The DEA is decreasing production of opioids again this year by another 20%. This will likely have a direct effect on our use and availability for our patients. We use opioids routinely for analgesia, especially for surgical procedures so this is causing some panic in our community.
This is mainly going to cause a shortage of schedule II drugs (for us this will mostly be hydromorphone, morphine, and fentanyl). And not only will these drugs be more difficult to get, but the price could be much higher.
What will we do to ensure sufficient analgesia to our patients? We are creatures of habit.
- We may need to modify our drug protocols to fit the needs of the patient while using drugs we have on hand (such as buprenorphine which is easier to obtain than hydromorphone). We might want to save our morphine for more painful procedures and use buprenorphine or butorphanol for less painful procedures (such as minor mass removals or neuters). Butorphanol does not have great analgesia but works well for sedation purposes; this would not be a good alternative for very painful procedures.
- Local analgesia is likely to become a much more important tool for us in the future. I remember making soaker catheters during my internship. This is actually a very valuable tool in managing pain locally. It works very well for amputations, chest tubes, large mass removals, and some orthopedic procedures. Do you remember how to make and use these?
- Judicious use of NSAIDS is very important in those patients that can tolerate them.
- What about alternative treatments? I have a friend who runs a holistic practice, and she routinely uses acupuncture and cold laser therapy for her patients. These can be great adjunctive therapies and they really should be considered. If you don’t do these treatments, there is likely a veterinarian nearby that does either in-clinic or mobile, so consider referring clients to them for these specific treatments if a patient may benefit. Many practices now have laser therapy available which is good at reducing inflammation.
- Herbal remedies? These are often controversial, but there are some herbals that may be good for additional pain control, such as Boswellia, Yucca, cannabis oil, or hemp.
- Be mindful of your procedures. Try to keep incisions small when possible, use good local blocks, minimize tissue damage, delicate handling, etc.
- Make patients comfortable post-op. Make sure they have good heat support, soft and supportive bedding, they are being adequately turned when needed, good nursing care, quiet area, etc. The more comfortable they are in the hospital, the better they will heal and recover. Minimizing their discomfort and pain in every way is important.
Everything you do in a multi-modal approach to pain is important. Judicious use of the drugs we have available to us will allow us to continue to be successful in adequate analgesia for our patients. Read about the DEA increasing production.