Profound Opioid and Medetomidine Withdrawal: A Case Series and Narrative Review of Available Literature

Medetomidine, a potent veterinary α-2 agonist, has emerged as a fentanyl adulterant in the non-medical opioid supply. Its use has been linked to a novel withdrawal syndrome that is often resistant to conventional treatment protocols. Four cases are presented demonstrating extreme forms of this withdrawal syndrome. A literature review is provided showing both the paucity of available literature as well as potential avenues for treatment and future research. As adulterants continue to proliferate in the illicit drug supply, clinicians should anticipate atypical withdrawal phenotypes and consider early aggressive intervention.