Amy Nham, John N. Le, Shawn A. Thomas, Kimberly Gressick, Emily N. Ussery, Jean Y. Ko, R. Matt Gladden, Christina Mikosz, Joshua G. Schier, Alana Vivolo-Kantor, Maria Fiorillo, McKenna McMaster, Darlene Nolasco Magana, Livia Verklan-McInnes, Michael Wahl, Taylor Wood, Axel Adams, Alex Krotulski, Jordan Trecki, Ross Ellison, Roy Gerona, Ponni Arunkumar, Mojde Mir, Leslie M. Wise, Emma Betancourt, Kathleen Monty, Jhoanna Gulmatico, Angie Pojas, Ruchi Fitzgerald, Miao Hua
Morbidity and Mortality Weekly Report (MMWR)Summary
What is already known about this topic?
Medetomidine, a nonopioid sedative not approved for use in humans, has been detected in illegally manufactured opioids across North America since 2022.
What is added by this report?
Twelve confirmed and 26 probable cases of medetomidine-involved overdose occurred in Chicago, Illinois, during May 11–17, 2024, mostly among non-Hispanic Black or African American men aged 45–64 years. Bradycardia and lack of response to naloxone were defining clinical features. Fentanyl was present in all blood specimens and drug samples that tested positive for medetomidine.
What are the implications for public health practice?
Multisector surveillance is needed to quickly identify and respond to new adulterants introduced into the illegal drug supply. Clinicians who observe atypical toxidromes associated with suspected opioid-involved overdoses should contact their local health department and continue to provide naloxone and linkage to evidence-based treatment.
Abstract
Medetomidine, a nonopioid sedative not approved for use in humans, has periodically been detected in illegally manufactured opioids across North America since 2022. On May 11, 2024, the Chicago Department of Public Health (CDPH) and the Illinois Department of Public Health were alerted by hospitals and the Illinois Poison Center to an increase in emergency medical services responses for suspected opioid-involved overdoses with atypical symptoms, mostly clustered on Chicago’s West Side. CDPH and CDC investigated and identified 12 confirmed, 26 probable, and 140 suspected overdoses involving medetomidine mixed with opioids among patients treated at three hospitals in Chicago’s West Side during May 11–17, 2024. Medetomidine had not been previously identified in Chicago’s illegal drug supply. Fentanyl was identified in all drug samples and blood specimens containing medetomidine. Most patients were male, non-Hispanic Black or African American, and aged 45–64 years; most patients with confirmed cases experienced bradycardia and had no or only a partial response to naloxone. This cluster is the largest reported for confirmed medetomidine-involved overdoses. Multisector surveillance, including by health care providers, toxicology laboratories, and public health personnel, was essential for quickly identifying and responding to new adulterants in the illegal drug supply. Because all specimens and samples in this investigation that contained medetomidine also contained natural or synthetic opioids, administering naloxone for all suspected opioid-involved overdoses remains crucial.
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