'Unusual symptoms' in overdoses suggests new drug laced into fentanyl has reached Wisconsin

Health officials in Milwaukee and Dane counties are raising alarms that a powerful chemical sedative could complicate and worsen the opioid crisis.

Health officials say medetomidine, an animal tranquilizer, is being mixed with fentanyl and other street drugs in cities around the country.

“Medetomidine’s presence in the illicit drug supply is an emerging public health issue across the nation,” said Michelle Haese, state Department of Health Services director of substance use initiatives, in an email to the Journal Sentinel. “Wisconsin remains committed to monitoring this trend closely.”

Public Health Madison & Dane County issued an overdose spike alert Thursday noting “unusual symptoms after drug use” over a 48-hour period across Dane County. At least 10 residents received treatment from local hospitals for suspected opioid overdoses, which is more than public health officials typically see in the community in such a short time frame.

It comes on the heels of another spate of unusual overdoses. Last week, seven other residents who’d taken crack cocaine reported symptoms of drowsiness, nausea, sedation and weakness, which is especially noteworthy because crack cocaine typically elicits the opposite effects, said Jake Niesen, a public health program coordinator for Public Health Madison & Dane County.

That response has raised the specter that the crack was mixed with something, although Niesen said it's not clear from the emergency medical service report what exactly it was mixed with.

New drug makes opioid overdoses more likely

Medetomidine’s entry in the state further challenges what health officials term "harm reduction" efforts, Niesen said, or how to engage people who use drugs with better safety measures. It demonstrates the swiftness with which the illicit drug market can change. The fast-changing drug scene makes “opioid-naïve” people more vulnerable, Niesen said.

“Before we had oxycontin, we had heroin, and then we had fentanyl. Now we have Nitazene, we have xylazine, medetomidine, we have ketamine in the supply, we have seroquel in the supply, we have quetiapine in the supply,” Niesen said. “There’s just an abundance of things in drugs. That definitely is very challenging to navigate.”

More: Drug overdose deaths in Milwaukee have doubled in the past decade. Here's how you can respond.

Medetomidine shares similar traits with xylazine, also known as “tranq,” another powerful animal tranquilizer that recently made its way into Wisconsin’s illicit drug market. Similar to xylazine, medetomidine causes negative health outcomes like sedation, slowed heart rate and difficulty breathing, symptoms that are further exacerbated when taken with opioid and non-opioid sedatives, Haese said.

One key distinction for Niesen is medetomidine’s higher sedative potency than xylazine.

And, like xylazine, medetomidine is not affected by opioid-reversing drugs like Narcan, making it especially dangerous in overdose cases.

“It makes opioids even more dangerous and harder to reverse,” said Dr. Ben Weston, an emergency physician and the director of medical services for the Milwaukee County Office of Emergency Management.

Still, health care officials emphasized that Narcan or naloxone nasal spray should always be administered in suspected overdoses. The tranquilizer is often found in opioid cocktails, and Narcan would have an effect on the opioid component.

“If you have naloxone nasal spray available, you want to certainly administer it. Because opioids are almost always a component of what’s going on,” Weston said.

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Already, mass overdose outbreaks linked to medetomidine have cropped up in Philadelphia and Chicago. The Philadelphia Department of Public Health issued a public health advisory May 13 after 160 residents were hospitalized over a three- to four-day period.

Seven days later, Chicago Public Health issued its own high-level public health advisory on the effects of medetomidine. It’s the first time the drug had entered the recreational drug supply in either city.

Wisconsin officials have not identified medetomidine in any overdose deaths yet. But the Milwaukee County medical examiner has begun testing for the drug.

“Unfortunately I wouldn't be surprised if it is circulating in Milwaukee,” Weston said.

The county has seen a “concerningly high level” of overdoses recently, Weston said — including 18 emergency calls for overdoses in 24 hours on Monday — but it was not possible to link those calls to medetomidine.

Considering it is already present in Chicago, Weston expects medetomidine to mirror xylazine’s rapid spread across the country. In just two years, xylazine went from not being on the radar to being responsible for 5% of all overdose deaths in Wisconsin .

“The trends that we are seeing nationally probably mean that it’s only a matter of time until we see medetomidine here in Milwaukee County and in Wisconsin,” Weston said.

More: Slate of suspected overdose deaths prompts officials to warn of possible 'bad batch' of street drugs

Fentanyl remains the main concern

Still, public health officials remain focused on the broader opioid crisis. Fentanyl, Haese said, continues to “command our attention, as this powerful drug continues to poison our communities causing tragic overdose fatalities.”

Fentanyl has dominated the drug scene to such an extent that it’s become the main attraction of drug users, Niesen emphasized.

“The society model of fentanyl being cut, that’s long gone. Heroin is cut into fentanyl, it’s not the other way around,” Niesen said. “Fentanyl is the drug. That’s it.”

Niesen wants to see the state commit to comprehensive drug checking services, which go far beyond drug test strips. Wisconsin currently does not have comprehensive drug checking services, which would allow for people to have their drugs tested for potency levels and analyzed to detect every ingredient from sugar to fentanyl.

It’s important for users to understand their drugs could be laced with unknown substances, said Capt. Gregory Miller of the Milwaukee Fire Department. He is the director of the Milwaukee Overdose Response Initiative.

“You have to question everything,” Miller said. “Be very skeptical of whatever you’re using.”

There have been 166 confirmed drug deaths in Milwaukee County this year, according to data from the medical examiner. There are 66 additional deaths that are still pending a final cause, but the medical examiner considers them probable overdoses.

How to find help

A list of fire station locations to receive a free Narcan Hope Kit is available at https://tinyurl.com/98b636jh . The kits include xylazine test strips.

The Milwaukee Health Department has Narcan and fentanyl test strips available at Keenan Health Center, the Northwest Health Center, and Zeidler Municipal Building. Anyone searching for these items can also contact the health department anonymously by emailing HarmReduction@milwaukee.gov or calling (414) 286-3521 .

If you need help with mental health and substance abuse issues, the Milwaukee County Behavioral Health Division has a crisis line: 414-257-7222.

Public Health Madison & Dane County distributes harm reduction supplies such as fentanyl test strips and Narcan from its Syringe Services Program at  2705 E. Washington Ave. or 2300 S. Park St. in Madison.

You can also contact the Behavioral Health Resource Center of Dane County for treatment and recovery services: 608-267-2244.

The federal Substance Abuse and Mental Health Services Administration has a free, confidential, 24/7, 365-day-a-year treatment referral and information service in English and Spanish for individuals and families facing mental and/or substance use disorders: 800-662-HELP (4357).

Natalie Eilbert covers mental health issues for the Milwaukee Journal Sentinel. She welcomes story tips and feedback. You can reach her at neilbert@gannett.com or view her Twitter profile at @natalie_eilbert . Sophie Carson is a general assignment reporter who reports on religion and faith, immigrants and refugees and more. Contact her at scarson@gannett.com or 920-323-5758.

This article originally appeared on Milwaukee Journal Sentinel: 'Unusual symptoms' in overdoses suggests new drug laced into fentanyl has reached Wisconsin