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.”
Cat play for
Q: I’ve just gotten my first kitten! What kind of toys should I get her, and are there any special ways that cats like to play?
A: Congratulations on your foray into feline servitude, er, companionship. Cats are wonderful friends and wonderfully entertaining, especially during kittenhood. The right toys and play will help your kitten fulfill her natural instincts, get lots of exercise and mental stimulation, and learn how to interact with you and other people.
Cats are hunters at heart. They are wired to prowl, stalk, chase, kick and bite. A number of toys, from simple to complex, can help them meet those needs, and proper use of them can prevent injury to your own delicate skin.
Puzzle or interactive toys that allow cats to forage for food or treats by pawing inside a box or snagging food from a textured mat challenge cats’ brains, teach them to overcome obstacles and build their fine motor skills. Batting at a wand with a dangling toy or feather; chasing a ball, wind-up or battery-operated mouse; or hunting the dot from a laser pointer or flashlight is great exercise, especially if you direct the beam up and down the stairs a few times. Soft toys stuffed with catnip excite the “bite, kick and disembowel” instinct.
You don’t have to spend a lot on toys. Rotate them every few days to make sure your kitten always has something new and interesting to play with. Put away toys with string where she can’t get to them if you aren’t there to supervise.
Protect yourself from kitty tooth and claw injuries. Don’t “arm wrestle” with your kitten, and walk away if she tries to play rough with you. Most important, continue playing with her into adulthood to help her stay healthy and svelte. -- Dr. Marty Becker and Mikkel Becker
Do you have a pet question? Send it to firstname.lastname@example.org or visit Facebook.com/DrMartyBecker.
Cat recovers well
after hip surgery
-- Fridgey, a 2-year-old Bengal cat who has had bilateral hip problems, gave veterinarians at Purdue Veterinary Teaching Hospital in West Lafayette, Indiana, their first opportunity to perform total hip replacement surgery -- a common procedure in dogs -- on a cat. He underwent the surgery in March, followed by extensive physical rehab sessions to get him back in shape, including sessions on an aquatic treadmill. Fridgey has recovered well, his veterinarians report. Between surgery and rehab, the cost of Fridgey’s care was approximately $10,000, but owners Tyler and Faith Goldsberry had pet health insurance, which covered 80 percent of the expense.
-- Summer is still in full swing. If you haven’t been to the beach with Rover yet, here are 11 dog-friendly options: Muir Beach in Marin County, California; Dog Beach in Fort Myers Beach, Florida; Jekyll Island off the coast of Georgia; Montrose Dog Beach in Chicago; Long Meadow Dog Beach in Brooklyn’s Prospect Park; Cape Hatteras National Seashore in North Carolina’s Outer Banks; Ecola State Park in Cannon Beach, Oregon; Kinney Shores in Saco, Maine; Edisto Island Town Beach and State Park in South Carolina; Padre Island National Seashore in Corpus Christi, Texas; and Magnuson Park in Seattle.
-- Got a constipated canine or a cat who’s hacking up hairballs? Add a little plain canned pumpkin to his diet. The added fiber can get things moving in your pet’s digestive tract, and it also helps to reduce the incidence of hairballs. For pets with mild diarrhea, the fiber helps to firm up loose feces. Pets on a diet will appreciate some pumpkin mixed with their food to help them feel fuller. Ask your veterinarian how much to give, based on your pet’s size, and be sure to use plain canned pumpkin, not the sweetened pie filling. -- Dr. Marty Becker, Kim Campbell Thornton and Mikkel Becker
ABOUT PET CONNECTION
Pet Connection is produced by a team of pet-care experts headed by "The Dr. Oz Show" veterinarian Dr. Marty Becker and award-winning journalist Kim Campbell Thornton. They are affiliated with Vetstreet.com and are the authors of many best-selling pet-care books. Joining them is dog trainer and behavior consultant Mikkel Becker. Dr. Becker can be found at Facebook.com/DrMartyBecker or on Twitter at DrMartyBecker. Kim Campbell Thornton is at Facebook.com/KimCampbellThornton and on Twitter at kkcthornton. Mikkel Becker is at Facebook.com/MikkelBecker and on Twitter at MikkelBecker.