Health care workers say a powerful new street drug is clogging Pittsburgh-area emergency rooms with people suffering from violent withdrawal symptoms, including losing control, fighting with staff and needing to be restrained. 

For years now, Pittsburgh paramedics and EMTs have been reviving people overdosing with Narcan and rushing them to the ER for follow-up treatment. But in recent months, doctors say many of those patients have suddenly become combative and violent at the hospital, posing a danger to themselves and the health care workers alike.

"They'll come out of this opiate overdose state and go into this severe withdrawal state sometimes right in front of our eyes," said Dr. Brent Rau, the director of emergency medicine at Allegheny General Hospital. 

The ER at Allegheny General Hospital is now seeing about a dozen patients a week who have overdosed on a mixture of fentanyl and an extremely powerful veterinary sedative called medetomidine. Rau says when the drug wears off, it can produce violent withdrawal reactions as a patient's heart rate jumps from 30 beats a minute to 160 or 170 beats per minute. They can lose all control of bodily functions, become delirious and fight with staff.

"They're extraordinarily agitated," Rau said. said. "They can't sit in bed, their picking at different things, clawing at staff. They usually need to be restrained for their own safety as a patient." 

In Philadelphia, medetomidine has resulted in what health officials there call a withdrawal crisis, and emergency rooms are overwhelmed. In Pittsburgh, testing by the organization Prevention Point shows that two-thirds of what is sold on the street as fentanyl is mixed with medetomidine. As a result, ERs began to get inundated over the spring and summer months, with both Allegheny Health Network and UPMC reporting a dramatic spike in patients.

UPMC Mercy is now admitting two or three patients a day in extreme withdrawal, and other UPMC hospitals are admitting several per week, putting a strain on resources and the critical need for beds. Staff and security must take extra measures to subdue violent patients, many of whom need to be sedated again and monitored in the intensive care unit for several days, according to Michael Lynch, UPMC's senior medical director of substance abuse services. 

"It's clear that it's significantly altering the way that we practice in emergency medicine in Pittsburgh," Lynch said. 

While the situation is not yet as dire as that of Philadelphia, both UPMC and AHN are bracing.

"No, we are not to that level, but the concern is these things tend to drift from east to west," Rau said.