About a dozen states are experiencing a surge in emergency department visits related to a new combination of fentanyl and a sedative 100 to 200 times more potent than xylazine, The New York Times reported Dec. 15.
The dangerous drug combination is rapidly spreading across U.S. cities, including Philadelphia.
Medetomidine is a non-opioid, veterinary sedative similar to xylazine that can cause longer-lasting sedation and more severe withdrawal symptoms, according to the Allegheny County, Pa., health department and medical examiner’s office.
“Our ICUs have been overwhelmed,” Daniel del Portal, MD, senior vice president of medical operations and chief clinical officer of Temple University Health System in Philadelphia, told the Times.
Dr. del Portal said physicians, emergency medical workers and outreach teams categorize the issue as “the withdrawal crisis.”
Fentanyl-medetomidine mixtures can spur life-threatening withdrawal symptoms within a few hours, according to the Times. A person’s heart rate slows significantly shortly after use, but during withdrawal, a person can experience a skyrocketing heart rate and blood pressure, tremors and uncontrollable vomiting. In withdrawal, heart rates can reach as high as 170 beats per minute.
Five things hospital leaders should know:
1. About a dozen states have detected medetomidine, including Colorado, Delaware, Florida, Illinois, Maryland, Massachusetts, Missouri, New Jersey, North Carolina, Ohio and Pennsylvania, according to the Times.
2. The mixture of medetomidine and fentanyl is relatively new. In Philadelphia, for example, 2,787 admissions to hospital emergency departments in 2023 were related to withdrawal. During the first nine months of 2025, this number was 7,252.
3. The substantially high blood pressure experienced during withdrawal can cause brain damage. Many people refuse to visit a treatment center, however, out of fear of inadequate care, according to the Times.
4. To contain withdrawals, the Philadelphia health department recommends an intravenous treatment of dexmedetomidine.
5. Health systems and hospitals face several struggles amid the emerging problem. Reimbursement is limited because “medetomidine withdrawal is not yet a recognized diagnosis that requires extended hospitalization,” according to the Times. Safely discharging these patients is another concern, as some are temporarily cognitively impaired and many are homeless.
