Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
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1. Patients report severe withdrawal and treatment challenges as powerful veterinary tranquilizer spreads through illicit opioid supply
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-02480
URL goes live when the embargo lifts
A brief research report explored patient experiences on the clinical effects of medetomidine, a veterinary sedative that has increasingly contaminated the illicit fentanyl supply, and its impact on treatment outcomes. Interviews with people exposed to the drug suggest that medetomidine can create medical complications and withdrawal symptoms that differ from those associated with opioids, raising new concerns for clinicians and public health officials. The report is published in Annals of Internal Medicine.
Researchers from the University of Pittsburgh School of Medicine interviewed 16 adults hospitalized with opioid use disorder between September and November 2025 who had confirmed exposure to medetomidine. Through in-depth interviews, they explored patients' experiences with the changing drug supply, the effects of medetomidine, withdrawal symptoms, and treatment outcomes. Participants described feeling powerless to avoid exposure, experiencing extreme sedation that increased their vulnerability to harm, and enduring severe withdrawal symptoms that often required hospital care. Many also reported that standard medications for opioid use disorder did not adequately address symptoms related to medetomidine exposure. The authors conclude that health systems and clinicians need greater awareness of medetomidine, improved surveillance of the drug supply, and clinical protocols to manage its unique withdrawal and treatment challenges.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org .
To contact corresponding author Margaret Shang, MD, MS, please email Liz Reid at reide4@upmc.edu .
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2. Updated KDIGO guideline recommends more personalized treatment for anemia in chronic kidney disease
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-02326
The 2026 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Management of Anemia in Chronic Kidney Disease (CKD) calls for a more individualized approach to treatment, including tailored decisions on when to start anemia medications and preferred use of intravenous iron for patients receiving hemodialysis. A synopsis of the guideline highlighting the primary recommendations regarding the use of iron, erythropoiesis-stimulating agents (ESAs), and hypoxia-inducible factor–prolyl hydroxylase inhibitors (HIF-PHI) is published in Annals of Internal Medicine.
KDIGO convened an international Work Group and conducted a systematic review of evidence through October 2024 to inform updates to its 2012 guideline on anemia in CKD. The guideline recommends using iron measures such as transferrin saturation and ferritin levels to guide treatment, with intravenous iron preferred for patients on hemodialysis. The recommendations emphasize addressing reversible causes of anemia before starting drug therapy and maintaining hemoglobin levels below 11.5 g/dL during treatment. It also recommends ESAs rather than HIF-PHI as the preferred first-line drug treatment and encourages personalized decisions based on patients' symptoms, health status, and preferences.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org . To contact corresponding author S. Susan Hedayati, MD, MHSc please email susan.hedayati@stonybrookmedicine.edu .
3. Updated VA/DoD lipid management guideline calls for broader risk assessment and more intensive treatment for high-risk patients
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-01374
The U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) updated their clinical practice guideline on lipid management for cardiovascular disease risk reduction in adults in 2025. The updated guideline recommends expanded use of cardiovascular risk assessment tools and more aggressive cholesterol-lowering treatment for patients at the highest risk for heart attack and stroke. A synopsis summarizing the new recommendations relevant to primary care clinicians is published in Annals of Internal Medicine.
The VA/DoD convened a multidisciplinary work group with expertise in cardiology, lipidology, internal medicine, clinical pharmacy, nursing, physical therapy, and dietetics to review literature published from 16 May 2019 to 15 January 2025 and update the 2020 VA/DoD lipid management guideline. The panel issued 24 recommendations, including use of the PREVENT calculator to estimate heart disease risk, coronary artery calcium scans for patients with uncertain risk, and one-time lipoprotein(a) testing to uncover inherited risk factors. For people at elevated risk, moderate-intensity statins remain a key treatment, while patients with established cardiovascular disease may benefit from combining statins with additional cholesterol-lowering medications. The guideline concludes that more personalized risk assessment and intensified treatment for high-risk patients may help further reduce heart attacks, strokes, and other cardiovascular complications.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org . To contact corresponding author James Sall, PhD please email james.sall@va.gov .
Also in this issue:
Disclosure Without Context: The Case for More Transparent Clinical Practice Guidelines
Jonathan D. Alpern, MD; and David J. Satin, MD
Ideas and Opinions
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-02051
Quality Improvement at a Crossroads: Securing Its Place in Academic Medicine
Ryan Howard, MD, MS; and Michael Englesbe, MD
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-02512
Annals of Internal Medicine
News article
People
Medetomidine Exposure in a Shifting Drug Landscape: Insights From Patient Experiences
15-Sep-2026