'It's time to think outside the box': NC street drug scientist warns about deadly substance

A substance, crowding emergency rooms in some states, is appearing in North Carolina’s street drug supply, according to scientists at the University of North Carolina’s Street Drug Analysis Lab.

The substance, called medetomidine, has become a growing concern for public health officials and addiction experts who warn that its withdrawal symptoms can be life-threatening.

Street drug scientists say medetomidine has already overwhelmed emergency rooms in cities like Chicago, Philadelphia and Pittsburgh, and while North Carolina has not reached that point, they are watching it closely.

The issue is deeply personal for people like Alexis West, whose struggles with addiction left lasting physical reminders.

“I've gone through a lot in my life,” West said. There are good parts, of course, but it's just been a lot of bad. And I used the drugs to numb everything.”

West said nearly losing her hand became the turning point that pushed her toward recovery through Edgecombe County’s Emergency Paramedic Program. The experience also introduced her to street drug testing programs that revealed what was actually in the substances she was using.

“You think you're doing one thing, and really, you're doing another,” West said.

Edgecombe County sends drug samples to UNC’s Street Drug Analysis Lab, where scientists test substances circulating in local communities and return the results to health officials and outreach programs.

West said the fentanyl she believed she was taking was often mixed with several other substances.

“Half of the names you can't even pronounce. It's not good that you're putting drugs in your body. But then again, it's scary, because it's like these things; you don't even know what they are,” she said.

Among the substances identified by the lab is medetomidine, which scientists say first appeared in North Carolina’s drug supply in 2022. One sample collected in Tarboro in April showed the substance mixed with multiple drugs in what researchers described as a “messy brew.”

 The U.S. Centers for Disease Control and Prevention [CDC] states that medetomidine is an alpha-2 adrenergic agonist sedative, more potent and longer-acting than clonidine and xylazine. It was first identified in the illegal drug supply in 2021, according to the CDC.  

According to the CDC, medetomidine is not approved for human use but is approved for sedation and analgesia in dogs. It is also known as "rhino tranq," "mede" or "dex."

“It’s a fraternal twin to a molecule called xylazine that we’ve had in North Carolina for a few years, just a few different atoms,” said UNC Street Drug Scientist Nabarun Dasgupta.

Dasgupta said those small molecular differences can have severe consequences, especially for people who suddenly stop using the drug.

“If someone stops cold turkey, there's a very good chance that they'll have a heart attack and end up in the ICU for a week,” he said.

The CDC states that medetomidine can cause profound sedation, bradycardia and hypotension. Stopping medetomidine following regular use may lead to severe withdrawal, similar to clonidine withdrawal, with symptoms including hypertension, anxiety, nausea, vomiting and fluctuating alertness, that can require emergency or intensive care.

Because fentanyl is involved in most overdoses involving medetomidine, the CDC states opioid overdose reversal medications should be administered to restore normal breathing in suspected overdoses.

Watch: UNC lab tracks America's 'synthetic soup' of street drugs with Dr. Nabarun Dasgupta

Dasgupta said education and drug-testing tools could help slow the spread of medetomidine before it becomes more widespread in North Carolina.

“I think it's time to think outside the box,” Dasgupta said. “There are test strips that can detect whether the drugs have medetomidine in it, and they're cheap, couple bucks, and so we are encouraging people to be educated about this, to use those test strips, and if they are starting to see their supply regularly contaminated medetomidine, to really think about ... 'it might be the time to really stop using drugs in the way I have been.'”

As medetomidine continues appearing in drug samples across the state, researchers and recovery advocates say awareness may be critical in preventing a larger public health crisis.