ORN Spring 2026: Medetomidine Impacts on Clinical Management and Systems of Care-2026-05-13 - Recording - ORN Spring 2026

Video Transcription

Video Summary

The webinar introduced Dr. Michael Lynch’s update on metatomidine, a relatively new adulterant in the opioid supply that has spread across the U.S., especially in the Northeast and Pennsylvania. He explained that metatomidine is an alpha-2 agonist, similar to xylazine and clonidine, and is increasingly found in fentanyl samples, sometimes alongside xylazine. Because it is more potent and increasingly concentrated, it can cause significant clinical effects.<br /><br />Dr. Lynch reviewed the two main clinical problems: acute toxicity and withdrawal. Acute toxicity typically looks like opioid overdose with sedation, pinpoint pupils, bradycardia, and hypotension, though naloxone should still be given because it reverses opioid-related respiratory depression. However, naloxone does not reverse metatomidine effects, and repeated dosing should not be used simply to wake patients up.<br /><br />The larger challenge is severe withdrawal, which can begin within hours to a day after last use and may include intense anxiety, nausea/vomiting, tremor, hypertension, tachycardia, delirium, metabolic derangements, and frequent ICU admission. There is no rapid FDA-approved test, so diagnosis is clinical and often supported by drug-checking data.<br /><br />Treatment is based on aggressive alpha-2 agonist therapy, especially clonidine, guanfacine, and sometimes tizanidine, with escalation to dexmedetomidine infusion in severe cases. He also emphasized treating co-occurring opioid withdrawal with buprenorphine or methadone, plus supportive care for vomiting, electrolyte abnormalities, and agitation. Dr. Lynch highlighted the growing impact on emergency departments, hospitals, and residential treatment settings, and stressed the need for local drug surveillance and flexible care pathways.

Keywords

metatomidine

opioid supply

xylazine

fentanyl adulterant

alpha-2 agonist

acute toxicity

withdrawal

naloxone

clonidine

dexmedetomidine