Constable: Veterinarians need to be dogged about opioid abuse
By Burt Constable
With more than 47,000 people dying from opioid overdoses in 2017, a massive civil trial that began Wednesday could delve into the manufacture and distribution of prescription painkillers, assess blame for the 2 million addicts in our nation and make those responsible pay.
But a team of veterinarians at the University of Illinois launched an online training program this week, warning that we also need to examine how opioids are prescribed for dogs.
Opioids, specifically tramadol, are "our go-to medication after every surgery," says University of Illinois veterinary anesthesiologist Ashley Mitek, a pain management expert. But evidence suggests oral opioid medications don't work that well for dogs, "so why are we prescribing it?" Mitek says.
In addition, a study at the Colorado School of Public Health found some humans intentionally hurt their pets in the hope of abusing the painkillers that veterinarians supply. Given the ineffectiveness of oral opioids for dogs and the risk of human abuse, Mitek and fellow veterinary clinical medicine professors Stephanie Keating and Maureen McMichael at the University of Illinois this week launched an online pain management training program for veterinarians.
"We need to increase our vigilance, as these drugs can be easily abused," Mitek says. "I don't think most veterinarians are thinking about it."
The Colorado study of 189 veterinarians found 13% reported seeing a client believed to have purposefully harmed a pet in an attempt to get opioids for their own use.
"As a profession, we need to be on our toes," Mitek says.
Injectable opioids, including morphine, are extremely effective for dogs undergoing surgeries, including the common spaying operation in which a dog's ovaries and uterus are removed, Mitek says.
Fentanyl, a synthetic opioid that can be distributed through patches adhered to a dog's skin, can work well for a couple of hours immediately after surgery, but sending patients home with a supply increases the chances for abuse. Keeping a dog in a hospital or clinic for 24 hours after surgery is ideal, but that is expensive and not possible at many clinics.
"Whether opioids are effective, and whether they are the best choice as compared with other options, depends on the animal, the animal's condition, what the desired outcome is, and which opioid and other options are under consideration," says Sharon Curtis Granskog, a spokeswoman for the American Veterinary Medical Association, headquartered in Schaumburg.
Unlike humans, dogs don't develop opioid addictions, Mitek says. However, drug-detecting dogs can overdose in the line of duty. Mitek is a co-founder of the National Educational Campaign for Opioid Overdose in Working Dogs, which offers online training for veterinarians and first-responders on how to save drug-detecting dogs, often by administering the same Naloxone drug used to save the lives of humans who overdose on heroin or other opioids.
The better veterinarians handle the preemptive drugs given to dogs before surgery, the better dogs are after surgery, Mitek says. Sending dogs home with anti-inflammatory drugs can be effective. Veterinarians also are looking at alternative pain treatments, such as hydrotherapy, cold laser, acupuncture, turmeric and cannabidiols (CBD).
Mitek says further study is needed before any of those become acceptable, but a recent study by the Cornell University veterinarian school found CBD oil could relieve pain and improve mobility in dogs with osteoarthritis.
"We have a passion for trying to make sure animals are pain-free," Mitek says, adding experts are moving away from oral opioids in pursuit of effective treatments that also limit the risk of human abuse. "Many veterinarians are trying to incorporate these into their practices."