As overdose deaths fall, a changing drug supply is making Philadelphia’s opioid crisis harder to escape

From Philly and the Pa. suburbs to South Jersey and Delaware, what would you like WHYY News to cover? Let us know!

“Excruciating doesn’t even begin to cover it,” said Thomas Harris, who’s been using “dope” for years. “Physically, I’ve never felt closer to dying.”

That afternoon, Harris stood underneath the Market-Frankford Line on Kensington Avenue waiting for a bus. He was dressed for a much colder morning, and sweat streamed down his face in the late October warmth. “I’m not using to get high anymore,” he said.

Overdose deaths in the city have fallen to their lowest level in nearly a decade, but some people who use illicit opioids say it’s never been harder to stop. One reason is the proliferation of medetomidine, a potent veterinary sedative, in Philadelphia street drugs since at least 2024.

The high

In Philadelphia, “dope” commonly refers to illicit drugs sold as opioids, often in small packets known as stamp bags.  What those packets contain has changed dramatically in recent years.

“A lot of people are really confused because the high, by all measures, is incredibly unpleasant,” said Dr. Jamaal Shaban, a general surgeon who frequently works with harm-reduction organizations throughout Philadelphia.

“With heroin, you saw casual use in the early to mid-1900s,” Shaban said. But the prevalence of fentanyl and other additives in the street-drug supply has increased the risk of dependence compared with heroin alone.

Fentanyl is a short-acting opioid. When used intravenously, most of its effects subside within an hour, according to the U.S. Food and Drug Administration. As soon as those effects wear off, withdrawal can begin. Sedatives such as medetomidine and xylazine can prolong a high and delay withdrawal symptoms by several hours, Shaban said.

“Medetomidine, on its own, does not create a pleasurable experience in any way,” said Hamilton Morris, a researcher, former chemist at the University of the Sciences in Philadelphia and journalist known for his Vice Media series “Hamilton’s Pharmacopeia.”

“The sedation is unlike anything I’ve ever seen,” said Anthony Kasper, a Kensington-based outreach worker. “Half the time, you can’t tell if someone’s dying or if they’re just high.”

That makes overdoses much more difficult to manage, he said. Narcan — also known by its generic name, naloxone — can reverse the effects of opioids, but not medetomidine. Experts say Narcan should still be administered in all cases of suspected opioid overdose.

Medetomidine was present in around 70% of drug samples tested by the Philadelphia Department of Public Health in 2025, while xylazine was only present in 30% to 40%, according to a department report.

“It’s cliché, but it’s much more of a silent killer,” Shaban said.

Medetomidine causes very low blood pressure, which can damage kidneys. Withdrawal can pose a different threat, including sustained elevated heart rate and blood pressure and a severe muscle breakdown that can also damage the kidneys, according to a 2026 Delaware Department of Health and Social Services report.

“You’re seeing very young people, people who historically would have had no major health issues from drug use, come into hospitals with kidney failure,” said Sarah Laurel, founder of Philadelphia and Delaware County-based recovery organization Savage Sisters.

A young person helped by Savage Sisters recently died of kidney failure stemming from their medetomidine use many months after getting clean, Laurel said.

‘They’re not treating what needs treating’

“It can be an exceptionally violent detox process,” said Dr. Jason Wallach, a chemist who runs St. Joseph’s University’s pharmacology lab.

Withdrawal from medetomidine can cause life-threatening complications, Shaban said. But current detox procedures don’t adequately address the needs of patients who are dependent on the city’s present dope blend, he said.

Harris said he’s experienced that gap firsthand.

“[Detox clinics and hospitals] only treat for opioids, so you just have to suffer,” he said. “They treat you for opioids, not medetomidine. They’re not treating what needs treating.”

“The last time I ended up in the hospital, nobody would give me Precedex,” he said.

Precedex, the brand name for dexmedetomidine, is a sedative that can help counter some of the most dangerous symptoms of medetomidine withdrawal, Shaban said. But it generally must be administered intravenously under close medical supervision, often in an intensive care unit, making it difficult to use in conventional detox facilities.

Philadelphia health officials have issued guidance recommending medical providers use dexmedetomidine and another medication, clonidine, to treat medetomidine withdrawal.

Hospitals can stabilize patients experiencing medetomidine withdrawal, but there is no established system for helping them recover from dependence on the drug, said Dr. Jeanmarie Perrone, an emergency room physician and founding director at the Penn Medicine Center for Addiction Medicine and Policy.

“People can’t get on dexmedetomidine for the rest of their lives,” she said.

“Current ICU volume challenges” further complicate physicians’ ability to treat patients in acute withdrawal, she said.