Editors Note , Practice Management

The Opioid Crisis: A Veterinarian’s Action Plan

Simon R. Platt BVM&S, MRCVS, DACVIM (Neurology), DECVN University of Georgia

University of Georgia
College of Veterinary Medicine
[email protected]

Simon R. Platt, BVM&S, MRCVS, DACVIM (Neurology), DECVN, is a professor of neurology and neurosurgery at University of Georgia College of Veterinary Medicine. His research interests include ischemic disease of the central nervous system, canine brain tumors, and epilepsy.

Dr. Platt is a member of the International Veterinary Epilepsy Task Force and a founding member of the Southeastern Veterinary Neurology Group. He has authored or coauthored more than 190 journal articles and 50 book chapters and is the co-editor of three textbooks: BSAVA Manual of Canine and Feline Neurology, Manual of Small Animal Neurological Emergencies, and Canine and Feline Epilepsy: Diagnosis and Management. Dr. Platt received his veterinary degree from University of Edinburgh (Scotland) and completed an internship in small animal medicine and surgery at Ontario Veterinary College (University of Guelph) and residency in neurology and neurosurgery at University of Florida.

The Opioid Crisis: A Veterinarian’s Action Plan
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“We, as clinicians, are uniquely positioned to turn the tide on the opioid epidemic.”1
— Vivek Murthy, former U.S. Surgeon General

Last year, the opioid overdose epidemic was responsible for an estimated 30,000 human deaths in the United States.2 Much needed attention has been focused on this public health concern, which has started to affect the veterinary profession and the way we practice on a daily basis. While we might not prescribe the most commonly abused drugs to our patients, such as oxycodone, we have plenty of other options that can be targeted by pet owners. However, if we are to address the restrictions resulting from the crisis, we need to adapt to be part of the solution, whether this is fair to us or not.

Multiple states have signed control measures into law, which may require clinicians to check statewide databases (prescription monitoring programs) before prescribing opioids and benzodiazepines. Should this be our role, too, or should veterinarians be exempt from checking up on pet owners? Other states now have legislation in place that shore up dispensing procedures and for reporting opioid prescriptions, while some are restricting the duration of an opioid prescription. If this were not enough, we now face a shortage of parenteral drugs such as fentanyl and hydromorphone. How do we keep pace with the requirements, understand the alternatives, and adapt to practice in this new era of opioid restriction?

The Food and Drug Administration published an article outlining a 6-step plan for veterinarians who stock and administer opioids.3

  1. Follow all federal regulations on prescribing opioids.
  2. Follow all state regulations on prescribing opioids.
  3. Use alternatives to opioids.

Obviously, sometimes finding alternatives to opioid use in an individual animal is easier said than done. Thankfully, organizations such as the International Veterinary Academy of Pain Management and American Animal Hospital Association are among several providing resources to help us with nonopioid protocols that may be useful in our patients.

  1. Educate pet owners on safe storage and disposal of opioids.
  2. Know what to do if a pet overdoses on fentanyl or other opioids.
  3. Have a safety plan and know the signs of opioid abuse.

This last step is a call to action, suggesting veterinarians have a safety plan in place. While it may be considered a simple case of self-education and responsible citizenship, we could also argue that we are now tasked with policing a problem that our profession did not create. Certainly, the answer to the opioid crisis may not be as simple as a 6-step plan; however, we can take small steps toward providing pain relief for our patients in a manner that aids them, complies with government regulations, and protects our practices from liability.

References

  1. Turn the Tide. turnthetiderx.org. Accessed September 18, 2018.
  2. National Institute on Drug Abuse. Overdose death rates. drugabuse.gov/related-topics/trendsstatistics/overdose-death-rates. August 2018. Accessed September 17, 2018.
  3. U.S. Food and Drug Administration. The opioid epidemic: what veterinarians need to know. fda.gov/AnimalVeterinary/ResourcesforYou/ucm616944.htm. Updated August 20, 2018. Accessed September 17, 2018.

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