticing in 2024 that opioid users in severe withdrawal were not responding to traditional treatments. They eventually identified medetomidine as the likely cause of these non-responsive symptoms.

To better manage this trend, health officials lobbied the International Classification of Diseases (ICD) system to include specific codes for tracking the substance. Without these standardized codes, doctors were forced to use various other diagnoses on patient charts to document medetomidine-related symptoms.

The tracking infrastructure is currently being implemented in stages. As of October 1, 2026, doctors nationwide can use an ICD code specifically for medetomidine toxicity. The CDC is expected to institute an ICD code for medetomidine withdrawal by October 1, 2027.

Daniel Teixeira da Silva, the director of Philadelphia’s Division of Substance Use Prevention and Harm Reduction, noted that the goal of this coding is to improve care by allowing doctors to log symptoms more accurately.

The shift in patient acuity is already being felt in hospital settings. Phil Durney, the inpatient medical director of Jefferson’s addiction consult service, told Inquirer.com that the cohort of patients coming to the hospital is increasingly critically ill.

These patients often require intravenous medication due to dangerous shifts in heart rate and blood pressure. This level of instability places additional strain on emergency medicine and addiction care teams who must now innovate their standard protocols.

While new coding helps with data, some providers remain concerned about the long-term volatility of the drug market. Some local addiction treatment providers have considered advocating for a “catch-all” ICD code to track withdrawal from various “new psychoactive substances” rather than reacting to each individual adulterant as it appears.

The medical community is currently waiting for the next potential shift in the illicit supply, as the arrival of new adulterants remains a constant variable in public health management.