The Indiana Department of Health has released information regarding an emerging drug known as medetomidine, which is a non-opioid sedative utilized in veterinary medicine that has begun to be found in seized illicit substances.
The department has begun alerting law enforcement agencies, first responders, clinicians and public health professionals, including those located in Clinton County and the surrounding counties, about the emerging drug as traces have begun to become more prominent within the illicit substances located across the state.
The department stated that medetomidine has been found as a mixer within illicit substances, commonly being detected alongside fentanyl and xylazine, another veterinary medicinal product, but the substance has also begun to be detected within other substances, such as heroin and fentanyl analogs.
The department released a background for the substance, stating that medetomidine is an alpha-2 agonist that is intended for veterinary use, similar to xylazine that saw an emergence over the past few years as well, and the substance was first approved by the Food and Drug Administration in 1996 for its use in veterinary medicine, specifically as a sedative and analgesic for dogs.
The department stated that medetomidine has not been approved for humane use, but the substance has a similar relation to dexmedetomidine, which was approved as a sedative for human patients in 1999. Medetomidine has been unapproved for humane use as its clinical effects are largely studied in relation to veterinary research, which has found that the substance is stronger and longer-acting as a sedative than xylazine, which was noted as a dangerous substance circulating around Hoosier communities in 2023.
Currently, neither medetomidine nor dexmedetomidine have been scheduled as controlled substances by the United States Drug Enforcement Administration, unlike xylazine, which became a schedule II controlled substance after a bill was passed in 2024.
Medetomidine has been identified in multiple states according to the department, with the substance first being detected in Maryland in July 2022, and has since been identified in drug products and has been connected to an outbreak of overdoses and adverse effects in Philadelphia and Chicago in 2024.
The department stated that medetomidine has been detected in Indiana through the Indiana Syringe Service Program in Marion County. The detection in the syringe program reportedly saw medetomidine be detected in syringes returned at multiple program sites spanning from November 2023 through March 2024, and recent reports showed that all syringes in Marion County that contained the substance also contained fentanyl or a fentanyl analog currently.
The department reported that no cases or records of medetomidine or dexmedetomidine were found in the Indiana Toxicology Program, as of May 2024, or the Indiana Prescription Drug Monitoring Program, according to data spanning from 2013 to 2024.
“While Indiana’s overdose surveillance has identified limited detections of medetomidine, it is imperative to continue monitoring for the drug in Indiana,” the department released. “Closely monitoring the emergence of novel substances is critical to inform prevention and control efforts, such as those implemented in response to the emergence of xylazine.”
The department issued a breakdown of the overdose signs and symptoms of medetomidine, which have not been fully studied due to the research on its impact on humans being limited due to its veterinary medicine classification. However, the department stated that findings suggest that the substance shares some similar symptoms to xylazine use, including respiratory depression, dry mouth, vasoconstriction, hypothermia, hypertension and low heart rate. Other symptoms do not mirror xylazine, which include muscle twitches, hallucinations and peripheral cyanosis. Research has not shown whether medetomidine use leads to the possibility of wounds, such as those typically associated with xylazine use.
The department reported that when combined with an opioid, the sedative effects of the substance are longer lasting and stronger, and veterinary literature has shown that combining the substance with opioids has resulted in greater respiratory depression, which sparked concern amongst researchers as the substance has been commonly detected alongside opioids in toxicology results across the nation. The department shared an additional concern related to the substance’s properties in relation to naloxone treatment.
“Because medetomidine is not an opioid, naloxone administration may not be as effective at fully reversing a medetomidine-involved overdose,” the department released. “However, whenever an overdose is suspected, naloxone should always be administered since multiple substances may be present, and naloxone will work on any opioids contributing to the overdose.”
The department released signs and symptoms of an opioid-involved overdose, which may include troubled breathing, small pupils, unconsciousness or unresponsiveness, snoring, choking or gargling, cold or clammy skin, pale or blue skin and discolored lips or fingernails. In the event of a suspected overdose, call 911 and administer naloxone immediately if available.
The department stated that naloxone may be obtained through two grant opportunities geared toward qualified agencies, and the grants are designed to provide the agencies with opioid rescue kids in the form of Narcan nasal spray.
Numerous community organizations throughout the Clinton County area have worked diligently to provide naloxone boxes throughout the county with numerous locations in Frankfort and locations in the surrounding towns that are routinely checked and replenished if the naloxone is utilized to combat an overdose.
For more information regarding naloxone boxes, contact Healthy Communities of Clinton County Coalition at 765-659-6063 or the Clinton County Health Department at 765-659-6385. For more information regarding public safety on a state level, visit in.gov/health.