Abuse of opioids affects veterinary providers

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We are all aware of the opioid crisis in the U.S. today especially with prescription medications. There is potential for abuse in veterinary practice and reports of “clients” going from veterinarian to veterinarian seeking controlled medications that are addictive. We have had requests citing the need for refills of these medications because they were misplaced and other excuses. As veterinarians, we do not prescribe many opioids and tend to use veterinary drugs designed for dogs and cats.

There is one drug, however, that has been commonly prescribed for pain over the last 10 years called tramadol. This drug is an opioid analgesic similar in some ways to morphine. It can be addicting but is considered to be very safe with minor side effects overall. The state of Connecticut recognized this potential for abuse a few years ago and will only allow three days of tramadol to be prescribed from the veterinary hospital. A script must be written for a human pharmacy to fill tramadol prescriptions if the pet requires more than three days.

A recent study at the University of Georgia looked at pain relief for 35 dogs with confirmed elbow or knee arthritis. The dogs received one of three treatments: a placebo, the NSAID rimadyl, or tramadol. The researchers used kinetic gait analysis and found that rimadyl definitely made the dogs more comfortable. Tramadol offered no therapeutic improvement over placebo for osteoarthritis pain. This is the latest study that supports the growing evidence for limited analgesic properties for tramadol. As a result, veterinarians are much less likely to prescribe tramadol. It is nice to be able to take tramadol off the list for canine lameness. We still prescribe tramadol for post surgical pain and the three day course is generally enough for most cases.

The other class of drug that is common for abuse is benzodiazepines (xanax, valium). These meds are often prescribed for behavioral disorders in dogs such as thunderstorm anxiety. This class of drug is considered addictive for humans and has the highest potential for abuse. There is an alternative canine-only medication called sileo that is much more effective for noise anxiety. This is an oral gel that is very effective and works quickly to calm the patient. As veterinarians, we are more likely to use animal-only drugs if possible.

The anticonvulsant phenobarbital is commonly used for seizures in pets and has potential for abuse. It is well tolerated in dogs and cats and has been used for decades. Here again is another controlled drug that we now have to script out for human pharmacies to dispense. It was more convenient and less expensive for clients to refill at the veterinary hospital but we can only prescribe a few days at a time until owners can get to the pharmacy.

Another medication that was very helpful to have on hand at the veterinary hospital was a narcotic cough suppressant. These hydrocodone-based medications were great for dogs suffering from “kennel cough” because they acted at the cough center in the brain. We can script out these medications now but it is again more expensive and another errand for the clients.

On the whole it makes sense for veterinarians to have human pharmacies take responsibility for overseeing controlled drugs. In the current climate of abuse of these addictive drugs we as veterinarians are always looking for alternatives that are effective for our pets and safe for society.