MIAMI VALLEY — The U.S. Food and Drug Administration (FDA) recently issued an addiction warning about another possible point of access for those trying to obtain opioids.
The FDA released a warning and resource guides in regard to pet owners or others with access to pets possibly abusing the animals’ opioid pain medication. The FDA advised veterinarians to continue following all state regulations on prescribing opioids and advised pet owners to be vigilant with their pets’ medication.
“We recognize that opioids and other pain medications have a legitimate and important role in treating pain in animals – just as they do for people. But just like the opioid medications used in humans, these drugs have potentially serious risks, not just for the animal patients, but also because of their potential to lead to addiction, abuse and overdose in humans who may divert them for their own use,” said FDA Commissioner Scott Gottlieb, M.D., in a statement on the FDA’s new resource guide to support responsible opioid prescribing for pain management in animals.
Dr. Nichole Olp, DVM, of Bigger Road Veterinary Center and a trustee with the Miami Valley Veterinary Medical Association, said that it has been a concern for the Miami Valley Veterinary Medical Association and local veterinary clinics that pet owners might use their pets to gain access to opioid medication.
“There have been confirmed cases in Ohio of clients ‘clinic-hopping’ or ‘vet-shopping’ — going from clinic to clinic in order to seek out opioid-based medications for personal use, using their pet as an excuse. The official term is ‘opioid diversion.’ Once we dispense or prescribe these medications, we have no way to monitor to make sure the pet is receiving the medication,” Olp said.
One example of suspicious behavior is if a pet owner continuously tries to fill their pet’s opioid medication before the refill is due.
“For pets that may need to be on an opioid medication daily long-term, I have seen cases where a client will try to refill a medication a few days or a week earlier than necessary. Occasionally, we will approve this. But a client who does this repetitively becomes suspicious,” Olp said.
Olp said that when this happens, they contact the client and let the client know that the clinic cannot refill the medication early. Olp added that they do not prescribe more than one to two months’ worth of opioid medication at a time.
The FDA also suggested that the following behaviors could be warning signs that a pet owner is potentially abusing opioids: suspected injuries in a new patient; a pet owner asking for specific medications by name; a pet owner asking for refills for lost or stolen medications; or a pet owner who is insistent in his or her request.
Olp also explained that a pet’s medication, such as common medications like Tramadol or hydrocodone, may be filled in a veterinary clinic or scripted out to be filled at a human pharmacy. “Human pharmacies are very strict about filling these prescriptions,” she said.
Olp said that there have been several cases where a pharmacist double-checks the dose range, as she noted large dogs’ doses can be much higher than common human doses.
“I even had one case when I had to fax a page from my animal dosing formulary to a human pharmacy to prove that I wasn’t prescribing too high of a dose for my patient,” Olp said.
The FDA also recommends warning pet owners that their pet’s medication may be at risk for being abused by family members or others with access to that medication. The FDA suggests pet owners should secure the medication and store it out of sight when their pets are actively receiving opioid medication.
Animals may receive opioid medications for a number of conditions, including illnesses beyond pain.
“Hydrocodone, commonly know as hycodan, is an anti-tussive (anti-cough) medication that we use for cases of such kennel cough, heart disease, or tracheal collapse. Kennel cough cases usually only need to be on it for couple of weeks, but dogs with tracheal collapse may need to be on it several times daily for years to help control their clinical signs,” Olp said.
For some of the controlled substances, the process pet owners go through in order to get refills may help veterinarians and pharmicists track the pets’ use of the medication.
“Many prescriptions can be called in over the phone, but because it is high controlled substance classification, we cannot do that with hycodan. We need to write a paper prescription, and cannot approve refills. Owners will need to come into the clinic to pick up a new prescription when refills are needed, this allows us and human pharmacies to more closely monitor how quickly the pet is going through the medication,” Olp said.
Olp said that, in terms of pain, Tramadol and buprenorphine are the most common opioid pain killers veterinarians prescribe.
“Typically, we only use these after surgeries to help with pain control, but occasionally, they will be used in other situations, especially hospice-type care when we want an older pet to be on pain medications to help with quality of life,” Olp said.
Veterinarians have also been avoiding some of the medications that are more commonly abused.
“General practitioners don’t usually prescribe the most abused medications, like oxycodone,” Olp said. “Veterinarians who do more advanced and painful surgeries such as orthopedic surgeries will occasionally use fentanyl patches. However, due to the current opioid shortage, we’ve had to change some of our protocols and rely on different medications.”
Olp said that the American Animal Hospital Association (AAHA) regularly releases articles about opioids.
“The American Veterinary Medical Association (AVMA) provides information to its members, including links to current state prescribing regulations, and how to identify vet-shoppers,” Olp said.
For more information and resources from the FDA, visit www.fda.gov/AnimalVeterinary/ResourcesforYou/.
Reach Sam Wildow at firstname.lastname@example.org