Dalton Barrett, a paramedic in North Carolina, recently wrote, “this week my exposure to medetomidine withdrawal is changing literally everything I thought I knew about withdrawal medicine,” adding that he has seen “patients who clinically look closer to being in shock than dope sick.”
Medetomidine––also known as “rhino tranq,” “mede,” and “dex”––is a non-opioid sedative that is more potent than xylazine. According to the Centers for Disease Control and Prevention (CDC), the symptoms associated with medetomidine withdrawal include tachycardia (more than 100 heart beats per minute), severe hypertension, tremors, and chest pain.
Barrett, who also leads his county’s Post Overdose Response Team, continued: “So what happens? Programs like ours have to bring pieces of ICU level thinking into the field… because patients are already living and withdrawing there.” He said, “we have to manage complex withdrawal in living rooms, trailers, motel rooms, cars, and homeless encampments.”
Based on his experiences in the field, he noted that treatment for medetomidine withdrawal could involve “sitting with patients for hours if needed,” as well as IV access, fluids, additional medications like clonidine, and the provision of treatment for opioid use disorder (e.g., buprenorphine).
Medetomidine was first identified in the nation’s illicit drug supply in 2021. In Philadelphia, by November 2024, 87% of fentanyl samples contained medetomidine, whereas 42% contained xylazine, illustrating how medetomidine may be replacing xylazine as an additive. In New York City, medetomidine was recorded in 134 deaths in 2025, up from 18 in 2024.
Nabarun Dasgupta, a researcher at the University of North Carolina at Chapel Hill, testified to Congress in March 2026 that “medetomidine withdrawal is unlike anything most emergency physicians have seen before” and that “abstinence-based treatment now carries serious heart attack risk not seen with fentanyl alone.”
The emerging threat of medetomidine was highlighted in The Drug Report in April after the CDC and the White House Office of National Drug Control Policy issued a Health Advisory about its spread through the illicit drug supply.