Older age had one of the strongest associations with mortality. Each additional decade of life was associated with a 50% higher hazard of tuberculosis-attributed death in the Cox model, corresponding to an adjusted hazard ratio of 1.50 and a 95% confidence interval of 1.45–1.55. The Fine–Gray model produced a similar estimate of 1.49, with a 95% confidence interval of 1.44–1.54. Both models reported p-values below 0.001 for the age association. Male sex was also associated with a higher mortality hazard, with an adjusted hazard ratio of 1.16 (95% CI 1.01–1.32; p = 0.035). These estimates describe the mortality hazard within the analyzed cohort rather than population-wide death rates.

TB–HIV/AIDS positivity was associated with a 64% higher hazard of tuberculosis-attributed death in the Cox analysis, with an adjusted hazard ratio of 1.64 (95% CI 1.32–2.03; p < 0.001). Unknown or unrecorded TB–HIV/AIDS status was likewise associated with mortality, with an adjusted hazard ratio of 1.38 (95% CI 1.20–1.58; p < 0.001). The source evidence does not identify the reference category used for the unknown-status estimate, so the comparison should not be interpreted beyond the reported adjusted association. The finding indicates that incomplete HIV-related information was present in the surveillance records and was associated with the outcome measured by the models.

Alcohol use and smoking were also associated with tuberculosis-attributed death. Alcohol use was linked to a 53% higher hazard in the Cox model, with an adjusted hazard ratio of 1.53 (95% CI 1.26–1.86; p < 0.001), while smoking was associated with a 30% higher hazard, with an adjusted hazard ratio of 1.30 (95% CI 1.06–1.61; p = 0.014). Patients with both pulmonary and extrapulmonary tuberculosis had the largest reported clinical association in the results: their adjusted hazard ratio was 3.00 (95% CI 2.29–3.92; p < 0.001). Because the cohort was retrospective and based on notified cases, these values characterize associations in the source population rather than causal effects or the prospectively measured risks for individual patients.

Incarceration showed an inverse association with tuberculosis-attributed mortality, with an adjusted hazard ratio of 0.42 (95% CI 0.27–0.65; p < 0.001). The authors advised caution, noting that the result could reflect structured follow-up or differential surveillance rather than a protective effect of imprisonment. The main survival cohort excluded cases without a valid treatment-closure date, post-mortem notifications, and records with inconsistent follow-up time, so the estimates apply specifically to the 52,066 retained cases. The competing-risk analysis treated cure and death from other causes as competing events, providing a complementary assessment of the time to tuberculosis-attributed death. Overall, the study identified clinical and information-related factors associated with mortality in the analyzed population while supporting restraint about causal interpretation.

Subject of Research: Clinical and surveillance factors associated with tuberculosis-attributed mortality in Pará, Brazil

Article Title: Factors associated with tuberculosis-attributed mortality in the Brazilian Amazon: a population-based retrospective cohort study with survival and competing-risk analyses

Article References: Marcos, W., Mota, N. C. V., Carvalho, F. I. C., da Silva Sousa Júnior, A., de Souza Melo, M. I., Sardinha, D. M., & Batista Lima, K. V. (2026). Factors associated with tuberculosis-attributed mortality in the Brazilian Amazon: a population-based retrospective cohort study with survival and competing-risk analyses. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14431-y

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14431-y

Keywords: tuberculosis, mortality, Pará, Brazilian Amazon, HIV coinfection, survival analysis, competing risks, population cohort, health surveillance, Factors, associated, tuberculosis-attributed

The study, led by Ingrid Jacobson of the Rural Cancer Institute in Staples, Minnesota, together with colleagues affiliated with several US medical institutions, set out to answer a question that had been surprisingly underexplored: does loneliness function as a population-level indicator associated with variation in cancer mortality between communities? While individual-level studies have previously linked loneliness and social isolation to cancer incidence and survival, the authors note that little to no research had examined this relationship at the community scale, where public health surveillance and intervention decisions are actually made. By shifting the analytical lens from the individual to the county, the researchers aimed to determine whether loneliness could serve as a practical signal for identifying communities at elevated risk.

Methodologically, the investigation drew on two large, publicly available data sources. Cancer mortality came from the National Cancer Institute’s State Cancer Profiles, which provides five-year age-adjusted, all-site cancer mortality rates per 100,000 population covering 2018 through 2022. Age adjustment is a critical technical step in this kind of comparison, because counties differ substantially in the age structure of their populations; without it, a county full of retirees would appear to have a cancer problem simply because cancer risk rises with age. Loneliness, meanwhile, was measured using 2022 County Health Rankings data capturing the percentage of adults who report subjective feelings of loneliness, a self-reported measure that reflects the psychological experience of perceived social disconnection rather than the more objective condition of living alone.

To isolate any independent contribution of loneliness, the researchers merged these data with a battery of covariates from the County Health Rankings system, spanning sociodemographic characteristics, health behaviors, and rurality as classified by the US Department of Agriculture’s rural-urban continuum codes. The analysis proceeded through a series of general linear models, beginning with unadjusted estimates and progressively adding controls. In the crude, unadjusted analysis, the association between county-level loneliness and cancer mortality was pronounced: each unit increase in the percentage of lonely adults was associated with a beta coefficient of 1.88 in the age-adjusted mortality rate, a relationship that was highly statistically significant with a p-value below 0.001.

The more consequential result, however, emerged from the fully adjusted models. When the researchers controlled simultaneously for sociodemographic factors, health behaviors, and rurality, the association between loneliness and cancer mortality was attenuated but persisted, with the coefficient falling to 0.88 while remaining statistically significant at p < 0.001. In practical terms, this means that roughly half of the raw association can be explained by the fact that lonely counties also tend to have other characteristics linked to cancer deaths, such as higher smoking prevalence, lower educational attainment, or economic disadvantage. Yet a substantial, independent signal remains, suggesting that loneliness captures something about community health that conventional covariates do not fully absorb.

The authors report that the sociodemographic and health covariates in their models were differentially associated with cancer mortality, meaning some factors carried more explanatory weight than others. This pattern is consistent with a broader epidemiological literature. Prior work has documented strong geographic inequalities in cancer mortality across US counties tied to social determinants, and umbrella reviews have established socioeconomic status as a robust correlate of cancer outcomes. Behavioral pathways are also well characterized: tobacco smoking remains a dominant driver of cancer incidence and death, alcohol consumption contributes to a measurable share of cancer mortality, insufficient sleep has been linked to cancer risk, and rural populations face documented disparities in risk factors and screening access. Loneliness may plausibly intersect with several of these pathways, influencing health behaviors, delaying care-seeking, or reflecting underlying community resource deprivation.

The new county-level findings also dovetail with individual-level evidence that has accumulated over the past decade. A cohort study of Finnish middle-aged men found that loneliness and social isolation were associated with increased cancer incidence, and a 2025 systematic review and meta-analysis published in BMJ Oncology examined the impact of loneliness on cancer mortality among patients. Research using SEER-Medicare data has shown that isolation affects survival among non-Hispanic Black women diagnosed with breast cancer, and a Colombian cohort study identified loneliness as a predictor of mortality in cancer patients. What the new study adds is the ecological perspective: the observation that the burden of cancer death is geographically patterned alongside the burden of loneliness, which matters for how health departments allocate attention and resources across communities.

At the same time, the study’s design imposes important interpretive limits that the authors themselves acknowledge by framing the work as an ecological analysis. Ecological studies examine groups rather than individuals, so the finding that lonely counties have higher cancer mortality does not prove that lonely individuals are more likely to die of cancer, nor that loneliness causes cancer deaths at all. This is the classic ecological fallacy problem: correlations observed at the aggregate level may not hold, or may hold for different reasons, at the individual level. Residual confounding is another concern, since no model can fully adjust for every characteristic that distinguishes one county from another, and cause-of-death data themselves carry well-documented limitations, including under-recording of certain conditions. The five-year mortality estimates and the single-year loneliness measure also come from different windows, complicating any causal sequencing.

Nevertheless, the policy context gives the findings real weight. Loneliness has been formally recognized as a health issue in leading medical journals, and the 2023 US Surgeon General’s advisory on the epidemic of loneliness and isolation called for social connection to be treated as a public health priority. Legislative and governmental responses have followed at multiple levels, including a proposed National Strategy for Social Connection Act in the US Senate, a Combating Loneliness Act in the House, resolutions in New Jersey, California community college districts, and Thurston County in Washington, and earlier national initiatives in the United Kingdom and Japan. If county-level loneliness is indeed a usable indicator of cancer mortality risk, as the study suggests, it could be incorporated into public health surveillance systems alongside measures like smoking prevalence and screening rates, helping to identify communities where social connection interventions might yield the greatest health returns.

The evidence base for such interventions is itself maturing. Meta-analytic work has identified effective approaches to reducing loneliness, and randomized trials have tested internet-based self-help programs with human or automated guidance, one-to-one peer support in mental health services, home-based interventions for older adults, and neighborhood-level efforts to build social connectedness. Telemedicine is also being explored as a tool for expanding access to care in isolated communities, which is particularly relevant given the rurality adjustments in the new analysis and the rural focus of the research team itself. None of this establishes that reducing loneliness would lower cancer mortality, a question that would require longitudinal and interventional study designs. But the study’s central message is difficult to ignore: the communities where Americans report feeling most alone are also the communities where cancer is most lethal, and a public health apparatus that tracks one but not the other may be missing an important part of the picture.

Subject of Research: The association between county-level loneliness and cancer mortality rates in the United States

Article Title: Loneliness is correlated with cancer mortality in US counties: an ecological analysis

Article References: Jacobson, I., Swenson, A., Schroeder, Z., McGovern, E., Northrup, G., & Swenson, W. (2026). Loneliness is correlated with cancer mortality in US counties: an ecological analysis. Supportive Care in Cancer, 34(10), Article 1016. https://doi.org/10.1007/s00520-026-11258-w

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11258-w

Keywords: loneliness, cancer mortality, ecological study, public health, social determinants of health, social isolation, County Health Rankings, National Cancer Institute, rurality, cancer epidemiology, health surveillance, United States

The technical challenge the authors faced is one that plagues much of global cardiovascular epidemiology. Reliable incidence data were available for only a limited number of countries, concentrated in Northern America, Western Europe and Oceania. Vast populations, including those of Sub-Saharan Africa and South Asia, are effectively invisible in the literature, not because clots do not form there, but because the diagnostic infrastructure, imaging capacity and registry systems needed to count them are absent or incomplete. Even where data exist, they are riddled with heterogeneity: different studies use different case definitions, different coding algorithms, different imaging thresholds and different follow-up windows, making direct comparison an exercise in careful caveats.

The headline incidence figures reveal striking regional variation. During 2012 to 2016, the global annual incidence of deep-vein thrombosis ranged from 25.1 to 131.5 cases per 100,000 population, a fivefold spread that reflects genuine biological and demographic differences as well as differences in detection. Pulmonary embolism incidence showed its own temporal dynamics: between the 2012 to 2016 window and the 2017 to 2022 window, incidence rose in Northern America and Asia but remained stable in Oceania. Rising incidence can mean more disease, but it can also mean more computed tomography pulmonary angiography, more sensitive D-dimer testing and more incidental findings on scans performed for other reasons. Disentangling true epidemiologic change from diagnostic drift is one of the central methodological puzzles the review confronts.

Mortality figures are equally variable and equally revealing. Among patients diagnosed with pulmonary embolism, 30-day all-cause mortality ranged globally from 1.0 percent to 9.0 percent, a ninefold difference across regions and studies. Perhaps the most provocative finding is that more than half of those deaths were not directly attributable to the pulmonary embolism itself. Patients who develop venous clots tend to be older, frailer and burdened with cancer, heart disease, infection or recent surgery, and competing causes of death claim many of them within the first month. This distinction matters enormously for interpreting regional comparisons: population-level pulmonary embolism-related mortality is generally higher in Northern America and Western Europe than in Asia, but whether that reflects true differences in disease severity, differences in age structure, or differences in how death certificates are completed remains unresolved.

Recurrence, the other key outcome, proved more consistent across the globe. The one-year cumulative incidence of recurrent venous thromboembolism ranged from 2.9 percent to 8.1 percent, and this figure remained fairly stable between the 2012 to 2016 and 2017 to 2022 periods. That stability is clinically meaningful. It suggests that despite the widespread adoption of direct oral anticoagulants, which have transformed outpatient treatment over the past decade, the fundamental recurrence risk has not dramatically shifted, and it reinforces the importance of risk-stratified decisions about how long patients should remain on anticoagulation. Extended-duration low-intensity apixaban strategies, currently under investigation in trials such as HI-PRO for patients with provoked clots and persistent risk factors, are one response to this persistent residual risk.

The review also catalogues the long shadow that these clots cast beyond the acute event. Survivors of deep-vein thrombosis face post-thrombotic syndrome, a chronic condition of leg pain, swelling and skin changes that can be debilitating. Survivors of pulmonary embolism can develop chronic thromboembolic pulmonary hypertension, a progressive and potentially fatal narrowing of the pulmonary arteries, as well as persistent functional impairment and reduced quality of life documented in cohorts across Europe. These non-fatal complications are a major driver of long-term disability and cost, yet they are precisely the outcomes least well captured in administrative data and least consistently reported in the literature, compounding the problem of underestimating the disease’s full burden.

Why does the global map look so lopsided? The authors point to a convergence of factors. Risk factors themselves are shifting: aging populations, rising obesity, growing cancer prevalence, increasing use of erythropoiesis-stimulating agents, and the thrombotic legacy of COVID-19 all push incidence upward, and these forces operate with different intensity in different regions. Genetic ancestry influences clot susceptibility, with well-documented variation in the prevalence of factor V Leiden, prothrombin mutations and other thrombophilias across populations. The so-called East Asian paradox, in which lower observed thrombosis rates coexist with different bleeding risks on anticoagulation, complicates the export of Western treatment algorithms. Meanwhile, misclassification, underdiagnosis and under-reporting systematically bias observed rates downward in resource-limited settings, so the absence of data should never be mistaken for the absence of disease.

The methodological machinery behind the review deserves attention in its own right. The authors aggregated population-based studies, national registries and WHO mortality database analyses, applying quality assessment tools such as the Newcastle-Ottawa Scale and harmonizing estimates where possible. They also drew on emerging validation science: recent work has shown that International Classification of Diseases coding algorithms for pulmonary embolism can be validated against chart review, and that natural language processing applied to electronic health records, including artificial intelligence triage of CT pulmonary angiograms, can improve case identification beyond what billing codes alone capture. These tools, the review suggests, will be essential for building the coordinated global surveillance system that the current data gaps demand, because standardized, validated case definitions are the precondition for any meaningful cross-country comparison.

The clinical implications extend to prevention as much as to counting. Hospitalization is a potent trigger for venous thromboembolism, and prophylaxis in medical and surgical inpatients remains underused worldwide, a gap the American Heart Association has flagged in formal calls to action. The review’s regional estimates give health systems a benchmark against which to measure their own performance: if 30-day mortality after pulmonary embolism can be 1 percent in one well-organized system and 9 percent in another, the difference is unlikely to be biology alone. Risk stratification tools, outpatient treatment pathways such as those validated in the Hestia study, contemporary guideline recommendations from both the European Society of Cardiology and the new 2026 American joint guidelines, and attention to disparities in care all represent levers that can be pulled where the will and the data exist.

What emerges from this effort is less a finished atlas than an urgent research agenda. The authors call for coordinated surveillance, standardized reporting and dedicated investigation into local and global drivers of venous thromboembolism, particularly in the regions where an estimated four million people develop these clots each year but where the evidence base is thinnest. For a condition that is largely preventable with prophylaxis and largely treatable when caught, the persistence of such stark blind spots is itself a global health failure. The review’s most important message may be that the world cannot manage what it does not measure, and that filling the empty spaces on the clot map of Sub-Saharan Africa, South Asia and beyond is now one of the most consequential unfinished tasks in cardiovascular medicine.

Subject of Research: Global epidemiology of venous thromboembolism, including deep-vein thrombosis and pulmonary embolism incidence, mortality and recurrence

Article Title: Global burden of venous thromboembolism: incidence and outcome estimates of deep-vein thrombosis and pulmonary embolism

Article References: Bikdeli, B., Rashedi, S., Pfeferman, M., Amalan, C., Leyva, H., Krishnathasan, D., Bukhari, S., Shen, B. H., Secemsky, E. A., Zhai, Z., Yamashita, Y., Sawano, M., Angchaisuksiri, P., Jimenez, D., Monreal, M., Sadeghipour, P., Zuin, M., Bertoletti, L., Ramacciotti, E., … Piazza, G. (2026). Global burden of venous thromboembolism: incidence and outcome estimates of deep-vein thrombosis and pulmonary embolism. Nature Reviews Cardiology. https://doi.org/10.1038/s41569-026-01334-3

Image Credits: AI Generated

DOI: 10.1038/s41569-026-01334-3

Keywords: venous thromboembolism, pulmonary embolism, deep-vein thrombosis, global burden of disease, epidemiology, mortality, recurrence, anticoagulation, cardiovascular disease, health surveillance, thrombosis registries, Nature Reviews Cardiology

The clinical picture that unfolded was unlike anything clinicians had managed during the fentanyl and xylazine eras. Experts in Philadelphia and Pittsburgh documented a novel, clinically distinct withdrawal syndrome attributable to medetomidine exposure. Patients presented with the familiar hallmarks of opioid withdrawal but layered on top were profound hypertension, with blood pressures frequently exceeding 180/120 millimeters of mercury, and extreme tachycardia, with heart rates climbing above 140 beats per minute. Intractable vomiting, a peculiar tremor without clonus or hyper-reactivity, and even cases of posterior reversible encephalopathy syndrome and myocardial injury appeared in the case series. In one multicenter study of 175 patients, more than 90 percent required intensive care unit admission. Pharmacologically, the explanation lies in medetomidine’s mechanism: as an alpha-2 agonist, it hyperpolarizes norepinephrine-producing neurons in a negative feedback loop, dampening norepinephrine release and producing sedation, analgesia, muscle relaxation, and anxiolysis. When the drug leaves the system, a catastrophic rebound of noradrenergic activity ensues, driving the severe cardiovascular and gastrointestinal chaos clinicians observed.

Recognizing that no coordinated playbook existed for this new threat, the Division of Substance Use Prevention and Harm Reduction at the Philadelphia Department of Public Health partnered with the Health Federation of Philadelphia’s Substance Use Response, Guidance, and Education program to convene a citywide Medetomidine Withdrawal Summit on November 6, 2025. The event, accredited for continuing medical education, pharmacy, nursing, and social work credit, drew 115 attendees. Most were health professionals, including 44 working in medical settings and 45 in behavioral health, spanning physicians, nurses, pharmacists, social workers, substance use navigators, certified recovery specialists, and harm reduction outreach workers from the city’s three academic health systems, correctional health, federally qualified health centers, crisis response centers, residential treatment facilities, and opioid treatment programs. Public health employees, academic researchers, and visitors from Pittsburgh, New Jersey, and New York rounded out the room, a testament to how far word of the emerging syndrome had traveled.

The summit’s architecture was deliberately case-driven, adapted from the structure of Fetal and Infant Mortality Review that the city had previously used to build xylazine wound care guidance. Four vignettes, based on real but de-identified patients, traced medetomidine withdrawal across four care settings. The first illustrated the power of low-barrier, co-located care: a young man with active injection drug use and housing instability living in supportive housing with an attached walk-in clinic, where staff could repeatedly check vital signs, adjust clonidine dosing as his blood pressure climbed to 164/91 mmHg, and escalate to emergency services if he developed vomiting, seizures, a blood pressure above 185/100 mmHg, an abnormal neurologic exam, or a Clinical Opiate Withdrawal Scale score over 20. The second case, an inpatient admission, showed how deceptively mild withdrawal could explode into severe symptoms within four to six hours, forcing escalation to the intensive care unit for a high-dose intravenous dexmedetomidine infusion, followed by an aggressive cross-taper to oral and transdermal alpha-2 agonists and a low-dose buprenorphine induction with transition to long-acting injectable buprenorphine.

The third and fourth vignettes exposed the fault lines in the system. In a residential rehabilitation program operating at ASAM 3.5 and 3.7 levels of care, a walk-in patient’s blood pressure rocketed from 174/98 to 203/108 mmHg within hours of admission, followed by intractable vomiting and an altered mental state that required a 911 call because the facility lacked a 24-hour on-site medical provider and sufficient staffing ratios. In the emergency department case, a young woman who received naloxone from both a bystander and emergency medical services arrived with hypotension and bradycardia, then flipped within two hours to severe hypertension, tachycardia, and intractable vomiting, requiring a demanding combination of intravenous, intramuscular, orally disintegrating, and transdermal medications before stabilizing on methadone maintenance. Together, the cases underscored the razor-thin therapeutic window for preemptive oral management and the critical importance of vigilant vital sign monitoring to track withdrawal progression.

A panel of emergency physicians, addiction medicine and toxicology consultants, primary care and opioid treatment physicians, and a clinical pharmacist distilled hard-won lessons for the audience. The Clinical Opiate Withdrawal Scale, long the standard instrument, appeared to underestimate severity in patients afflicted by a hypoactive delirium that many now recognize as a distinctive feature of severe medetomidine withdrawal. With no validated instrument for alpha-2 withdrawal, panelists urged clinicians to rely on elevated heart rate and blood pressure as more reliable indicators and to titrate treatments such as dexmedetomidine infusions to vital signs rather than mental status. Clonidine emerged as the mainstay of management, available in oral tablets and transdermal patches at three doses each, though the panel noted that patches may not be covered by outpatient insurance despite being on Pennsylvania’s medical assistance preferred drug list. Two pharmacokinetic insights proved especially valuable: transdermal clonidine takes 24 to 48 hours to deliver relief, and oral clonidine tablets can be absorbed sublingually with no loss of efficacy when patients cannot swallow, a practical workaround for a syndrome defined by vomiting.

Concurrent opioid replacement with intravenous or oral hydromorphone and methadone was identified as essential, with gabapentin serving as a helpful though dependency-risking adjunct for mild to moderate symptoms. Panelists also flagged that patients who become ‘quiet’ are often the most endangered, since decreased responsiveness signals the need for urgent transfer to a higher level of care. Managing withdrawal in pregnant patients proved especially thorny, as typical antiemetics proved ineffective and pregnancy antihypertensives failed to address the underlying withdrawal mechanism; the consensus held that clonidine’s benefits outweighed the risks of undertreated withdrawal, with lorazepam as the preferred benzodiazepine should one be needed during pregnancy. Dopamine antagonist agents such as metoclopramide, olanzapine, prochlorperazine, haloperidol, and chlorpromazine were reported anecdotally to control the syndrome’s relentless nausea and vomiting, thereby enabling patients to tolerate the oral clonidine that forms the backbone of treatment.

The breakout sessions generated 74 insights grouped into nine themes: overdose response, clinical recognition of withdrawal, monitoring, treatment approach, patient care navigation, workforce development, testing and surveillance, mobile outreach, and reimbursement. From these, the authors formulated twelve recommendations. Among them: fund community-based drug checking programs that deliver rapid, accurate results; include harm reduction networks in medetomidine information dissemination; keep naloxone as the first-line response to opioid overdose, redosing only when breathing is inadequate; monitor closely for rapid shifts between intoxication and withdrawal phases, using heart rate trends to distinguish bradycardic intoxication from tachycardic withdrawal; refer patients with profound hypertension for acute medical evaluation given the risk of neurologic and cardiac injury; treat a prior need for a dexmedetomidine infusion as the best predictor of future severe withdrawal, a better marker than current volume of drug use; align reimbursement with the true complexity of care; establish an ICD code for medetomidine withdrawal to enable surveillance and billing; and fund free accredited education for all medical and behavioral health team members.

Philadelphia’s broader response infrastructure offers a model worth emulating. The city’s health department has worked with the Center for Forensic Science Research and Education’s NPS Discovery early warning system since September 2020, collaborating with PA Groundhogs, an organization that conducts drug checking directly with people who use drugs. New rapid medetomidine testing strips now allow surveillance at the individual level. A cascade of Health Alerts began in May 2024, followed by more detailed alerts in December 2024, a CHART data publication in May 2025, and a June 2025 Health Update with granular guidance for non-hospital settings. The authors acknowledge the descriptive limitations of their summit report and call for quantitative evaluations of clinician confidence, compensation for people with lived experience in provider training, and stronger discharge planning and outpatient tapering protocols. But their central conclusion rings clear and increasingly urgent: proactive coordination among hospitals, community organizations, and public health agencies, grounded in case-based education and honest information exchange, is the essential foundation for confronting not just medetomidine, but the relentless, unpredictable evolution of the drug supply itself.

Subject of Research: The public health response to medetomidine, a new psychoactive adulterant in the illicit opioid supply causing a severe withdrawal syndrome in Philadelphia.

Article Title: Responding to medetomidine in Philadelphia: narrative summary of the public health response to a new psychoactive substance

Article References: Warrick-Stone, T., Simpson, S.-E., Durney, P., Goodstein, D., Abrams, C., Bobb, R., London, K., & Teixeira da Silva, D. (2026). Responding to medetomidine in Philadelphia: narrative summary of the public health response to a new psychoactive substance. Addiction Science &amp; Clinical Practice, 21(1), Article 64. https://doi.org/10.1186/s13722-026-00713-y

Image Credits: AI Generated

DOI: 10.1186/s13722-026-00713-y

Keywords: medetomidine, opioid crisis, withdrawal syndrome, Philadelphia, public health, fentanyl adulterants, harm reduction, drug checking, clonidine, alpha-2 agonist, substance use treatment, health surveillance