The shortage of opioid drugs affects veterinary medicine, too. Here’s how
By Kim Campbell Thornton
Andrews McMeel Syndication
If you don’t take pain medications or haven’t had surgery recently, you probably don’t think the opioid crisis you’ve been hearing about on the news has anything to do with you. But if you have pets, they could be affected. Not because they’re at risk of falling prey to drug dealers pushing controlled substances, but because pets who need surgery or treatment for acute pain are beneficiaries of the same pain-relieving medications used in humans.
A shortage of the medications — caused by a double whammy of inspection issues and production delays related to upgrades at a Pfizer facility in Kansas, plus a DEA-mandated 20 percent decrease in overall opioid production in an attempt to curb abuse by humans — means the drugs are less available for use in veterinary medicine.
Veterinarians use injectable opioids such as morphine, fentanyl, methadone and hydromorphone for surgical procedures and acute pain from trauma. Human doctors get priority when those and other opioid drugs are distributed, leaving veterinarians to scramble for ways to manage pain in pets.
“The opioid crisis the government is talking about is people OD’ing,” says Sheilah Robertson, a veterinarian who specializes in analgesia and anesthesiology and who is the senior medical director for Lap of Love Veterinary Hospice. “It’s a different crisis to us. Our crisis is that we’re short of opioids that our patients need.”
The shortage is expected to continue into 2019, according to a June 19 statement by the Food and Drug Administration. In one attempt to mitigate the shortage, the FDA and Pfizer coordinated the release of some products that were on hold due to potential quality issues, distributing them with instructions for safe handling and use to reduce risks to patients.
What the shortage means for pet owners is that in some instances, a pet’s surgery or other procedure may need to be postponed or performed with drugs that are less effective in managing pain, says pain expert Robin Downing, DVM, director of the Downing Center for Animal Pain Management in Windsor, Colorado.
The potent drugs are a cornerstone of pain relief before, during and after surgery, Dr. Downing says. Their use in anesthesia reduces the need for inhalant anesthetics. In turn, that reduces the risks associated with general anesthesia.
To get around the shortage, veterinarians are having to think creatively. They may use less-potent opioids such as butorphanol and buprenorphine in combination with drugs that provide local anesthesia and nonsteroidal anti-inflammatory drugs, known as multimodal analgesia. Local anesthetics completely block pain, and a single dose of some new drugs in that category work for 24 to 72 hours. Multimodal analgesia can also help to reduce grogginess, nausea or vomiting after surgery.
Sometimes there’s a learning curve to using unfamiliar drugs and techniques, though.
“I’ve taken calls from numerous veterinarians asking about alternatives to the opioid they usually use, which they are now having difficulty obtaining,” says Jordyn Marie Boesch, DVM, a lecturer in anesthesiology at Cornell University College of Veterinary Medicine. “The good news is that there is often an alternative opioid available. The silver lining is that the shortage is introducing veterinarians to many other ways of providing analgesia that they may not have been familiar with before.”
Veterinarians also hope drug companies will take steps to have some opioids labeled specifically for use in animals. In Europe, for instance, versions of fentanyl are made specifically for use in dogs and cats.
“If there’s a human shortage (of opioids in Europe), it doesn’t affect veterinarians, and that’s what we would like to happen here,” Dr. Robertson says. “We know that taking a drug through all the trials and FDA costs a lot of money, but we can no longer depend on our supply from human-labeled drugs anymore.”