I’m the lucky one ;)

You might be on to something

I still remember some codes

I'll wrap this up here so I don't keep rambling--thanks for reading everyone.

If you are concerned about yourself/someone, please call 911/go to the nearest hospital (pls do not dm/email me asking for medical advice).

(cont.) Good supportive care is key. Acute withdrawal from the opioids should be managed the same way you would normally manage opioid withdrawal (ie, meds like buprenorphine). Medetomidine withdrawal may require introduction of alpha 2 agonists like clonidine to help manage.

HOW DO CLINICIANS TREAT WITHDRAWAL FROM OPIOID/MEDETOMIDINE?

I recommend consulting with tox/poison center/addiction medicine. There's good data on opioid withdrawal treatment, but medetomidine withdrawal has less data and would benefit from expert involvement (see next tweet)

CAN YOU WITHDRAW FROM BOTH OPIOIDS & MEDETOMIDINE?

People can withdraw from opioids which can be incredibly awful to go through. One can withdraw from medetomidine as well and experience effects like tachycardia and encephalopathy. Going through both withdrawals would be awful

TREATMENT FOR OPIOID/MEDETOMIDINE TOXICITY?

For clinicians, treatment = supportive (protect airway, address hypotension with fluids & pressors if needed, etc), give naloxone if concern for opioid toxidrome present/respiratory depression. Calling poison control/tox is recommended

WHAT HAPPENS WHEN SOMEONE USES OPIOIDS + MEDETOMIDINE?

Medetomidine = sedation, bradycardias, hypotension. Some data show hallucinations. Opioids = sedation, bradycardias, hypotension, and life-threatening respiratory depression. Together these are a dangerous combination

CAN YOU TEST SOMEONE FOR MEDETOMIDINE?

Yeah you can do testing to look for medetomidine/metabolite of medetomidine but it’s certainly not a routine test that is quickly done. Usually it would be a test that a hospital would have to send out to specific lab.

WOULD SOMEONE KNOW IF THEIR OPIOIDS HAS MEDETOMIDINE IN IT?

There’s no data (to my knowledge) that says medetomidine has a certain taste/smell/appearance. People may feel their normal opioid hit them harder (or cause hallucinations?) and it may lead to a new withdrawal state

WHY IS MEDETOMIDINE IN THE ILLICIT OPIOID SUPPLY?

Not entirely clear, but possibly bc it can be used to mimic sedative effects of opioids (e.g., fentanyl) while reducing cost for suppliers. There's also market/cost factors $$$$$. Also its high potency may make it appealing

SO DOES THE LEVOMEDETOMIDINE DO ANYTHING?

Short version: eh
Long version: the data we have shows that it doesn’t seem to be cause any effects in dogs/rats at decent dosing; however, there may be some human cell/receptor interactions in some data (PMID 9584224)?

WAIT ISN’T DEXMEDETOMIDINE A HUMAN DRUG?

Ya there’s a drug called Precedex (dexmedetomidine) that is used in humans for sedation. It does not contain levomedetomidine.

WHAT IS MEDETOMIDINE?

Medetomidine is a veterinary anesthetic medication. It’s composed of two different types of molecules called enantiomers: dexmedetomidine and levomedetomidine. The dexmedetomidine is the active component and is an alpha 2 adrenergic agonist.