Mar
14
2018

The opioid shortage isn’t going away any time soon.

The shortage, which is severely affecting veterinarians’ ability to provide pain management for patients, is expected to last into 2019. The primary short-term cause is a production issue at a Pfizer, Inc. plant in Kansas, but residual hurricane damage in Puerto Rico, a major pharmaceutical manufacturing center, and a pre-existing Drug Enforcement Agency mandate to reduce the manufacture of opioid medication in the United States by 20% in 2018, are also having an effect.

It’s a grim prognosis for pet healthcare providers and their patients, but the news isn’t all bad.

NEWStat reached out to Ralph Harvey, DVM, MS, DACVA, for pain management recommendations. Harvey, an associate professor of anesthesiology in the Department of Small Animal Clinical Sciences at the University of Tennessee College of Veterinary Medicine and a coauthor of the AAHA Anesthesia Guidelines for Dogs and Cats, is an expert on pain management.

And he says the opioid shortage couldn’t have come at a better time.

Because pet health professionals have never had more options for pain management.

“One of the greatest assets we have is local anesthetics,” Harvey says. “We’ve been teaching [veterinarians] to make use of the concepts of multimodal analgesia for a very long time. [That means using] local anesthetics and nonsteroidal anti-inflammatory agents all together.”  

Harvey says one of the things that AAHA’s Anesthesia Guidelines emphasize is that, “Any time you take an animal to surgery, you should be thinking about how you can be using local anesthetics. That might be as simple as a field block or a splash block where the local anesthetic is literally sprayed into the surgical field. And they go on to very technically sophisticated blocks based not just on anatomical locations but [also on] the use of ultrasound devices or electronic nerve locaters, so we can get the local anesthetic adjacent to the nerves.

“So, there are a variety of ways we can use local anesthetics, [and] a variety of local anesthetic agents . . . and they tremendously reduce the requirements for opioid analgesics.”

Harvey isn’t dissing opioids.

“Opioids are still extremely valuable,” he says, “and I hope we'll always have them available. But I do feel we can confidently do surgical procedures and provide good surgical analgesia using nonopioid options when we have to.”

“We have good nonopioid alternatives, including the nonsteroidal anti-inflammatory drugs ,” Harvey says. “[For] humans, they include things like aspirin and ibuprofen. [For] our veterinary patients, they include drugs like carprophen, deracoxib, Rimadyl, Deramaxx, and Galliprant.”

And, fortunately, there are no shortages of those.

“Then we have adjunctive analgesics, another class of drugs that are used in combination to support the role of the primary analgesics,” Harvey says. “The point is, we just have so many options that come together in multimodal, or balanced, analgesia. Multiple modalities, or different drug classes, balance with one another to synergistically provide very nice analgesia without using high doses of any single one of those classes of drugs.”

An additional advantage to multimodal analgesia: “It minimizes complications.”

“There is a crisis,” Harvey emphasizes. “We are forced into this now and many vets are not ready for it. This will encourage us all to use those techniques of multimodal analgesia. This will move us forward to embrace those other options.”

“It's certainly not the first time we’ve had shortages of important drugs and shortages of anesthetics,” Harvey acknowledges. “It just falls upon us to be careful and creative and to reach out for resources. The pharmacists who work at veterinary colleges are a wonderful resource in this regard. They can be a wonderful source of help to veterinarians in finding suppliers that sill have opioids. And they can reach out to an anesthesiologist for particular recommendations on the drug doses that are necessary.”

In short, Harvey’s recommendation is, “Use more local anesthetics. Follow the AAHA Pain Management Guidelines. And any time we consider doing a surgical procedure, think: how can we use local anesthetic techniques?”

There’s never been a better time.

Photo credit: © iStock/winstonwolf89

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