Why is medetomidine being combined with illicit opioids?
Alpha-2 receptors in the central nervous system colocalize in the same areas of the brain as opioid receptors and when both receptor types are stimulated, their effects synergize. Alpha-2 agonists like medetomidine enhance the euphoric effects of opioids but without directly stimulating the opioid receptor. Chronic illicit users of opioids might be experiencing high levels of tolerance to opioid receptor stimulators, and their required daily doses are escalating as a result. This is a work around to enhance the desired opioid effects with less inducement of opioid receptor tolerance.
What are the risks of medetomidine?
Medetomidine can reduce respiratory drive and can stop people from breathing but naloxone, which blocks opioid receptors and not alpha-2 receptors, may not be effective or as effective at reversing those effects. Medetomidine may also reduce tissue oxygenation aside from reducing breathing so the anoxic damage to the body could be more severe than the level of breathing suppression suggests.
How does the possible comingling of illicit opioids and alpha-2 agonists like medetomidine or xylazine impact treatment of patents?
If a patient has used a combination illicit opioid and medetomidine product and experiencing respiratory depression, naloxone should still be used and will attenuate the opioid component of the overdose. This may be enough to revive the patient or at least reduce the severity of the issue. However, it may be advisable to call 911 upon discovering a person is respiratory depression before administering the first dose of naloxone so EMS can arrive on the scene sooner. In between naloxone doses, good Samaritans should provide rescue breathing for the 2 minute waiting period to nonresponsive people to maintain better oxygenation levels.
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