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35th AM (2025) - Poster Session
From TranqDope to Demon Dope Lessons From Philadel ...
From TranqDope to Demon Dope Lessons From PhiladelphiaFeld
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This poster reports on the emerging public health problem of medetomidine (nicknamed “Demon”) contamination in the illicit opioid supply in Philadelphia, particularly among fentanyl users. Medetomidine, an alpha-2 agonist previously only known from veterinary medicine, is increasingly detected in opioid users and is associated with opioid potentiation, autonomic instability, and severe withdrawal often necessitating ICU-level care.<br /><br />The authors present the case of a 30-year-old female with opioid use disorder on methadone who presented multiple times at an outpatient clinic excessively drowsy, with hypotension and bradycardia. She reported intravenous use of a combination of “Demon” (medetomidine), “Tranq,” and fentanyl. After syncope and worsening vital signs, she sought inpatient rehab but was admitted through the emergency department for severe withdrawal. She was treated with intravenous dexmedetomidine following an ICU protocol, stabilizing her before transfer to a stepdown unit for symptomatic management.<br /><br />Medetomidine, a racemic mixture used in veterinary sedation, can cause profound hypotension, bradycardia, and somnolence. Its presence in the illicit opioid supply raises concerns of a spreading epidemic along east coast patterns noted in prior substance geographic analyses. Institutional responses have included expanding the availability and use of dexmedetomidine to manage withdrawal symptoms outside the ICU, including initiation in emergency departments and stepdown units.<br /><br />The article highlights the need for clinician awareness about "Demon" contamination, its clinical effects, and the challenges in managing withdrawal. Additional resources include poison control centers, Substance Use Prevention and Harm Reduction programs, and recent biochemical studies identifying medetomidine exposure in fentanyl users in Philadelphia.<br /><br />This growing issue calls for continued surveillance, clinical preparedness, and expanded treatment protocols to address the complex, often severe presentations seen with medetomidine-contaminated opioid use.
Keywords
medetomidine
Demon contamination
illicit opioid supply
fentanyl users
opioid potentiation
autonomic instability
severe withdrawal
ICU-level care
dexmedetomidine treatment
opioid use disorder
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