Hey folks, Scott Weingard here, and this is the M-Crit podcast. Today on the podcast, probably the last

podcast for 2025, I'm going to be doing part three of the opioid series. Part one was with a harm

reduction specialist. Part two was about nidazines and the opioid chain of survival. Those

were both whee's. This one's a podcast because this fits the purpose of

MCRIT to a T. This is metatomedean overdose and withdrawal. And this is clearly a resuscitative

issue. It clearly is an intensive care issue. Many of these metatomedean withdrawal patients

wind up in the ICU. They be really really sick and in philly

it took up you know at any given time between one fifth and one third of their ICU beds and i am sure

this will be coming to an ICU and ed near you so you got to know this stuff hence hence why it is a podcast. I am joined by a guest,

toxicologist, addiction medicine specialist Jean-Marie Perrone. You will hear her introduced in a

moment or two. We're essentially going to be talking about two drugs that are adulterants to the

opioid supply. We'll briefly talk about xylasein,

which is a alpha-2 agonist with spillover to alpha-1. It was prevalent in Philly for a while.

It was causing these horrible wound complications, but it's almost completely gone.

Now it has been superseded by metatomedeen. So that's what the

lion's share of this discussion will be on. And we'll talk about metatomine overdose and how that

looks different than opioid overdose, as well as metatomide withdrawal, which is a pretty

brutal syndrome that patients get

super sick from. So what are these drugs? I mentioned xylosine, alpha-2 agonists was spelled over to

alpha-1. It's non-selective. And then metatomedean might seem new and novel. It's actually not

because it's essentially just dexmedatomodine. And so the thing is,

metatomodine is the racemic mixture of dex metatomidine and levo metatomodin. Dex metatomiton just

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