Russ Daly: Veterinary medicine and the opioid problem

Hardly a day goes by when the national news doesn’t mention the opioid abuse problem in our country. As measured by the number of people dying from overdoses of prescription opioids, heroin, and synthetic opioids, the problem has exploded over the past decade and shows no sign of decline. These numbers represent the tip of the iceberg. Many more people than that, even in our South Dakota communities, abuse these drugs with devastating consequences to their health and their families.

From most accounts, the opioid abuse epidemic sprouted from overzealous prescribing practices in human medicine. Opioid drugs are potent and effective pain relievers. Used properly, they can be life-changers for people with chronic pain or cancer. Some people, for reasons unclear, are predisposed to addiction to these medications, however. Untreated, this is the start of a downward spiral that ends up fatal for some.

Animals can also benefit from opioid drugs in the same manner as people do. These medications can be useful in dogs with chronic pain due to injuries or cancer, for example. Sometimes they’re used in animals on a short-term basis to relieve post-operative pain.

There was a time when pain relief for animals did not get much attention. We now realize the animal health benefits of pain relief. In addition, animal owner expectations of pain relief for their animals are growing – much as those expectations have increased in people. As a result, veterinarians now have many more pain relief options compared to even ten years ago. Most of these are non-steroidal anti-inflammatory drugs; opioids are usually used as a last resort.

Recognizing the national opioid abuse problem and the fact that these drugs are also available for animals, SDSU researchers were prompted to survey South Dakota veterinarians about opioids. There was a good response: more than a third of all the practicing vets in the state responded. While the amount of prescription opioids used in animals is a small fraction of those prescribed for people, about two-thirds of South Dakota vets had prescribed them for their patients. Most of those prescriptions were taken home by owners to give to their own animals. The specific opioid drugs most often used by these vets are different than those implicated in human opioid abuse, with lower abuse potential.

Interestingly, vets were keenly aware of the potential for clients or others to abuse the drugs they prescribe. Their decisions to prescribe take-home opioid medications are based just as much or more on client factors than animal factors. Did the client “misplace” the animal’s last prescription? Did they ask for an opioid drug by its specific name? Did they say their pet was in pain when the vet couldn’t detect any problem? If so, non-opioid alternatives are given. More disturbingly, a few vets (6%) suspected a client had intentionally injured a pet so they’d be given one of these medications.

And, should a desperate person think a vet clinic is an easy target from which to steal opioid drugs, they need to think again. All of the responding vets secure these drugs – and most have recently increased security. This means multiple locked boxes, cabinets, rooms, and video surveillance.

Unfortunately, veterinarians and clinic staff members are people too. What I mean by that is that they are not immune to the opioid abuse epidemic. About a third of vets knew of another vet or clinic staff member who had an issue with opioid abuse. Seven percent had had this happen in their own clinics. Many of the security improvements mentioned created better accounting for who has access to these drugs: some clinics only allow doctor access to controlled drugs, while others allow staff access.

What was encouraging was that the vast majority of vets felt they could play a role in preventing opioid abuse in their own community – they aren’t just throwing up their hands or minimizing the potential of their influence.

I hope people by now understand the role that veterinarians play in the health of the people – as well as the animals – in their communities. Commonly we think of zoonotic diseases – rabies, salmonella, etc. – in this regard. But the opioid epidemic serves as yet another example of how the actions of veterinarians can keep a human health problem from getting worse.