Medetomidine-Involved Overdoses Among Emergency Department Patients: Results From a US Multicenter Sentinel Surveillance Program.

Abstract

Medetomidine is an alpha-2 adrenoreceptor agonist approved only for veterinary sedation and was reported in the US illicit drug supply starting in 2022. Our aim was to determine the prevalence of medetomidine exposure and associated clinical characteristics among emergency department patients presenting with opioid and/or stimulant overdoses. The Toxicology Investigators Consortium (ToxIC) Drug Overdose Toxico-Surveillance (DOTS) Reporting Program included 17 US medical centers. Emergency department (ED) patients with acute opioid and/or stimulant overdose were enrolled between April 2023 and September 2024. Blood was obtained for toxicological analysis, and chart reviews and structured patient interviews were conducted. Among 964 cases, medetomidine was detected in 2.8% (n = 27). After adjusting for confounders, medetomidine exposure was associated with an increased odds (odds ratio: 4.03; 95% CI: 1.35, 10.58) of bradycardia (<50 beats per minute) within 24 hours of presentation. Patients with medetomidine exposure had significantly higher rates of BVM (20.5%) than those without medetomidine exposure (3.7%; P=0.03) but did not require more intubation, BiPAP/CPAP, or naloxone than medetomidine-unexposed patients. No differences between medetomidine-exposed and unexposed groups were found for length of stay, critical care unit disposition, hypotension (<50 mmHg), or sedation. No patients completing an interview (n = 24) reported medetomidine use. Medetomidine exposure among ED patients with overdose was associated with increased bradycardia but not greater sedation, respiratory support, or need for higher level of care. Sentinel toxico-surveillance can identify emerging drug trends not captured through routine clinical data.