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This episode of the EMERGE, join me and Dr. Mike Lynch, an expert in emergency medicine, medical toxicology, and addiction medicine. The discussion delves into the public health emergency of medetomidine-related toxicity and withdrawal. Dr. Lynch shares insights from real cases, emphasizing the clinical red flags and management strategies for medetomidine withdrawal. We discuss the transition from Xylazine to medetomidine in the drug supply, the role of naloxone, and the risks of misidentifying opioid-related cases. Key points include the need for extended observation in the ED, the potential requirement for ICU care, and the effectiveness of dexmedetomidine in managing severe withdrawal symptoms. The episode also highlights the importance of medication for opioid use disorder (MOUD) and the evolving drug supply landscape.