As the drug toxicity crisis continues to impact families, peers, and neighbours right here in the Tri-Cities, the substances circulating in the unregulated supply are changing rapidly. At the Tri-Cities Community Action Team (CAT), our goal is to ensure frontline workers, peers, and people who use drugs have the most accurate, up-to-date information to handle these shifts.
We want to highlight a vital learning resource recently hosted by CATIE in partnership with the Canadian Centre on Substance Use and Addiction (CCSUA). Their webinar focusing on a powerful substance showing up in the unregulated supply—Medetomidine—is now officially available to stream on-demand.
What is Medetomidine?
Medetomidine is a synthetic veterinary tranquilizer (a non-opioid central nervous system depressant) that is increasingly being detected in the unregulated opioid supply across Canada, including right here in British Columbia.
It is frequently mixed into fentanyl or “down” without a person’s knowledge. While it is chemically similar to xylazine, medetomidine is estimated to be significantly more potent. It can show up in pebbles, chunks, or powders of any color—meaning you cannot see, smell, or taste it.
The Danger: Prolonged Sedation & “The Heavy Nod”
The presence of medetomidine introduces two major, life-threatening safety challenges for our community members:
- Extreme Vulnerability: Medetomidine causes a deep, involuntary state of unconsciousness or “heavy nod” that can last for hours. When folks are physically stuck or completely unresponsive for long stretches, they are left highly vulnerable to extreme weather, theft, physical assault, and intense public stigma.
- It Does Not Respond to Naloxone: Because medetomidine is not an opioid, Naloxone will not reverse its sedative effects.
If someone has taken a mixture of fentanyl and medetomidine, you can give them Naloxone, and they may still remain completely unconscious. This does not mean the Naloxone didn’t work. The Naloxone is actively working to reverse the fentanyl and keep them breathing, but it cannot wake them up from the veterinary tranquilizer.
How to Respond: Focus on Breathing, Not Waking Up
Because of medetomidine, we need to shift how we measure a successful overdose reversal. Our goal is to restore normal breathing, not necessarily to make the person sit up and talk right away.
If you suspect a drug poisoning, take these steps immediately:
- Call 911 right away. Let them know the person is unresponsive.
- Check for breathing. If they are breathing slowly (fewer than 12 breaths a minute) or making gurgling/snoring sounds, give Naloxone.
- Provide rescue breaths. If they aren’t breathing, give 1 breath every 5 seconds. If you have oxygen and are trained to use it, do so.
- Monitor oxygen over consciousness. If their skin/lips return to a normal color and they are breathing steadily on their own, the Naloxone has done its job against the opioids.
- Use the Recovery Position. If they are breathing but remain deeply sedated from the medetomidine, roll them onto their side into the recovery position to keep their airway clear. Stay with them until emergency responders arrive.
How to Stay Safe: Harm Reduction Tips
If you or someone you know uses substances, please practice and share these safety strategies:
- Don’t use alone. Because of the extreme, long-lasting sedation, having a buddy is more critical than ever. If you are using in a group, stagger your use so someone is always alert enough to respond if things go wrong.
- Use the Lifeguard App or Brave App. If you must use alone, use these free BC smartphone apps, or call the National Overdose Response Service (NORS) at 1-888-688-6677. They will stay on the line with you and call for emergency services if you stop responding.
- Get your drugs checked. If you are able to access local drug checking services (like FTIR spectrometry testing), use them to help understand what is in your supply.
- Test your boundaries slowly. When starting a new batch, always do a small test dose first to see how strong the sedative effects are.
Watch the Webinar Recording
For an in-depth look at how this substance is impacting the unregulated supply, the challenges it poses to service providers, and implications for frontline response, you can watch the recorded session directly on the CATIE website.
👉 Watch the CATIE Medetomidine Webinar Recording Here
The Tri-Cities Community Action Team is dedicated to saving lives and reducing the harms of substance use through education, advocacy, and community support. Let’s look out for one another.