Clinical Guidance
ASAM Clinical Considerations: Medetomidine Intoxication and Withdrawal
Download Read the Announcement
01046234bdc84b84bfaeabd83dd96780.png?sfvrsn=17cc2930_1 "Met Doc")
Background
Although overdose mortality in the US has recently declined, morbidity associated with unregulated substance use continues to exact a serious toll on individuals and communities. The opioid supply has been shifting rapidly, with exposure to combinations of potent synthetic opioids, sedatives, analgesics, and synthetic precursors leading to new health impacts and medical complexities for patients with substance use disorders (SUDs). Medetomidine, a veterinary sedative that acts as an imidazoline and α2-adrenergic receptor agonist, has recently emerged as an adulterant that is associated with uniquely severe withdrawal syndrome, necessitating rapid adjustment of clinical practice.
Medetomidine intoxication and withdrawal represent distinct clinical syndromes with varying timelines, physiologic mechanisms, and treatment approaches. Persistent sedation accompanied by bradycardia and occasionally hypotension is characteristic of acute toxicity, whereas autonomic hyperactivity developing hours after cessation of substance use may suggest withdrawal.
This Clinical Consideration is based on expert consensus and available evidence to address two key questions on the treatment of medetomidine intoxication and withdrawal:
- For patients presenting for treatment of medetomidine intoxication, what medical interventions are effective for intoxication management?
- For patients with moderate to severe medetomidine withdrawal, what medical interventions are effective for withdrawal management?
The document also provides additional context for treatment of medetomidine withdrawal in outpatient and residential settings, and for treatment of specific populations, along with example protocols that were currently in use as of November 2026.
See document for citations.
Last updated: 11/10/26
Download Clinical Consideration
Live Webinar
Tuesday, December 1st, 2026 | 3:00 pm - 4:00 pm Eastern Time
This 60-minute live webinar based on the Clinical Considerations: Medetomidine Intoxication and Withdrawal, equips learners with practical strategies to recognize and manage medetomidine intoxication and withdrawal, an emerging clinical challenge associated with the unregulated opioid supply. Participants will gain valuable insights into identifying this potentially severe condition, understanding how it differs from traditional opioid withdrawal, and applying effective management approaches in clinical practice.
Medetomidine Guidance Committee
Bridget R. Durkin, MD, MBE
Michael J. Lynch, MD, FACMT
Jeanmarie Perrone, MD
ASAM Quality Improvement Council
Itai Danovitch, MD, MBA, DFAPA, DFASAM (Chair)
Michael P. Frost, MD, DFASAM, FACP
Scott Hadland, MD, MPH
Gregory Hobelmann, MD, MPH
Larissa J. Mooney, MD
Carrie Patnode, PhD, MPH
Evan S. Schwarz, MD, FASAM
Cynthia Vuittonet, MD, FASAM
Field Reviewers
Joseph D'Orazio, MD, FCPP
Philip A. Durvey III, MD
Umer Farooq, DO
Dennis Goodstein, PharmD, BCPS
Ilana W. Hull, MD, MSc
Cresta W. Jones, MD, FACOG, FASAM
Michael R. Lawson, MD
Samuel J. Lee, MD
Jessica Moore, MD
Jordan Nahas-Vigon, MD
Kurt D. Palumbo, MS, PA-C
Kelly S. Ramsey, MD, MPH, MA, FACP, DFASAM
Gregory K. Wanner, DO, FACEP
TaReva L. Warrick-Stone, DO
Scott J. Whetsell, MD, MBA, FAAP, FASAM
ASAM Staff & Author Contribution
Literature Search and Evidence Summary: Sarah Framnes-DeBoer, MS
First Draft: Expert Committee, Emily B. Einstein, PhD
Revisions: Expert Committee, Emily B. Einstein, PhD, Viviana Bauman, PhD, MPH, Maureen P. Boyle, PhD
Final approval: Quality Improvement Council and Board of Directors