Emerging Illicit Substances: What Clinicians Need to Know

EP 02

🎙 Special Series: ASAM's 56th Annual Conference

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This episode is part of a special four-part series spotlighting key sessions from ASAM’s 56th Annual Conference.

 

In this episode of ASAM Practice Pearls, In this episode of ASAM Practice Pearls, Dr. Stephen Taylor is joined by Drs. Jeanmarie Perrone and Alaina Steck to explore key insights from their session, Emerging Illicit Substances: What Clinicians Need to Know. The conversation covers emerging drugs of concern, clinical challenges, and practical strategies for clinicians navigating this rapidly evolving field.

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Host

Stephen M. Taylor, MD, MPH, DFAPA, DFASAM

Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.

Expert

Jeanmarie Perrone, MD

Dr. Jeanmarie Perrone is a Professor in the Department of Emergency Medicine and the founding Director of the Center for Addiction Medicine and Policy at the University of Pennsylvania. Dr. Perrone leads programs for the treatment of Opioid and Alcohol Use Disorders in the emergency department (ED) and a virtual telehealth bridge clinic (CareConnect). Her work has been funded by city health departments and by NIDA, PCORI, CDC, and SAMHSA. She has advocated at the state and national levels and contributed to working groups to enhance low-barrier treatment access for substance use disorders. She has been recognized with awards for leadership, education and mentorship and her initiatives have been featured in the media including National Public Radio, the New York Times and USA Today.

Expert

Alaina Steck, MD

Dr. Alaina R. Steck is an Associate Professor in the Emory Department of Emergency Medicine. She completed her residency training in Emergency Medicine at Boston Medical Center in Boston, MA, and her fellowship in Medical Toxicology at the Emory / Centers for Disease Control and Prevention Combined Fellowship in Medical Toxicology, followed by board certification in Addiction Medicine. She currently serves as the Medical Director of the Grady Medication for Alcohol and Opioid Use Disorder Treatment clinic, the Addiction Medicine Clerkship Director, Assistant Medical Director at the Georgia Poison Center, and Pharmacology Thread Director at the Emory School of Medicine.

📖 Show Segments

• 00:05 – Introduction
• 00:59 – An Overview of the Emerging Illicit Substances Session
• 02:08 – What Practitioners Should Know about Emerging Illicit Substances
• 03:36 – Specific Substances of Growing Concern
• 04:35 – Challenges in Clinical Practice
• 05:33 – Surprising Insights and Discussion from the Session
• 06:40 – Resources for Recent Data Trends
• 07:19 – Key Lessons for Practitioners to Implement Now
• 08:56 – Unique Withdrawal Syndromes 
• 11:27 – Anecdotal Examples of Rising Illicit Substances
• 14:06 – Communicating with Colleagues
• 16:14 – Conclusion and Additional Learning Opportunities

📋 Key Takeaways

• Emerging Illicit Substances: The landscape of psychoactive substances is evolving rapidly, with new agents continually appearing on the market.
• The Rise of Medetomidine as an Illicit Drug Adulterant: Medetomidine, a veterinary anesthetic, is an emerging concern as it seeps into the fentanyl drug supply as a replacement for xylazine in some parts of the country.
• New Withdrawal Syndromes: Medetomidine has led to a unique withdrawal syndrome that requires high-dose opioids and other sedative agents for management.
• Importance of Naloxone: Despite the emergence of new substances, fentanyl remains a major driver of opioid fatalities, and naloxone is still effective for these overdoses.
• Communicate with Colleagues: Regional variations can significantly impact the local drug supply, making communication and information sharing between different parts of the country critical to identifying trends and preparing effective responses.
• Utilize Available Resources: Important resources, such as the National Drug Early Warning System and local drug checking services, can inform clinicians about local and national trends.

🔗 Resources

• ASAM’s 56^th Annual Conference Sessions: Access HERE
• Opioid Withdrawal and Autonomic Complications Associated with Medetomidine Adulteration: Access Poster HERE
• CAMP Webinar Recording: An Emerging Adulterant in Philadelphia: Medetomidine Withdrawal in People Who Use Fentanyl - Discusses the latest findings on medetomidine.
• CDC SUDORS Dashboard - National Drug Overdose Fatality Data Source.
• CSFRE NPS Discovery - The Center for Forensic Science Research and Education provides drug and forensic toxicology testing results, trend reports, and emerging new substances data.
• Drug Overdose Toxico-Surveillance (DOT) Reporting Program - The Emergency Department Overdose Biosurveillance Project, conducted by the American College of Medical Toxicology in collaboration with CSFRE, assesses the sociodemographic characteristics, clinical information, and contextual data on opioid and/or stimulant overdoses.
• National Drug Early Warning System (NDEWS) - Provides real-time surveillance and research on emerging drug trends in the U.S., offering tools like machine learning analyses, online monitoring, and community-based reporting to inform public health responses.
• National Forensic Laboratory Information System (NFLIS) - A DEA program that collects and analyzes forensic drug chemistry laboratory data, medical examiner and coroner data, and toxicology laboratory data across the U.S., providing data resources, publications, and a public data query system to support drug enforcement and public health initiatives.
• PENN CAMP: Center for Addiction Medicine and Policy – Offers information and resources related to addiction medicine in clinical services, educational programs, community engagement, harm reduction strategies, research initiatives, and policy and advocacy.
• StreetCheck: Community Drug Checking – A community-partnered platform that streamlines the collection, analysis, and reporting of drug samples for harm reduction programs, offering tools such as a web-based app, training resources, and real-time drug trend data to help communities respond to the evolving illicit drug supply.
• Notes from the Field: Suspected Medetomidine Withdrawal Syndrome Among Fentanyl-Exposed Patients — Philadelphia, Pennsylvania, September 2024–January 2025: Huo S, London K, Murphy L, et al. MMWR Morb Mortal Wkly Rep 2025;74:266–268.

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