As Policymakers Begin to Crack Down on Xylazine (Tranq), They Should Get Ready for Medetomidine

Jeffrey A. Singer

The iron law of prohibition—the harder the law enforcement, the harder the drug—is the reason why, in recent years, fentanyl has replaced heroin, the veterinary tranquilizer xylazine began being added to fentanyl to make more potent and deadly tranq, and, more recently, the synthetic opioid isotonitazene (“iso” or “tony”) has made its debut in the dangerous black market that prohibition fuels. As policymakers keep doubling down on law enforcement strategies to prosecute the futile war on drugs, they provide greater incentives for drug trafficking organizations to create new and more potent drugs and drug combinations to meet market demand.

State lawmakers have begun to crack down on xylazine by designating it a controlled substance. Florida, Ohio, Pennsylvania, and West Virginia have already done so, and several other state legislatures are also considering doing so. The American Veterinary Medical Association has called on Congress to add xylazine to the schedule of controlled substances, and a bill before Congress that would designate xylazine as a Schedule III drug has drawn bipartisan support.

Enter medetomidine/​dexmedetomidine, or Domitor. Law enforcement first detected this veterinary tranquilizer in fentanyl, fentanyl analogs, and cocaine samples seized in Maryland in 2022. The DEA has since detected it in St. Louis and in clandestine laboratory seizures in Florida, Ohio, and Canada.

Like xylazine, medetomidine is a potent veterinary anesthetic/​analgesic. Estimated to be 200 times more powerful than xylazine, PAGround​hogs​.org, a Pennsylvania non‐​profit harm‐​reduction drug testing organization, found it in two bags of fentanyl in Philadelphia and two dozen samples from Pittsburgh, Cambria County, and Blair County in Pennsylvania.

Look for medetomidine to become more prevalent if policymakers make it more difficult for drug traffickers to access xylazine.

Last year, in testimony before the House Judiciary Committee Subcommittee on Crime and Government Surveillance, I warned lawmakers that nitazenes were on the horizon and that doubling down on law enforcement to address the fentanyl overdose crisis may make a nitazene crisis come sooner. Instead, Congress passed the FEND OFF Fentanyl Act, which President Biden recently signed. Intended to put more pressure on the makers of illicit fentanyl and fentanyl precursors, the new law is likely to incentivize drug trafficking organizations to switch more rapidly to nitazenes, the precursors of which will be easy to come by but harder for law enforcement to track.

As is usually the case in the war on drugs, policymakers are fighting the last battle while drug trafficking organizations are opening new fronts.