New Drug Cocktail Sparks Wave of Overdoses in the U.S.
Public health officials report that Mexican cartels and drug gangs in the U.S. are mixing medetomidine, a dangerous chemical sedative, into FYL and other street drugs. This combination has triggered a new wave of overdoses since late April, accelerating through May.
"The numbers reported out of Philadelphia were 160 hospitalizations over a 3 or 4-day period," said Alex Krotulski, head of NPS Discovery, an organization studying illicit drugs in the U.S.
Medetomidine, commonly used by veterinarians as an animal tranquilizer but also formulated for human use, has been linked to recent mass overdose outbreaks in Chicago. Preliminary data also suggested another mass overdose event in Pittsburgh, but those findings proved false, according to Krotulski.
Experts warn that medetomidine, mixed into counterfeit pills and powders sold on the street, dangerously slows the human heart rate. It is undetectable by drug users. Public health advisories have been issued in Illinois and Pennsylvania.
Dr. Brendan Hart at Temple University in Philadelphia reports that they first began hearing of street drug users exposed to the FYL-medetomidine mix in April.
"Some of our emergency medicine doctors started stopping me in the hallway," Hart told NPR. "They said 'Something funny is going on with the overdoses.' Patients were coming in with heart rates as low as in the 20s. A normal heart rate is sixty to a hundred [beats per minute] so 20s is extremely low."
Laboratory tests of street drug samples confirmed the presence of the powerful sedative, which is used in some medical formulations but only in carefully controlled settings.
Medetomidine had previously been detected in the illicit drug supply as early as 2022 but only rarely and in small amounts. Now, experts say it appears to be spreading rapidly, with large-scale overdose events also reported earlier this year in Toronto, Canada.
U.S. Drug Supply Grows More Toxic
Last year, the Biden administration warned that street FYL was being mixed with another veterinary tranquilizer called XYL. This mix led to more overdoses, with many users also experiencing severe flesh wounds that can linger for months or years.
Medetomidine is even more potent than XYL, experts told NPR. As it spreads, Krotulski said no one knows what long-term health effects this new cocktail of chemicals will cause in the human body.
"Patients are being cared for as we speak in emergency rooms," he said. "These are very complex drug products. You’ve got FYL adulterated with XYL that now also contains medetomidine."
The presence of these chemical additives severely complicates the medical response to high-risk overdoses. XYL and medetomidine don't respond to naloxone, the medication used to reverse most FYL overdoses. There’s currently no way for street users to know when their drugs are laced with these chemicals.
Dr. Bertha Madras, a drug researcher at Harvard Medical School and McLean Hospital, said it’s not clear why drug gangs are mixing these new chemicals with FYL. Some experts believe sedatives may prolong the opioid high, making the drugs more desirable on the street.
According to Madras, it's urgent that first responders and emergency rooms be prepared to treat overdoses complicated by heart conditions triggered by medetomidine. She also thinks people using drugs need to be warned that illicit pills and powders are more perilous than ever.
"It’s critical to alert street users," Madras said. "They’re playing Russian roulette now with the drug supply."
Experts are working to understand where the medetomidine appearing on U.S. streets is coming from. It's not yet clear whether the sedative is being illegally diverted from veterinary supplies or from medications intended for use in hospitals and clinics. It’s also possible that drug gangs are formulating their own medetomidine compounds from precursor chemicals acquired illegally.
Evolving Street Drug Supply Outpaces Public Health, Law Enforcement
Madras said Mexican cartels and U.S. drug gangs are quickly creating new combinations of powerful synthetic drugs, often using chemicals like medetomidine which aren't yet regulated or tightly controlled under U.S. law. She said it's nearly impossible for U.S. law enforcement and public health to keep up.
"There is an almost endless supply of new psychoactive substances and there are literally thousands and thousands of drugs that can be made," she said.
Experts believe the decision to experiment with XYL, medetomidine, or other chemicals in illicit street drug combinations likely reflects which substances are cheap, poorly regulated, and readily available.
Some critics, including Dr. Jeffrey Singer, a drug policy analyst at the libertarian Cato Institute, believe law enforcement efforts aimed at regulating chemicals used in street drugs are encouraging cartels to experiment with more readily available substances that may be more harmful, including medetomidine.
"Law enforcement is trying harder and harder to crack down on XYL," Singer said. "If the drug trafficking organizations are interested in adding a sedative [to their street drug mixes], they can always add medetomidine."
Singer believes interdiction of synthetic drugs is so difficult that U.S. policymakers should focus resources on helping drug users find medical treatment instead of funding more law enforcement efforts.
Efforts to tightly regulate medetomidine could be complicated by the fact that a version of the sedative called dexmedetomidine is widely used by physicians as well as veterinarians.
"That medicine is used everywhere along the lifespan, from [neonatal intensive care units] to sedate babies that need to be on respirators, to elderly patients who can’t breathe on their own," said Dr. Nabarun Dasgupta, a street drug expert at the University of North Carolina at Chapel Hill. "[Restricting access to] medetomidine like XYL or even FYL will have major impacts on every hospital in the country."
Fatal overdoses in the U.S. dropped 3 percent last year, but roughly 107,000 people in the U.S. still died after using street drugs. Addiction experts worry modest gains in saving the lives of drug users could be reversed as more toxic chemicals like medetomidine and XYL hit the streets.
Source: NPR