Pittsburgh-area emergency rooms are facing a surge in patients exhibiting violent withdrawal symptoms after overdosing on a dangerous drug combination, raising concerns among healthcare workers.
For years, paramedics and emergency medical technicians in Pittsburgh have relied on naloxone, commonly known as Narcan, to reverse opioid overdoses and transport patients to hospitals for further care. However, in recent months, doctors have observed a disturbing trend: patients becoming unexpectedly combative and aggressive while in the hospital, creating a safety risk for both themselves and staff.
“They’ll come out of this opiate overdose state and go into this severe withdrawal state sometimes right in front of our eyes,” explained Dr. Brent Rau, the director of emergency medicine at Allegheny General Hospital.
Allegheny General Hospital’s emergency department is currently treating approximately a dozen patients each week who have overdosed on a mixture of fentanyl and medetomidine, an extremely potent veterinary sedative. Dr. Rau noted that as the drug’s effects subside, patients can experience violent withdrawal reactions, with heart rates escalating dramatically from as low as 30 beats per minute to 160 or 170 beats per minute. This can lead to a loss of bodily control, delirium, and physical altercations with medical personnel.
“They’re extraordinarily agitated,” Rau said. “They can’t sit in bed, their picking at different things, clawing at staff. They usually need to be restrained for their own safety as a patient.”
The situation mirrors a crisis unfolding in Philadelphia, where medetomidine has led to what health officials describe as a widespread withdrawal emergency and overwhelmed emergency rooms. Testing conducted by Prevention Point in Pittsburgh reveals that two-thirds of the fentanyl sold on the streets is now laced with medetomidine. Consequently, emergency rooms experienced a significant influx of patients throughout the spring and summer months, with both Allegheny Health Network and UPMC reporting a substantial increase in cases.
UPMC Mercy is admitting two to three patients daily experiencing extreme withdrawal, while other UPMC facilities are admitting several patients each week. This surge is straining resources and creating a critical need for available beds. According to Michael Lynch, UPMC’s senior medical director of substance abuse services, staff and security personnel are implementing additional measures to manage violent patients, many of whom require sedation and monitoring in the intensive care unit for several days.
“It’s clear that it’s significantly altering the way that we practice in emergency medicine in Pittsburgh,” Lynch said.
While Pittsburgh’s situation isn’t yet as severe as Philadelphia’s, both UPMC and Allegheny Health Network are preparing for a potential escalation.
“No, we are not to that level, but the concern is these things tend to drift from east to west,” Rau said.
