It’s 5pm on a blazing hot Friday as a young man walks into a cooling center in Kensington. He looks confused as he shows a staff member his hand, swollen and red with large boils on it. “I don’t know how this happened,” he says, slowly, “I just fell asleep outside for a bit.” While there are no medical providers working to assess, his injury looks to be a result of sun poisoning, developed after falling asleep on the pavement. His experience illustrates two evolving crises which are rarely discussed in tandem: the changing illicit drug supply and increases in severe and unpredictable temperatures.
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Potent sedatives and tranquilizers have entered the supply across the country, impacting thermoregulation and mobility, and leading to extreme sedation. These symptoms intensify climate risks for people who use the combination of drugs known as “dope” by dulling responses to extreme weather.
The experience in Philadelphia, where the emergence of medetomidine in the drug supply has rapidly transformed drug use and related treatment, provides an example of how these compounding crises are unfolding. Introduced into the dope supply in 2024, medetomidine is a veterinary tranquilizer 200 to 300 times more potent than its precursor, xylazine (or tranq), and has been associated with dangerous symptoms, including heavy sedation, intense withdrawal, and changing mortality rate.
Additionally, tachycardia, severe hypertension, intractable nausea and vomiting associated with medetomidine withdrawal correlate with reduced efficiency of withdrawal management protocols, and emergency room visits due to withdrawal have risen by 75 percent.
These physiological impacts compound climate risks. As Philly faces severe heat, flash floods, wildfire smoke and increasingly unpredictable winters, many people who use dope spend extensive periods outside, whether due to housing insecurity, lack of indoor spaces to use safely and comfortably, conducting outdoor jobs and hustles, or a wide range of other activities. Medetomidine users risk severe sedation during heat waves or cold snaps, prolonging exposure to extreme temperatures with decreased sensitivity to its effects. When taken during heat episodes, medetomidine increases risk of dehydration, heatstroke, and hyperthermia; in cold conditions, it can contribute to hypothermia and frostbite.
Instead of operating as separate challenges, drug use and extreme weather intersect in ways that amplify risk and strain to urban systems, but also present a shared opportunity for supporting those who are most at-risk of negative health effects from climate concerns.
While extreme weather is a dangerous risk for people using medetomidine, these health concerns are rarely connected to a wider climate planning narrative, and extreme weather is often handled as an emergency to be managed, rather than a pervasive concern that is here to stay.
Instead of operating as separate challenges, drug use and extreme weather intersect in ways that amplify risk and strain to urban systems, but also present a shared opportunity for supporting those who are most at-risk of negative health effects from climate concerns. In order to address these issues comprehensively, Philadelphia can consider establishing cross-sectoral task forces that incorporate sustainability, public health, addiction medicine, and emergency management; expanding tracking of weather-related emergency room presentations; moratoriums on encampment evictions during extreme weather; expansion of climate-controlled spaces for people impacted by these crises to simply be; increased water and bathroom accessibility; and furthering investment in cooling and warming centers which often have staffing and resource shortages.
As public health and addiction medicine providers have developed medical protocols to respond to the increase in medetomidine in the two years, some of those working directly with dope users are worried about the next adulterant to the supply. This June, the Pennsylvania House advanced a bill to label medetomidine as a schedule III controlled substance, meaning it has moderate potential for abuse. That bill, now SB866, is on the desks of the Senate’s Agricultural & Rural Affairs Committee. If signed, it will return to the Senate, and, if passed there, move onto the governor for passage or veto.
More importantly, this move would lead to the regulation of medetomidine, which has not previously been scheduled as it was intended for veterinary use only.
While this may lead to less medetomidine in the dope supply, as was the case with the scheduling of xylazine, another adulterant may be added that can avoid detection. As one drug use services staff shared, “Something else will be next. But we have no idea what it’ll be.” Nationally, signs of what may come next are already emerging: Cychlorphine, a synthetic opioid estimated to be up to 10 times more potent than fentanyl, has appeared in counterfeit pill markets earlier this year and has been linked to several deaths across the country.
Whatever is next in Philadelphia, providers also don’t know how it will interact with extreme weather, but they do know that it will likely impact the same people, who are some of the most at risk of health impacts from a changing drug supply and extreme weather. Framing the impacts of a changing drug supply and increasingly severe temperatures as interlocking struggles provides a basis for integrating drug supply into climate and health policy, and expands support to those who are most at risk.
Andrea McIntosh is a researcher focusing on the intersections of climate change, urban planning and development, and homelessness. She spends her time between Philadelphia and Barcelona, where she is currently a PhD candidate at the Universitat Autònoma de Barcelona and working with the Barcelona Lab For Urban Environmental Justice and Sustainability.
BATTLING OPIODS IN PHILADELPHIA
