Medetomidine Objective Withdrawal Scale (MOWS)

Summary

We are seeing cases of medetomidine withdrawal in hospitalized patients; medetomidine is an alpha-2 adrenergic agonist. This syndrome is driven by autonomic hyperactivity and persists despite aggressive treatment of opioid withdrawal and/or benzodiazepine withdrawal. Patients have been known to decompensate quickly and prompt intervention is imperative to prevent escalation of care to higher acuity areas.

A medetomidine withdrawal protocol has been developed to support recognition, scoring, and management using PRN clonidine.

Background

Over the past two years, medetomidine has emerged as a novel adulterant in the illicit fentanyl supply across multiple regions of North America.

As of December 2025, medetomidine has been detected on over 30% of unregulated opioid samples in the province of British Columbia. In Philadelphia approximately 25% of ICU beds are occupied by patients with complications from medetomidine withdrawal. Watch our interview with Dr. Jeanmarie Perrone (UPENN) on how alpha-2 agonists are changing addiction medicine in Philadelphia.