Illinois Ag Connection - The Opioid Epidemic: What Veterinarians Need to Know

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The Opioid Epidemic: What Veterinarians Need to Know
Illinois Ag Connection - 08/17/2018

The epidemic of opioid abuse is affecting medical and health professionals such as physicians and pharmacists, but also veterinarians, reports the U.S. Food and Drug Administration (FDA).

Prescription opioids are powerful pain-reducing medications that include oxycodone, hydrocodone, and morphine, among others, and they have both benefits as well as potentially serious risks, such as addiction, abuse, and overdose.

While opioids are a small part of the veterinarian's medical arsenal for treating pain in animals, stocking and administering these drugs also makes it important for veterinarians to understand how they can help combat the abuse and misuse of pain medications.

So what steps can veterinarians take if they stock and administer opioids? The FDA provided this week the following:

1. Follow All State Regulations on Prescribing Opioids

Each state creates its own regulations for the practice of veterinary medicine within its borders. These include regulations about secure storage of controlled substances, like opioids, and under what conditions veterinarians can prescribe them to patients.

States are enacting new laws or strengthening existing ones in an effort to restrict access to opioids. In some states, veterinarians are also subject to these laws. According to the American Veterinary Medical Association, fifteen states and the District of Columbia currently have regulations requiring veterinarians to report when they dispense opioids and other controlled substances to patients: Alaska, Arkansas, California, Connecticut, Illinois, Indiana, Michigan, New Hampshire, New York, North Dakota, Oklahoma, South Carolina, Vermont, Washington state, and West Virginia. Thirty-four states, however, exempt veterinarians from Prescription Drug Monitoring Programs.

Not only are states changing reporting requirements, some are also setting limits on the number of pills that can be prescribed at one time and some are even limiting the duration of a patient's treatment with opioids. States such as Colorado and Maine require veterinarians to look at a pet owner's past medication history before dispensing opioids or writing an opioid prescription.

To ensure that they are in full compliance with current state laws, veterinarians can contact their State Board of Veterinary Medicine and their State Board of Pharmacy for updated regulations.

2. Follow All Federal Regulations on Prescribing Opioids

FDA approves controlled drugs and monitors reported adverse events associated with these drugs. The Drug Enforcement Administration (DEA), however, creates and enforces the regulations regarding controlled substances. Veterinarians should contact their local DEA office if they have questions about the federal regulations regarding controlled substances.

When controlled substances are stolen from the clinic, veterinarians must report the theft to DEA and to their local police department as soon as possible.

Prior to March 2018, there had been two FDA-approved opioid products approved for use in animals. Wildlife Laboratories, the sponsor of a potent analog of fentanyl called carfentanil (marketed as Wildnil), voluntarily relinquished the approval for this drug in March 2018, as it hadn't been marketed in at least five years, and because the sponsor wanted to avoid the possibility of diversion of the drug if marketed in the future.

Recuvyra (fentanyl), now the only FDA-approved opioid for use in animals, is not being marketed. Therefore, veterinarians who need to use an opioid to control pain in their patients use products approved for use in humans.

FDA has pre-approval (abuse potential review) and post-approval safeguards in place for these drugs, and requires Risk Evaluation and Mitigation Strategies (REMS) for some products to ensure that the benefits outweigh certain risks.

While veterinarians using approved human opioids extra-label in animals do not have to follow the human drug's risk mitigation requirements, they do have to follow the regulations for extra-label use in animals. FDA also strongly encourages veterinarians to read the label information for human opioid drugs and take any associated training. Veterinarians can find a list of FDA-approved human drugs marketed under REMS programs on FDA's website.

3. Use Alternatives to Opioids

Pain management is an important issue in veterinary medicine, and in many cases non-opioid protocols may adequately control pain in animals. The International Association of Veterinary Pain Management disclaimer icon is a good resource for pain management information for companion animals, as is the American Animal Hospital Association and American Association of Feline Practitioners 2015 Pain Management Guidelines disclaimer icon.

4. Educate Pet Owners on Safe Storage and Disposal of Opioids

Pet owners may be unaware that pet opioid prescriptions in the home pose a risk for accidental or intentional misuse by family members or guests. Whenever pets are actively receiving opioids, veterinarians should advise pet owners to secure the opioids and store them out of sight. When the pet owner has unwanted opioids, disposing of the medication should be a priority. Because of their inherent risks, FDA has specific recommendations for opioid disposal.

5. Know What to Do If a Pet Overdoses on Fentanyl or Other Opioids

Not only can people overdose on opioids, but so can pets. Working dogs, like narcotics detection dogs, are particularly susceptible because they may inhale the powdered drug. Because fentanyl and fentanyl-related drugs are potent, it only takes a tiny amount of drug to cause an overdose. Veterinarians can contact the University of Illinois College of Veterinary Medicine's emergency hotline for suspected cases of canine opioid overdoses. An AVMA/University of Illinois video disclaimer icon may also give veterinarians important information on what to do in the event of an overdosing canine patient.

6. Have a Safety Plan and Know the Signs of Opioid Abuse

Veterinarians should have a safety plan in the event they encounter a situation involving opioid diversion or clients seeking opioids under the guise of treating their pets. Local police departments can advise veterinarians about what to do in these situations. The Fairfax County Police Department in Virginia, for example, has released a brochure for veterinarians about "veterinarian shopping" and preventing diversion of controlled substances.

How do you know if a client or employee may be abusing opioids?

While these may all be ordinary occurrences, some warning signs that a client is potentially abusing opioids may include:

- Suspect injuries in a new patient

- Asking for specific medications by name

- Asking for refills for lost or stolen medications

- Pet owner is insistent in their request

Some warning signs that veterinary staff may be abusing opioids include:

- Mood swings, anxiety, or depression

- Mental confusion and an inability to concentrate

- Making frequent mistakes at work

- Not showing up for work

Combating opioid addiction and addressing misuse of pain medication continues to be one of FDA's highest priorities. Veterinarians as medical professionals have an opportunity to partner with FDA and others to take on this deadly epidemic, and the agency encourages them to continue to work with their clients and both local and national organizations to join in the fight.

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