OasisLMS

Medetomidine, a highly potent veterinary alpha-2 adrenergic agonist, has recently emerged as a significant adulterant within the U.S. illicit opioid supply. This presentation entitled will review the introduction of medetomidine in the U.S. drug supply, the pharmacology and clinical effects of medetomidine, and the distinguishing features of medetomidine toxicity and withdrawal. We will outline emerging treatment strategies emphasizing early, aggressive alpha-2 agonist therapy; nuanced antiemetic approaches; when and how to escalate to IV dexmedetomidine; and approaches to concurrent opioid withdrawal management. Participants will gain insight into diagnostic challenges, observation and disposition considerations, and strategies for system-level preparedness.

At the conclusion of this seminar, attendees should be able to:

1. Describe the emergence of medetomidine as an illicit drug adulterant and its impact on overdose toxicity and withdrawal presentations.
2. Recognize the clinical features of medetomidine toxicity and differentiate medetomidine withdrawal from withdrawal syndromes.
3. Apply evidence-informed strategies for early, aggressive management of medetomidine withdrawal, including the use of alpha-2 agonists and antiemetic therapies.
4. Identify system-level challenges posed by medetomidine and outline approaches to multidisciplinary coordination.

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Jon Lepley, DO Jon Lepley is a family physician with over 20 years of experience treating addiction in primary care, addiction treatment facilities, and correctional institutions. In 2018, he spearheaded the implementation of buprenorphine treatment for all patients with opioid use disorder in the Philadelphia jail system, regardless of their treatment status at the time of entry. He then transitioned to the University of Pennsylvania Health System and served six years as the medical director of addiction medicine at Lancaster General Health. Currently, he treats addiction as a family medicine physician in Lancaster County, Pennsylvania. Dr. Lepley is a past president of the American Osteopathic Academy of Addiction Medicine (AOAAM) and serves as a trustee for the Foundation of the Pennsylvania Medical Society.

ACCREDITATION: 
In support of improving patient care, American Academy of Addiction Psychiatry is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

DISCLOSURE AND CONFLICT OF INTEREST RESOLUTION:
All conflicts of interest of any individual(s) in a position to control the content of this CME activity will be identified and resolved prior to this educational activity being provided. Disclosure about provider and faculty relationships, or the lack thereof, will be provided to learners.

Funding for this initiative was made possible (in part) by grant no. 1H79TI088037 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.