Veterinarians shifting to opiate alternatives
Nationwide shortage creates need for substitutes
A nationwide shortage of injectable opioids, like morphine, that are often used in surgery is forcing some veterinarians to seek other options to ease pain and discomfort for their furry patients.
The shortage happened when a U.S. Drug Enforcement Agency decision to reduce opioid production in response to the opioid crisis coincided with a manufacturing issue at Pfizer, one of the nation’s largest drug manufacturers.
Veterinarians are feeling the brunt of that shortage as manufacturers prioritize providing the drugs to hospitals for use by people. The shortage may last until 2019, while other drug makers ramp up production.
Diane Matt, CEO of Colorado Veterinary Medical Association, said the group is aware of the shortage and people are worried that the drugs won’t be available to help animals before and after surgery.
So far, the association’s sister organization that runs Pet Aid Animal Hospital and serves income-qualified clients has been able to meet its patients needs, Matt said. Other Boulder County veterinarians have reported little or no issues stemming from the shortage, but others say they have been forced to find alternative ways to help manage pain for their patients.
Both the Boulder Valley Humane Society and the Alpine Hospital for Animals in Boulder have reported running out of various medications, and being unable to order more for a period of time.
According to Lesli Groshong, the chief shelter veterinarian at the humane society, the availability of drugs such as morphine, fentanyl and hydromorphone has been unstable for a few years.
“When we order injectable drugs, we are told that they aren’t available,” Groshong said. “(…) There’s some that we can’t get anymore.”
The shelter still has some opioid options, but they also have alternatives like nonsteroidal anti-inflammatory drugs. Groshong said they’re being “more creative” and talking with academic colleagues to see what alternatives seem to work the best when they run out of a particular drug.
However, Heather Loenser, a senior veterinary officer for the American Animal Hospital Association, said that some substitutes for injectable opioids may not be as effective because they are meant to be used in conjunction with opioids. She cites the associations pain management guidelines for cats and dogs from 2015, which says that opioids are “the most effective drug class for managing acute pain.”
According to Loenser, the lack of injectable opioids is forcing veterinarians to “improvise beyond a manner with which many are comfortable when treating acute, chronic, and post-operative pain.”
Loenser estimates that the shortage is possibly affecting hundreds of thousands of pets, as opioids are usually used whenever a cat or dog needs surgery, ranging from a spay or neuter to an amputation. There are about 25,000 veterinary hospitals in the United States that see one to five patients per day, she said.
Still, Amanda Mones, the administrator for the Alpine Hospital for Animals, said the shortage isn’t hampering their practice, but improving it.
“We’re just being more mindful in our practice. . . We’re taking a step back and saying, from a pharmacological perspective, does it really warrant that level of pain management?” Mones said. “I don’t think it’s a bad thing, honestly, compared to the epidemic.”
Morphine was unavailable for the hospital, which Mones said seemed to be directly related to the federal allotment, and now hydropmorphone is unavailable and morphine is still difficult to get. It’s hard to discern which
scarcity is due to the drug agency’s changes, and which is due to the recent manufacturing issues.
Alpine Hospital prioritizes patient comfort and tries to get ahead of pain before it starts, according to Mones, as recovery outcomes are proven to be better for animals when pain is managed well.
The hospital now uses more antiinflammatory medications and local anesthetics, as well as alternatives like acupuncture, laser therapy and simple ice packs.
“We have to think strategically on how we can best provide that comfort, and it doesn’t always mean drugs,” she said. “We probably should’ve had that mindset from the beginning.”