The epidemic of opioid abuse affects not only physicians and pharmacists, but veterinarians, as well. As a veterinarian you have an important role in combatting the misuse of pain medication, a continuing public health crisis in this country.
Opioids are a small part of a veterinarian’s medical arsenal for controlling pain in animals, but stocking, prescribing, and administering these products also makes veterinarians vulnerable to abuse from those seeking these drugs for personal use.
So how can you protect yourself, your staff, and your clients?
1. Follow All State Regulations on Prescribing Opioids
Each state creates its own regulations for the practice of veterinary medicine within its borders. These include regulations about secure storage of controlled substances, like opioids, and under what conditions veterinarians can prescribe them to patients.
States are enacting new laws or strengthening existing ones to restrict access to opioids. In some states, veterinarians are also subject to these laws. According to the American Veterinary Medical Association, eighteen states and the District of Columbia currently have regulations requiring veterinarians to report when they dispense opioids and other controlled substances to patients: Alaska, Arkansas, California, Connecticut, , Indiana, Maine, Michigan, Nebraska, New Hampshire, New York, North Carolina, North Dakota, Oklahoma, South Carolina, Tennessee, Virginia, Washington, and West Virginia. Thirty-two states, however, exempt veterinarians from Prescription Drug Monitoring Programs.
Not only are states changing reporting requirements, some are setting limits on the number of pills that can be prescribed at one time and others are limiting the duration of a patient’s treatment with opioids. States such as Alaska, Colorado, Connecticut, Indiana, Maine, Oklahoma, and West Virginia require veterinarians to look at a pet owner’s past medication history before dispensing opioids or writing an opioid prescription.
To ensure you are in full compliance with current state laws, contact your State Board of Veterinary Medicine and your State Board of Pharmacy for updated regulations.
2. Follow All Federal Regulations on Prescribing Opioids
FDA approves controlled drugs and monitors reported adverse events associated with them. The Drug Enforcement Administration (DEA), however, creates and enforces the regulations regarding controlled substances. Contact your local DEA office if you have questions about federal regulations regarding controlled substances.
When controlled substances are stolen from the clinic, veterinarians must report the theft to DEA and to their local police department as soon as possible.
Two opioids are approved and marketed for use in animals, butorphanol and buprenorphine. Another, droperidol fentanyl citrate, is approved but is not currently marketed. Thiafentanyl is a marketed veterinary opioid listed in FDA’s Index of Legally-Marketed Unapproved New Animal Drugs for Minor Species. Due to the limited number of approved and marketed veterinary opioids, veterinarians who need to use opioids to control pain in their patients generally use products approved for use in people.
FDA has pre-approval (abuse potential review) and post-approval safeguards in place for opioids and requires Risk Evaluation and Mitigation Strategies (REMS) for some products in order to ensure that the benefits of use outweigh certain risks.
When using approved human opioids off-label in animals, you do not have to follow the human drug’s risk mitigation requirements, although you do have to follow the regulations for off-label use. FDA also strongly encourages you to read the label information for human opioid drugs and take any associated training. You can find a list of FDA-approved human drugs marketed under REMS programs on FDA’s website.
3. Use Alternatives to Opioids
Pain management is an important issue in veterinary medicine, and in many cases non-opioid protocols may adequately control pain in animals. The International Association of Veterinary Pain Management is a good resource for pain management information for companion animals, as is the American Animal Hospital Association and American Association of Feline Practitioners 2015 Pain Management Guidelines.
4. Educate Pet Owners on Safe Storage and Disposal of Opioids
Pet owners may be unaware that pet opioid medications in the home pose a risk for accidental or intentional misuse by family members or guests. Whenever pets are actively receiving opioids, you should advise pet owners to lock up the opioids and store them out of sight. If a pet owner has unwanted opioids, getting rid of the medication should be a priority. Because of their inherent risks, FDA has specific recommendations for opioid disposal.
5. Know What to Do If a Dog Overdoses on Fentanyl or Other Opioids
Not only can people overdose on opioids, but so can pets. Working dogs, like narcotics detection dogs, are particularly susceptible because they may inhale the powdered drug. Because fentanyl and fentanyl-related drugs are potent, it only takes a tiny amount of drug to cause an overdose. If you have a suspected case of canine opioid overdose, you can contact the University of Illinois College of Veterinary Medicine’s emergency hotline for help. An AVMA/University of Illinois video also shares important information on what to do in the event of an overdosing canine patient.
6. Have a Safety Plan and Know the Signs of Opioid Abuse
In the event you encounter a situation involving opioid diversion or clients seeking opioids under the guise of treating their pets, you should have a safety plan in place. Local police departments can advise veterinarians about what to do in these situations. The Fairfax County Police Department in Virginia, for example, has released a brochure for veterinarians about “veterinarian shopping” and preventing diversion of controlled substances. The American Veterinary Medical Association also has a poster and other resources about veterinarian shopping and drug diversion for member veterinarians.
How do you know if a client or employee may be abusing opioids?
Some warning signs that a client is potentially abusing opioids include:
- Suspicious injuries in a new patient (in some cases, injuries that the owner has purposely caused to obtain drugs),
- Asking for specific medications by name,
- Asking for refills for lost or stolen medications,
- Being insistent in their request for opioids.
Some warning signs that veterinary staff may be abusing opioids include:
- Mood swings, anxiety, or depression,
- Weight loss,
- Mental confusion and an inability to concentrate,
- Withdrawing from family, friends, or coworkers,
- Making frequent mistakes at work, and
- Not showing up for work.
Combating opioid addiction and addressing misuse of pain medication continues to be one of FDA’s highest priorities. You have an opportunity to partner with FDA and others to take on this public health crisis. FDA encourages you to continue working with your clients, and local and national organizations, to join in the fight against misuse of pain medication.
Signs of Opioid Abuse
- Know the Signs and Get Help for Opioid Addiction
- Signs of Opioid Abuse
- AVMA.org - Vet Shopping and Drug Diversion: A Guide for Veterinarians
- Substance Abuse and Mental Health Services Administration (SAMHSA), Opioids
- Centers for Disease Control and Prevention (CDC) Opioid Basics
Food and Drug Administration (FDA)
- Risk Evaluation and Mitigation Strategies (REMS)
- Risk Minimization Action Plans (RiskMAPs) for Approved Products
- Disposal of Unused Medications: What You Should Know
- Lock It Up: Medicine Safety in Your Home
Drug Enforcement Administration (DEA)
- Don’t Be Scammed by a Drug Abuser
- Pharmacy Robbery and Burglary: Tips to Protect Your Customers, Your Business, and Yourself
Fairfax County Police Department Brochure: Call 703-277-2488
American Veterinary Medical Association (AVMA)
- Veterinary CE Requirements by State (Only available for AVMA members.)
- Vet Shopping and Opioid Diversion: A Guide for Veterinarians
Personal correspondence with AVMA, Mr. William Corcelius, February 19, 2021.
Zezima, K. “With Drug Overdoses Soaring, States Limit the Length of Painkiller Prescriptions”. https://www.washingtonpost.com/politics/with-drug-overdoses-soaring-states-limit-the-length-of-painkiller-prescriptions/2017/08/09/4d5d7e0c-7d0f-11e7-83c7-5bd5460f0d7e_story.html?utm_term=.9146c7e2a6a0. August 9, 2017. The Washington Post. Accessed February 22, 2021.
Mercer, M. “War on Opioids Moves to Veterinarians’ Offices.” http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2017/08/23/war-on-opioids-moves-to-veterinarians-offices. August 23, 2017. Stateline. Accessed February 22, 2021.
DEA. Office of Diversion Control, Liaison and Policy Section. (n.d.) “Drug Addiction in Healthcare Professionals.” [Brochure]. https://www.deadiversion.usdoj.gov/pubs/brochures/pdfs/drug_addiction_in_health_care_professionals.pdf. Accessed February 22, 2021.
American Animal Hospital Association. “2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats.” https://ivapm.org/wp-content/uploads/2017/03/2015_aaha_aafp_pain_management_guidelines_for_dogs_and_cats-03.10.17.pdf. Accessed February 22, 2021.
Cima, Greg. “Synthetic Opioids Put Police Dogs at Risk.” https://www.avma.org/javma-news/2018-02-01/synthetic-opioids-put-police-dogs-risk. Journal of the American Veterinary Medical Association. January 18, 2018. Accessed February 22, 2021.
Fairfax County, Virginia, Police Department. (n.d.) “Drug Diversion Information for Veterinarians” [Brochure]. Fairfax County, VA: Fairfax County Police Department Franconia District Station Criminal Investigations Section.
Fairfax County Police Department. “Vet Shoppers Requesting Pet Meds for Personal Use.” https://fcpdnews.wordpress.com/2017/12/21/vet-shoppers-requesting-pet-meds-for-personal-use/
Johns Hopkins Medicine. “Signs of Opioid Abuse” https://hopkinsmedicine.org/opioids/signs-of-opioid-abuse.html. Accessed February 19, 2021.
DEA. Office of Diversion Control, Liaison and Policy Section. (n.d.) “Drug Addiction in Healthcare Professionals.” [Brochure]. https://www.deadiversion.usdoj.gov/pubs/brochures/pdfs/drug_addiction_in_health_care_professionals.pdf. Accessed September 13, 2017.