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  Volume No. 16 Issue No. 7 July 2019  

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Dr. Jim Humphries

  Pain meds for pets and the opioid issue
  By Dr. Jim Humphries

   Opioids play an extremely important role in human and veterinary medicine. They are important tools in the therapeutic arsenal of any medical doctor. Health care providers are diligent in the use of these drugs; first, for medical reasons; and, secondly, because the DEA (drug enforcement agency) regulates them so carefully.
   A medical doctor or veterinarian can lose their ability to practice for the misuse or diversion of these drugs. Many people and even health care providers actually fear these compounds, as they are associated with abuse, addiction and the dire consequences of diversion; or selling legitimately obtained drugs for illicit use.
   However, all this media hype about a “crisis” is causing real concerns about the under-treatment of disorders where opioid therapy is absolutely appropriate and where there are no good alternatives. One good example is in both human and veterinary anesthesiology. Safe anesthesia protocols cannot be accomplished without the use of a variety of opioid drugs.
   Providers and patients are rightly concerned that these drugs will become so hard to obtain or prescribe that treatment failures may become commonplace — all over a media hype that ignores the real issue.
   People who honestly need these drugs are in a bit of a panic because they know once something turns into a media storm this size, it will create the dreaded “unintended consequences.” And they are right. Most health care professionals will tell you this issue is blown way out of proportion, as some other stories in today’s news. Opioid drugs have been with us for thousands of years; and, for some reason, there has never been a crisis, until now — now that we have wall-to-wall media hype, a crowd of talking heads competing for ratings and mind-numbing social media.
   You know it has become serious when people are taking their pets into a veterinarian, faking pain symptoms so they can get an opioid prescription and take it themselves. That is a crisis.
   An eye-opening study, published in the Journal of the American Medical Association, finds that the increase in opioid prescriptions for people over the past decade parallels a rise in similar prescriptions for pets, and that some of those pet meds aren’t being used for the pet’s “pain.”
   The study looked at all opioid pills and patches dispensed or prescribed for dogs, cats and other small animals at the University of Pennsylvania School of Veterinary Medicine from January 2007 through December 2017. During that time, while the number of visits rose by only 13 percent annually, the number of opioid prescriptions rose by 41 percent.
   The use of prescribed opioids is well-intended by the veterinarian, but the concern is that it can mean an increased chance of leftover pills being misused later by household members, sold or diverted or endangering young children through unintentional exposure. But this is true for almost any veterinary drug, some frankly more dangerous than opioids; however, because the term “opioid” is attached, it becomes a worldwide crisis and the media is all too eager to jump on the story.
   One good result of all the attention is that this has forced doctors to look at many old and new drugs that can be used to reduce the dose or completely change the way we control pain. The use of NSAIDs (non-steroid anti-inflammatory drugs) and a whole array of multi-modal drugs acting together could reduce the overall dose of all drugs to control pain. And there is even more emphasis now on things like laser treatments, physical therapy and natural remedies.
   I frankly believe pet opioid prescriptions contributing to misuse is a small risk — the fact that we know this is happening means we all have to be more aware and take extra precautions. Leftover opioids are one of the big drivers of opioid overuse and misuse. Consequently, don’t be surprised if your veterinarian is reluctant to prescribe these drugs for you to take home.
   However, in the case of anesthesiology, acute and chronic serious pain, cancer and other diseases where alternative meds or therapies simply don’t help like we would hope, opioids must be available and used with proper direction and oversight –- for yourself and for your pets.
Dr. Jim Humphries is a veterinarian in Colorado Springs and also serves as a visiting professor at the College of Veterinary Medicine at Texas A&M University. He lives in Falcon with his wife, horses and Great Danes.
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