New guidance on opioid-sparing techniques for treating pain

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Veterinarians have a new resource on opioid-sparing methods for treating animal pain that may also help mitigate the opioid abuse epidemic seizing the nation.

Late last year, the American College of Veterinary Anesthesia and Analgesia along with the International Veterinary Academy of Pain Management published a white paper titled "Opioid-sparing pain therapy in animals: working task force" on both organizations' websites. The document is a consensus report from a 13-member task force on increasing restrictions on the use and availability of opioids in veterinary medicine.

The paper offers background, guidance, and resources for veterinarians on how to "implement a comprehensive, patient-centered, multidisciplinary, multimodal opioid-sparing approach for the treatment of acute and perioperative pain in companion animals."

Dr. William Muir, a professor of physiology and anesthesiology at Lincoln Memorial University College of Veterinary Medicine, is one of the task force organizers. He said the task force emerged this past August from a discussion during the Veterinary Pain Short Course, an international symposium devoted to pain-related issues in animals held every two years in San Diego.

"We got people together from industry, from the colleges of veterinary medicine, as well as the specialty colleges in addition to private practitioners whose practice is largely devoted to treating pain in animals," he explained. "We were able to pull it off, and we put together this white paper."

The white paper emphasizes that the human opioid epidemic underscores the need for the veterinary profession "to actively pursue approaches that will minimize opioid use and its availability for diversion and abuse." Veterinarians can help, the paper adds, by quickly adapting to the current and likely long-term shortages of opioid drugs they're experiencing.

SyringeExtralabel use of opioids by veterinarians will be more closely monitored and regulated, and these drugs may become less available, depending on state and local regulations and distributor decisions, according to the white paper. Butorphanol and buprenorphine—opioids licensed for veterinary use—will remain available for the foreseeable future, as will opioid adjuncts.

The paper encourages treating pain with subanesthetic doses of dissociative anesthetics, local anesthetics, anxiolytics, gabapentinoids, and anti-inflammatory drugs. Nonpharmacological methods, including complementary therapies such as acupuncture and physical therapy, are also discussed as possible alternatives to opioids.

Several websites on opioid use in animals are listed in the white paper, which also contains opioid-sparing strategies, a list of animal pain assessment instruments, and recommendations for reducing opioid use in veterinary medicine.

"All veterinarians have the obligation and responsibility to protect human well-being and to promote animal health and welfare and relieve animal suffering. Veterinarians should, therefore, read and employ opioid-sparing techniques and practices for the betterment of man and animals," said Dr. Muir.

The white paper "Opioid-sparing pain therapy in animals: working task force" is available on the American College of Veterinary Anesthesia and Analgesia website and the International Veterinary Academy of Pain Management website.

Related JAVMA content:

What veterinarians need to know about the opioid epidemic (Oct. 15, 2018)

Frustration mounts over opioid shortage (July 1, 2018)

DEA provides update on opioid shortage (June 1, 2018)