As medetomidine increasingly emerges as an adulterant in the illicit drug supply, emergency clinicians must be prepared to recognize and manage this evolving toxidrome. Through an evidence-based review and case discussions, this session will explore the unique presentation of medetomidine overdose and withdrawal, differentiate it from opioid and polysubstance toxicity, and review practical strategies for resuscitation, hemodynamic support, airway management, and harm reduction. You'll leave with the knowledge and confidence to identify this high-risk presentation early, optimize patient stabilization, and improve outcomes in an increasingly complex emergency care environment.