Innovations In Clinical Practice: Managing Medetomidine Intoxication and Withdrawal in Philadelphia-Recording - Innovations In Clinical Practice: Managing Medetomidine Intoxication and Withdrawal in Philadelphia

Recording - Innovations In Clinical Practice: Managing Medetomidine Intoxication and Withdrawal in Philadelphia

Video Transcription

Video Summary

Dr. Tariva Warwick-Stone discusses managing metatomidine intoxication and withdrawal amid Philadelphia's evolving illicit opioid supply. Metatomidine, a potent synthetic alpha-2 agonist used in veterinary medicine, has emerged as a major adulterant in fentanyl, surpassing xylosine. Its presence complicates overdose management and leads to a severe withdrawal syndrome marked by bradycardia, hypotension, sedation, intractable vomiting, tremors, hypertensive crises, and hypoactive encephalopathy resembling posterior reversible encephalopathy syndrome (PRES). Unlike xylosine withdrawal, conventional oral alpha-2 agonists (e.g., clonidine, guanfacine) and standard naloxone doses provide inadequate symptom control. Effective management requires early screening for alcohol and benzodiazepine use, aggressive short-acting opioids to control opioid withdrawal, multimodal antiemetics and anxiolytics, and high-dose or frequent administration of alpha-2 agonists, including clonidine via oral, intramuscular, or transdermal routes. Severe cases often necessitate ICU admission and dexmedetomidine infusions to stabilize autonomic hyperactivity. Philadelphia hospitals have developed protocols reflecting these findings, noting a rise in withdrawal-related presentations since metatomidine's introduction. Public health surveillance emphasizes prioritizing respiratory support over rapid reversal with naloxone due to prolonged sedation effects. Metatomidine’s spread mirrors xylosine’s prior trajectory, underscoring the need for ongoing local drug supply monitoring and tailored clinical responses to novel adulterants to reduce morbidity and mortality in the fentanyl era.

Keywords

Metatomidine intoxication

Withdrawal syndrome

Illicit opioid supply

Fentanyl adulterant

Alpha-2 agonists

Overdose management

Philadelphia hospitals

Respiratory support

Dexmedetomidine infusion