{"id":3543,"date":"2018-12-17T13:28:28","date_gmt":"2018-12-17T18:28:28","guid":{"rendered":"https:\/\/todaysveterinarynurse.com\/?post_type=articles&p=3543"},"modified":"2022-02-07T17:24:16","modified_gmt":"2022-02-07T17:24:16","slug":"veterinary-clinic-opioid-shortage","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/practice-management\/veterinary-clinic-opioid-shortage\/","title":{"rendered":"Opioid Shortage: What\u2019s a Veterinary Clinic to Do?"},"content":{"rendered":"

The veterinary community is experiencing an opioid shortage, and although many rumors abound, let\u2019s start with the facts that the Food and Drug Administration (FDA) has laid out.<\/p>\n

The largest manufacturer of opioids in the United States, Pfizer, has been required to decrease production because of mandatory upgrades to their plant (FIGURE 1<\/strong>). The FDA is working with other producers to expand their production to help reduce a portion of the shortage until Pfizer is able to get back to normal production.1<\/sup><\/p>\n

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FIGURE 1.<\/strong> Morphine<\/p><\/div>\n

The American Veterinary Medical Association (AVMA) has been closely monitoring the shortage and recommends that you contact the FDA at AskCVM@fda.hhs.gov or call them at 240-402-7002 (the office of the FDA\u2019s Center for Veterinary Medicine) to voice your concerns. If we stay silent, the FDA will not know how profoundly this affects veterinary patients. The AVMA further suggests using adjunct therapies to help provide analgesia for your patients.<\/p>\n

Rethinking Our Strategy<\/h1>\n

Best medicine practice has always been to provide multimodal analgesia for the patient. In the past, the veterinary profession may have relied more heavily on opioids and not used adjunct therapies to their full advantage. We need to rethink our strategy.<\/p>\n

Obtaining pure mu opioids may still be possible, but it will take more time and effort on your part than in the past. The best option is to make requests from multiple distributors, for a variety of opioids, and to use standing orders. Veterinary healthcare teams must be willing to use different opioids and different strengths of the formerly used drugs. Examples of this include using sufentanil instead of fentanyl and using a hydromorphone concentration of 10 mg\/mL instead of 2 mg\/mL. This will require some updated education on your part, but it\u2019s worth it for the analgesic results in the patient (FIGURE 2<\/strong>).<\/p>\n

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FIGURE 2.<\/strong> Hydromorphone<\/p><\/div>\n

Those hospitals lucky enough to still have pure mu opioids in their possession should use them sparingly. One option suggested by Andrea Looney, DVM, DACVAA, is to incorporate a butorphanol and dexmedetomidine premedication and then, just before incision, administer a pure mu opioid injection. She has had good results using this method along with adjunct therapies.2<\/sup><\/p>\n

Preemptive Analgesia<\/h1>\n

What else can be used if your supply of opioids has been depleted or diminished?<\/p>\n

Preemptive analgesia is always the best option. One way to accomplish preemptive analgesia is with local and regional blocks. These blocks are one of the most effective ways of blocking transmission of pain.3<\/sup> Common blocks include the following:<\/p>\n