The opioid shortage is both a manufacturing issue and a manufactured one.

The manufacturing part can be traced back to production issues at a Pfizer Inc. plant in Kansas and residual damage from last year’s Hurricane Maria in Puerto Rico, a major pharmaceutical manufacturing center.

The manufactured part can be traced back to the US Drug Enforcement Agency (DEA), which mandated a reduction in opioid production quotas in each of the past two years—a reduction of 25% in 2017 and 20% in 2018, respectively. Those reductions are expected to continue for the foreseeable future; the DEA has already announced a further reduction of 10% for 2019.

The cuts in production quotas are an attempt by the DEA to reduce the impact of opioid diversion on the very real opioid crisis. However, those reductions have had an unintended negative impact on the practice of veterinary medicine.

A recent nationwide survey by Wedgwood Pharmacy, a compounding pharmacy which serves both the human-health and veterinary markets, sheds new light on those negative impacts.

53,968 veterinary professionals were invited to participate; 1,135 completed the survey.

Among its other aims, the survey sought to determine the impact of the difficulty in obtaining necessary supplies of five opioids on the DEA’s “most abused” list that 50% to 80% of respondents considered important to their practice and to their patients’ health: hydromorphone, morphine, fentanyl, hydrocodone, and oxymorphone.

Up to 73% of respondents reported having difficulty obtaining necessary supplies of those five opioids in 2017.

In an attempt to limit diversion of opioids from medical practices both human and veterinary, the DEA suggests four warning signs that a client is potentially abusing opioids:

• Suspicious injuries in a new patient
• Asking for specific medications by name
• Asking for refills for lost or stolen medications
• Pet owner is insistent in their request

Yet, significantly, nearly 90% of respondents rarely or never see any of those four signs.

The survey also reports that shortages of key opioids have led to the use of less effective, non-narcotic alternatives such as NSAIDs (83%), increased patient suffering (71%), use of a local anesthetic (49%), postponed procedures (26%), and patient deaths (3%).

Among the survey’s findings:

• The key impact of reduced supplies of opioids for veterinary use is pain, suffering, and death of animals because alternatives are not as effective for anesthesia, analgesia, and sedation
• Shortages limit therapeutic choices and are especially problematic given the number of species veterinarians treat and how differently they react to opioids or NSAIDs
• Opioid alternatives are also much more expensive, causing hardship for clients, who are making more decisions to euthanize to end suffering

The survey also included hundreds of write-in comments from respondents expressing their frustration at the unintended consequences for the practice of veterinary medicine of the DEA’s well-meaning diversion-reduction efforts.

Some are pointed, such as this one:

“It is entirely unethical to deny these essential pain-relieving medications to patients [who] will not develop a dependency on them. Veterinarians are not the medical professionals causing this opioid crisis and our patients should not suffer because of human weakness, laziness, or incompetence.”

And some are simply heartbreaking:

“Animals cannot divert medications. Veterinary medicine has taken a long time to get to the point of addressing pain adequately. Please don’t take that away! The amount of opioid diversion is an epidemic, no doubt, but please do not punish our patients for this!”

 Photo credit: © iStock/edelmar