Medetomidine and its active isomer dexmedetomidine ('dex') are rapidly replacing xylazine ('tranq') as adulterants in the illicit fentanyl supply. Reports from cities like Philadelphia indicate a massive surge in prevalence, rising from 29% to 87% of fentanyl samples within months. This shift complicates overdose reversal and causes severe health complications, including heart and brain damage and agonizing withdrawal symptoms.
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