By: Amy Racines, MS, Research & Development Senior Project Coordinator

The opioid crisis has affected the United States for more than a decade. In 2017, the United States declared the opioid crisis a public health emergency, and, since then, new drugs have emerged on the illicit market with fentanyl, xylazine, and, most recently, medetomidine¹. Medetomidine entered the illicit market in July 2022 and has been on the rise ever since, with public health alerts issued from late 2023 through 2024². It is almost always used in combination with opioids, and the user may not be aware of its presence.  

Medetomidine is a potent and short-acting sedative and analgesic medication. Medetomidine can exist as two isomers: dexmedetomidine or levomedetomidine. Dexmedetomidine was approved for use by the FDA in 1999, and it is currently being used for critically ill patients, during surgery, or for those on ventilators³. It is only available by prescription. Medetomidine can also exist as a racemic mixture of both isomers, levomedetomidine and dexmedetomidine. This form is only approved for use in veterinary medicine and is not approved for human consumption, yet it has entered the illicit market¹. 

Medetomidine is about 200 times more potent and 10 times more selective than xylazine, and its effects are longer-lasting^4,5. It binds to the alpha2-adrenoergic receptor just like xylazine. Medetomidine’s desired effects include sedation, muscle relaxation, analgesia, and anxiolysis⁶. However, the adverse effects of medetomidine are mainly respiratory and cardiovascular effects such as bradycardia and associated arrhythmias, hypertension or hypotension, and reduced cardiac output. NARCAN has no effect on a medetomidine overdose, though it should still be used due to medetomidine use often being concurrent with opioid use. The medication atipamezole reverses the sedative and cardiovascular effects of medetomidine in some animals, though it has never been studied in humans⁷. 

References:

1. Medetomidine Infiltrates the US Illicit Opioid Market 
2. Medetomidine_Public_Health_Alert__Final.pdf 
3. Use of dexmedetomidine in critical-ill patients: is it time to look to the actual evidence? | Critical Care | Full Text 
4. Scheinin, H., Virtanen, R., MacDonald, E., et al. Medetomidine—a novel alpha 2-adrenoceptor agonist: a review of its pharmacodynamic effects. Prog. Neuropsychopharmacol. Biol. Psychiatry. 13:635–651, 1989. [DOI] [PubMed] [Google Scholar] 
5. 9. Tyner, C.L., Woody, B.J., Reid, J.S., et al. Multicenter clinical comparison of sedative and analgesic effects of medetomidine and xylazine in dogs. J. Am. Vet. Med. Assoc. 211:1413–1417, 1997. [PubMed] [Google Scholar] 
6. A review of the physiological effects of α2-agonists related to the clinical use of medetomidine in small animal practice – PMC 
7. Sedative and cardiopulmonary effects of medetomidine hydrochloride and xylazine hydrochloride and their reversal with atipamezole hydrochloride in calves in: American Journal of Veterinary Research Volume 69 Issue 3 

 Learn more about Medetomidine Testing at USDTL.

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By: Amy Racines, MS, Research & Development Senior Project Coordinator

Phenibut was first developed in Russia in the 1960s to relieve anxiety, insomnia, and alcohol withdrawal and as a potential treatment for Parkinson’s disease¹. It is structurally similar to a naturally occurring neurotransmitter, GABA, and therefore mimics GABA in the body. Phenibut is still widely used in Russia but is banned in some European countries. In the United States, it is not scheduled, banned, nor approved by the FDA. Phenibut is readily available to be purchased online and is frequently advertised as a supplement for anxiety, sleep, and post-traumatic stress disorder². 

The desired effects of phenibut include sedation and decreased consciousness, but other reported symptoms include agitation, delirium, seizures, hallucinations, and decreased respiration³. Tolerance is observed with phenibut use, with some cases happening in less than a week, and therefore dependence can occur. Since there is no FDA regulation or guidance of this compound, it has been reported that users take far greater doses than the recommended dose of 500-1500 mg/day, further increasing their risk of dependence⁴. Withdrawal symptoms can include hallucinations, psychosis, agitation, tachycardia, hyperthermia, seizures, and myoclonus. 

The statistics on phenibut use in the United States are unknown, but the number of calls to poison control centers involving phenibut has been on the rise since 2015⁵. It is thought that the key demographic of phenibut users is males between the ages of 20-35⁶. Many users may not be aware of their addiction, especially since phenibut is advertised as a supplement, so further public awareness and education around this compound is needed.  

 References:

1. https://www.cdc.gov/mmwr/volumes/69/wr/mm6935a5.htm) 
2. https://pmc.ncbi.nlm.nih.gov/articles/PMC5952553/ 
3. July21-Phenibut.pdf 
4. A Systematic Review of Phenibut Withdrawals 
5. Notes from the Field: Phenibut Exposures Reported to Poison Centers — United States, 2009–2019 | MMWR 
6.  A Systematic Review of Phenibut Withdrawals 

 Learn more about Phenibut Testing at USDTL.

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We are excited to announce the addition phenibut, medetomidine, and tianeptine to our umbilical cord tissue, hair, and nail testing menus. These substances can be ordered as an individual test or an add-on to any umbilical cord tissue, hair, or nail drug panel beginning March 10, 2025.

Click here to learn more about our new phenibut, medetomidine, and tianeptine testing.

For more information on hair testing click here, for more information on nail testing click here, and for more information on umbilical cord tissue testing click here. 

Jones, J. , Coy, D. and Jones, M. (2024) A Comparison of Turnaround-Times for Two Popular Specimen Types Used for Newborn Toxicology: Meconium and Umbilical Cord Tissue. Open Journal of Obstetrics and Gynecology, 14, 1541-1547. DOI: 10.4236/ojog.2024.1410123.

Screened Negative Results = ~24 Hours* Confirmed Results (positive/negative) = additional ~48-72 Hours*
*Estimates are calculated based on the time the specimen is received at our laboratory.

Abstract

Background: Prenatal exposure to illicit substances is responsible for several long-term negative health consequences. It is critical for healthcare professionals to know the extent and scope of prenatal substance exposure in their cases. Several studies exist with mixed results comparing the effectiveness of umbilical cord tissue (UCT) and meconium (MEC) as toxicology specimen types. The specific aim of this study is to compare the use of UCT and MEC regarding the time interval between the birth of the neonate, receipt of the specimen at the laboratory, and the hospital’s receipt of the final toxicology report.

Method: The study queried de-identified results of 5358 consecutive UCT and 706 MEC from our laboratory.

Results: The mean time from birth to receipt of the specimen at the laboratory for MEC and UCT was 4.5 days ± 2.9 days and 2.8 days ± 1.9 days, respectively. The mean time from birth to final report for MEC was 6.9 days ± 3.8 days, 5.7 days ± 3.3 days, and 8.4 days ± 3.8 days for all MEC specimens, negative MEC, and positive MEC, respectively. The mean time from birth to final report for UCT was 4.3 days ± 2.4 days, 3.5 days ± 2.2 days, and 5.4 days ± 2.2 days for all UCT, negative UCT and positive UCT, respectively.

Discussion/Conclusion: Receipt of drug test results of the neonate prior to release from the hospital is critical. This study shows that UCT offers an advantage when results are needed quickly to make informed decisions about the health and well-being of newborns.

Click here to read the full abstract. Click here to learn more about our Newborn Testing. 

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Jones, J., Coy, D., Gidron, D. et al. Using umbilical cord tissue to identify prenatal ethanol exposure and co-exposure to other commonly misused substances. J Perinatol (2024). https://doi.org/10.1038/s41372-024-02075-2

Abstract

Click here to read the full abstract. Click here to learn more about umbilical cord tissue testing. 

Jones J (2023) Toxicology as a diagnostic tool to identify the misuse of drugs in the perinatal period. Front. Pediatr. 10:1071564. doi: 10.3389/fped.2022.1071564

Abstract

The use, misuse, and abuse of substances are a continued public health concern in this country and around the world. Perinatal exposure to substances of abuse is associated with several long-term negative consequences for the neonate. Limited resources exist to assist perinatal health professionals on this very complex subject. The purpose of this document is to provide additional information about selecting monitoring protocols, the specifics of appropriate testing methodologies, and the interpretation of toxicological findings. Understanding these concepts better allows perinatal healthcare professionals to be a voice for the voiceless in order to protect and enrich lives during this unprecedented opioid epidemic.

Acknowledgments

I would like to thank Loretta Finnegan for the encouragement to prepare this manuscript. Additionally, I would like to thank Guida Brown for reviewing and editing the paper.

Click here to read the full abstract. Click here to learn more about Newborn Testing. 

We will be implementing an important update to our system over the weekend. Unfortunately, this means the system will be down over the weekend, 10/26-10/27.

As a result, there may be some delays in the processing of specimens. We appreciate your understanding and patience during this time. If you have any questions, please feel free to contact us.