As psychedelic-assisted psychotherapy nears FDA approval and broader use in the USA, current postmarket surveillance systems are ill-suited to monitor its real-world safety and effectiveness. Without a fit-for-purpose program, risks include misattributing adverse events to illicit psychedelics and failing to achieve equitable patient access. A successful surveillance mosaic should incorporate environmental, personal, and outcome domains to ensure safe, appropriate, and equitable care. The authors argue for intentionally designed data systems to proactively monitor utilization and inform reasonable limitations.
Medetomidine, a veterinary tranquilizer more potent than xylazine, has emerged as an adulterant in the U.S. illicit fentanyl supply. Analysis of 11,363 drug samples from a national mail-based drug checking program between December 2022 and April 2025 found medetomidine in 2.4% of samples, with growth beginning June 2024. It commonly appeared with fentanyl (58.8%) and xylazine (55.9%). Samples where medetomidine was the primary ingredient were nearly 12 times more likely to be associated with reported hallucinations (17.6%) compared to all other samples (1.2%). These unexpected hallucinations may serve as a signal for medetomidine's presence in local drug markets, contradicting its clinical use for preventing delirium.