Analgesia without Opioids

Katrina Lafferty, BFA, RLAT, CVT, VTS (anesthesia/analgesia) University of Wisconsin-Madison, Veterinary Medical Teaching Hospital

Introduction:

In veterinary medicine, opioids are the mainstay for treatment for most pain states, from mild to severe. However, in human medicine, opioid therapy can lead to abuse, addiction, overdose, and death. This has brought opioid availability, prescription, and management to the forefront; opioids are in the spotlight worldwide. To tackle the emerging opioid crisis, the DEA decreased opioid production by 25% in 2017, 20% in 2018, and reduced production by 10-15% in 2019. The decreases are targeting full mu agonist opioids, which have the highest potential for abuse. These drugs primarily include morphine, fentanyl, and hydromorphone. As the impact of opioid availability is felt and opioid analgesics are more challenging to obtain, supplies are prioritized toward human medical needs, and veterinary medicine will see shortages. In 2017 and 2018, DEA-mandated decreases in opioid production coupled with natural disasters and manufacturing shortages created an opioid shortage felt throughout the veterinary medical community. Universities and private practices alike found themselves unable to obtain many necessary opioid analgesics such as fentanyl and hydromorphone. Practitioners were forced to prioritize pain management for cases, “saving” hydro or fentanyl for the cases that could not do without. This shortage, and the knowledge that shortages will likely get worse before they get better, has made the veterinary field take a step back and examine how to conserve opioids while still providing the analgesia and pain management that patients and their conscience demand.