A New Drug is Driving a Dangerous Withdrawal Crisis

A powerful veterinary sedative called medetomidine is rapidly reshaping the overdose crisis in Philadelphia and placing new strain on hospitals and treatment systems, according to the New York Times. Unlike prior waves of the crisis, this crisis is not defined solely by fatal overdoses but by severe, life-threatening withdrawal.

Medetomidine, which is increasingly mixed into the illicit fentanyl supply, causes extreme sedation shortly after use. When it wears off, withdrawal can trigger life-threatening symptoms, including dangerously high heart rate and blood pressure, severe vomiting, tremors, and hallucinations. Many patients require intensive care. 

Reports indicate that medetomidine is rapidly replacing the prevalence of xylazine in some areas and is up to 200 times more potent, signaling a rapid shift in the illicit drug supply and introducing new clinical challenges. Philadelphia hospitals have seen a sharp rise in withdrawal-related emergency visits. Public health records cited by The New York Times show more than 7,200 emergency department admissions for withdrawal in the first nine months of 2025, compared with fewer than 2,800 for all of 2023.

Clinicians report that many patients are unaware they are using medetomidine at all. Temple Health emergency physician Dr. Brendan Hart told The New York Times, “People are dependent on a substance they didn’t intend to use and hadn’t heard of.”

The severity of withdrawal has also created barriers to care. Some individuals avoid hospitals or treatment centers out of fear their symptoms will not be adequately managed, while others leave emergency departments before receiving treatment and return to use to relieve symptoms.

Although Philadelphia was the first city to experience widespread medetomidine-related harms, the drug has already been detected in several other states, raising concerns that similar withdrawal crises could emerge elsewhere.

The spread of medetomidine highlights how quickly the illicit drug supply can change and how critical it is for treatment systems, clinicians, and policymakers to adapt rapidly to emerging substances.

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