Prescribing oral opioids for dogs probably doesn’t help them—and could hurt their owners

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Given the popularity of tramadol among opioid addicts and how often pet owners doctor shop for veterinarians willing to prescribe it, sending home oral opioids such as tramadol may not be the best option for managing canine pain at home.

Especially if it doesn’t even work all that well.

“Unfortunately, oral tramadol does not appear to be effective in managing postoperative or arthritis pain in dogs based on our current evidence,” Stephanie Keating, DVM, DVSc, DACVAA, told NEWStat.

Keating, assistant professor and pain management expert in veterinary clinical medicine at the University of Illinois’ (UI) College of Veterinary Medicine, said that the way dogs absorb and metabolize oral tramadol may hinder the drug’s pain-reducing effect.

And she said researchers have known that for a long time: “There has never been compelling evidence that oral tramadol has been effective in dogs for treatment of these conditions.”

That isn’t to knock the efficacy of tramadol or other opioids—when a dog is hospitalized and in acute pain, intravenous (IV) opioid administration is one of the best pain management options available, Keating said. But IV drugs are not an option for an animal at home, whereas less effective oral forms are, and that’s where the potential for abuse begins.

Yet many veterinarians routinely prescribe tramadol in pill form for dogs when they leave the hospital after surgery or for other painful conditions such as osteoarthritis.

Keating said the practice of prescribing oral tramadol for outpatient analgesia in dogs may have originally started due to the drug’s low cost. That, combined with data demonstrating analgesic efficacy with fewer side effects compared with other oral opioids in human patients made a compelling case for prescribing them.

Unfortunately, the veterinary profession hasn’t necessarily kept up with the research. What can we do about that?

“I think the best way to prevent the overprescription of oral opioids for canine patients is through ongoing outreach and education in the veterinary community,” Keating said. And she’s helping do just that—Keating and a few UI colleagues recently developed a free, online continuing education program in pain management for veterinarians. The videos include advice on effective pain management for veterinary patients and cautions about unwarranted prescription of oral opioids.

“As this issue has gained recognition in light of the opioid epidemic, research efforts by veterinary pain and pharmaceutical specialists have followed in hopes [of identifying] more effective analgesic options for dogs that reduce human risk,” Keating said.

Keating said that both veterinary patient care and human safety will improve with ongoing research, drug development efforts, and continuing education in the veterinary community: “Ultimately, these factors will provide new analgesic options for our canine patients and shift prescribing practices.”

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