The tools mostly work.
For example, ocamlfind (with this package, which is installed automatically) and dune (see, e.g., this example) both support MetaOCaml.
I don’t know how well Merlin works with MetaOCaml, but it might work reasonably well if you use attributes rather than quotation syntax (i.e. (2 + 3) [@metaocaml.bracket] rather than .<2 + 3>.).
Libraries mostly work unmodified (since MetaOCaml is binary-compatible with OCaml), but a few libraries conflict with MetaOCaml’s additional syntax (e.g. by using >. for float comparison) and need minor modifications.