Survey: Opioid shortages are harming veterinary patients

A survey by Wedgewood Pharmacy, which compounds medications for veterinarians, shows that there are unintended consequences for veterinary medicine caused by the Drug Enforcement Administration's (DEA's) efforts to address the national opioid crisis, according to a release from the company.

Opioids in animal medicine are the foundation-and often the only method-of pain control and anesthesia, Wedgewood states. They are critical for the treatment of animals that have been hit by a car, shot by a gun, mauled by another animal, undergone surgery, or suffer from a severe disease or other trauma. Most pet owners, regulators, elected officials, and state board of pharmacy members are not aware of the repercussions, according to the release.

To address the misuse and diversion of opioids by people, the DEA has proposed an average 10 percent decrease in the 2019 manufacturing quotas for six frequently abused opioids, including five opioid drugs commonly used by veterinarians. The DEA decreased allowable opioid manufacturing quotas by 25 percent in 2017 and 20 percent this year. When supplies of these drugs are limited, manufacturers and distributors give preference to allocating their limited supplies for use in human health, creating shortages for veterinary medical practitioners, the release states. For example, in August, Pfizer suspended delivery of injectable opioids to veterinary customers.

According to Wedgewood's survey, these shortages have had the unintended results of creating unnecessary pain, suffering and death of animals because alternatives are less effective and are more expensive.

Here are some key findings from the survey's data:

> In the past year, from 27 to 73 percent of veterinary professionals have had difficulty obtaining necessary supplies of five opioids they consider important to their practice and to patient health. They include hydromorphone, morphine, fentanyl, hydrocodone and oxymorphone.

Source for all data: Impact of Opioid Shortages on Veterinary Medicine, Wedgewood Pharmacy, 2018

> Shortages of these Class II opioids have caused ...

• The use of less effective, non-narcotic alternatives such as NSAIDs (83%)

• Increased patient suffering (71%)

• Use of a local anesthetic (49%)

• Postponed procedures (26%)

• Patient deaths (3%).

> 88 percent of respondents “rarely” or “never” see the four warning signs published by the DEA that a client is potentially abusing opioids. Nevertheless, 63 percent “have training and/or procedures in place for medical and other staff members to recognize the signs of opioid abuse.”

One veterinarian wrote this comment to illustrate the effect of opioid shortages: “We have an emergency practice, so we see a lot of very painful animals from surgeries, traumas and severe illness. Most of our patients in acute pain are not candidates for NSAIDs or other treatments like laser and acupuncture, which take longer to work and are not proven effective for severe pain. Not having access to opioids almost makes treatment cruel.”

Wedgewood conducted the survey in September, sending the invitation to participate to 53,968 veterinary professionals, of whom 1,135 completed the survey. Wedgewood planned to submit the results (which include hundreds of write-in comments from veterinarians) in formal comments to the DEA regarding the proposed production quota reductions.

The sampling of participants in the survey was participant-driven, not random, and therefore measures of statistical significance such as confidence levels and sampling error do not apply to the results of the study, the release states. They represent the opinions of the professionals who participated.

Comments to the DEA from veterinarians

Wedgewood submitted these comments to the DEA as it reviews policies for 2019.

“How would you feel if your body had been ravaged by an F350 and the best your doctor could do was sedate you and have you swallow aspirin?”

“We are having to treat gunshot wounds, hit by car, traumatic fractures and limb amputations without full mu opioids, which is significantly increasing patient suffering.”

“I cannot practice effective medicine without access to these pain-modifying drugs. I don't script these potent medications out to clients, as they are only used in hospital for urgent pain management needs. Please rethink how you are designing your programs so that we do not have useless suffering.”

“Entire research studies have been halted due to not being able to acquire adequate pain meds. These studies will affect human medical care, as many are orthopedic studies where NSAIDs can't be used due to their mechanism of action.”

“I work on horses so need larger volumes for postop pain relief. Not all narcotics are useful in horses, so my options are already extremely limited.”

“We have experienced patients waking up from procedures in pain, recovery times increased, stress increased on the animals. For a shelter environment, prolonged lengths of stay and longer recoveries are life-threatening situations.”

“Patient deaths occur when a pet is painful and we can't get access to meds we need for comfort. The owner elects to put the pet down to ease suffering.”

“We had one patient die as a result of anesthesia complications that may have survived if we had access to morphine or hydromorphone.”

“It is entirely unethical to deny these essential pain-relieving medications to patients that will not develop a dependency on them. Veterinarians are not the medical professionals causing this opioid crisis and our patients should not suffer because of human weakness, laziness, or incompetence.”