Racked with nausea and full-body tremors, Derek Smith could not stop vomiting last month.

The 42-year-old Cecil County construction worker had become addicted to illegal opioids four years ago while trying to numb the pain from a heartbreaking string of misfortunes: the loss of his home to a fire, his wife to a divorce and his father to a car crash.

After a recent overdose, he thought about his 4-year-old son growing up without a father. So once again, he tried to quit. But thanks to a dangerous new additive tainting the Maryland drug supply, the withdrawal this time was far worse, forcing him into a desperate prayer:

“God, give me another day, another hour, another minute.”

Over the past year, a growing amount of the powerful animal sedative called medetomidine has been found in drug samples collected from syringe exchange programs across Maryland.

It’s usually mixed with fentanyl, making the potent synthetic opioid even more dangerous to use and harder to quit, according to people who use drugs and addiction medicine experts interviewed by The Banner. Drug dealers are cutting sedatives like medetomidine into fentanyl in an attempt to extend the high, law enforcement experts say.

Doctors are also reporting an increasing number of patients in Maryland who are dangerously sick with drug withdrawal. They have had to spend days in a hospital’s intensive care unit because typical treatments haven’t worked.

And bystanders are struggling to revive people from overdoses. That’s because the opioid-reversal drug naloxone is not effective against a sedative like medetomidine.

In October, health officials traced medetomidine to a mass overdose in Baltimore’s Penn North neighborhood that rendered 11 people unconscious before they were revived — the third such incident to hit the neighborhood since July.

Though only trace amounts of medetomidine have been confirmed in most parts of Maryland so far, the substance has proliferated alarmingly quickly in Philadelphia, a city which has served as a kind of early warning sign for Baltimore because of the drug trafficking that travels south down Interstate 95.

Now some are worried a wave could be coming for Baltimore, which in recent years has struggled with an overdose crisis worse than in any other major city in the country.

“Clearly the same supply is starting to drift down,” said Dr. Josh King, medical director of the Maryland Poison Center and an associate professor with the University of Maryland’s schools of medicine and pharmacy.

With area hospitals already crowded, “we should start preparing now in the emergency medicine space,” King said, noting that health systems and government agencies are developing detailed plans on how to recognize and respond to medetomidine withdrawal.

Doctors in a special unit at Johns Hopkins Bayview Medical Center that helps people in drug or alcohol withdrawal said they had been largely clueless about medetomidine. Then in October 2024, a patient checked in with tremors so severe they looked like seizures, extreme nausea and a dangerously high heart rate and blood pressure, said Dr. Jordan Nahas-Vigon, an addiction medicine specialist.

It wasn’t until Nahas-Vigon and colleagues consulted with a doctor friend in Philadelphia that they understood what was happening.

Since then, Bayview has treated at least 15 patients who needed around-the-clock treatment in the intensive-care unit, each stay usually lasting around three days, but some extending more than a week, she said. Though opioid withdrawal can also be dangerous, typically it is less severe and doesn’t require intensive care.

If more medetomidine entered the drug supply in Baltimore, “it would be a real strain on the system,” Dr. Nahas-Vigon said.

Smith, the single father in Cecil County who prayed for fortitude during his painful withdrawal, checked in at Bayview’s withdrawal treatment unit and spent five days in the hospital. Once the worst passed, doctors prescribed him buprenorphine, a medication to curb opioid cravings and prevent future overdoses, he said.

“They actually saved my life,” said Smith.

Never meant for people

Medetomidine was never meant for human consumption.

Veterinarians use the chemical to sedate dogs before surgery, and industrial marine paint manufacturers add it to their products to deter barnacle growth.

It’s a reality on the street that people who use drugs are often in the dark about what substances they’re actually snorting, injecting or smoking. But the rise of new and dangerous additives like medetomidine, experts say, has made that gamble even more risky.

The recent increase in medetomidine appears to be linked to authorities’ attempts to crack down on xylazine, another animal sedative. Xylazine had been commonly mixed with fentanyl and can cause severe flesh wounds when injected, experts say.

After Pennsylvania lawmakers made xylazine a controlled substance last year, there were signs that it began fading from the drug supply. Emergency room visits for drug-related skin damage fell while the number of visits for drug-related withdrawal rose, the Philadelphia Inquirer reported in November.

Dr. Ashish Thakrar, an assistant professor at the University of Pennsylvania’s Perelman School of Medicine, said medetomidine has “had a huge and dramatic impact” on Philadelphia’s health care system because of the many patients in intensive-care units for severe drug withdrawal.

Xylazine is not restricted in Maryland. The state health department concluded that attempts to control the substance in other places, such as Pennsylvania, led to increases in opioid overdoses with medetomidine, said department spokesperson Amanda Hils.

Cecil County, which is Maryland‘s county closest to Philadelphia, has seen by far the highest amounts of medetomidine in the state. Nearly half of drug samples collected from syringe exchange programs in the county from April 2024 to June 2025 tested positive for the substance, according to the Maryland Department of Health’s Rapid Analysis of Drugs program.

Around the same time, the county has seen a decline in the number of severe xylazine-induced skin wounds, according to Erin Wright, chief operations officer of Voices of Hope, a local nonprofit providing addiction recovery services.

“We have people hooked up to ventilators and breathing machines and they’re in medically induced comas,” Wright said, describing patients suffering from medetomidine withdrawal. “It’s like you trade one for the next, and none of it is good.”

There are also some countervailing signs that the amount of medetomidine in the drug supply may be falling, according to Dr. Enrique Oviedo, chief medical officer of MATClinics, which operates eight drug treatment offices across Maryland.

An analysis of thousands of monthly urine samples shows the percentage of drug treatment patients who tested positive for medetomidine peaked at 15% in the summer and dramatically fell to less than 1% by October, he said.

But it doesn’t mean that health officials should relax, he said. “It’s more important than ever for all providers in the field, emergency rooms to pay close attention.”

On the front lines, community-based organizations are spreading the news.

SPARC Women’s Center in Baltimore’s Pigtown neighborhood offers medetomidine test strips alongside ones for xylazine and fentanyl. That’s so people can gain a better understanding of what is in their drugs before they start using.

Staff at the center collect used drug paraphernalia to be tested at a national lab for medetomidine and other dangerous additives. They also solicit stories from clients about their experiences using drugs with unexpected effects.

All that information is shared through the organization’s networks, said Sam Wu, the group’s outreach program coordinator. In response to sedatives like medetomidine in the drug supply, SPARC is also training the public how to provide rescue breathing — in addition to administering naloxone and calling 911 — when responding to an overdose.

“People want to be informed,” Wu said, adding, “One of the most crucial things we can do is sharing resources and knowledge.”

Banner reporter Meredith Cohn and data journalist Allan James Vestal contributed to this report.