Opioid abuse is an epidemic. Over 10.1 million people misused prescription opioids and another 1.6 million misused prescription pain relievers for the first time¹. Unfortunately, 81,000 people also died from overdoses, one-third of which were from prescribed medications. To address these problems, numerous guidelines have been enacted to help prevent unintended use. Although pharmacies and healthcare organizations are at the forefront of these requirements, they don't stop there. In fact, the use of opioids in veterinary practices is increasing. A University of Pennsylvania study showed a 41% increase in opioids for small animals over the past 10 years which indicates another avenue of potential risk for human access to opioids². Ensuring proper opioid use is crucial for veterinary practices. Following appropriate processes and protocols is essential to ensure the safe use of opioids in veterinary practices.

What Are Opioids Used For In Veterinary Practices?

Used primarily for controlling pain, opioids are part of a veterinarian's medication tool set for treating their animal patients. Because there are a limited number of opioids formulated specifically for animals, veterinarians commonly use products approved for use in humans.

What Type of Opioids Can a Veterinarian Prescribe?

There are a number of opioids that veterinarians use for treatments. These medications are among the most common:

• Buprenorphine - usually used as a short-term painkiller for mild to moderate pain in small animals
• Tramadol - a pain treatment for dogs, cats and other small animals - also the most likely to get diverted from pet to human use
• Fentanyl - a treatment for animal patients suffering from moderate to severe pain
• Oxycodone - an effective drug for severe pain in dogs
• Butorphanol - designed to alleviate mild to moderate pain, butorphanol is a short-duration medication. Plus, it is used to stop or reverse the effects of other medications, such as morphine, while still providing pain control.
• Hydrocodone - commonly used to treat canine respiratory conditions like chronic bronchitis, bronchial compression, and kennel cough
• Alprazolam - is a sedative/tranquilizer used to treat anxiety or panic As important as opioids are to veterinary practices, they pose risks to animals and humans without proper control.

How to Safely Use Opioids in a Veterinary Practice

Identifying, labeling and segregating opioids are three steps that enable the safe use of opioids in a veterinary practice. They help ensure the animal receives the medication intended and minimize the problems associated with human misuse.

Look-Alike Sound-Alike Opioids

There are numerous medications on the Institute for Safe Medication Practices list of confused drug names, including opioids. Drug confusion can lead to dispensing errors, which means the wrong dose or even the wrong medication could be administered. The opioids to look out for include:

• Alprazolam - is confused with Clonazepam and Lorazepam
• Buprenorphine - is confused with Hydromorphone
• Fentanyl - is confused with Sufentanil
• Hydrocodone - is confused with Oxycodone
• Oxycodone - is confused with Hydrocodone, Oxybutynin, Oxycontin, Oxymorphone
• Tramadol - is confused with Trazodone

Applying Look-Alike Sound-Alike drug labels to these often confused medications reduces the risk of misuse. Visible warnings on these drugs and other opioids alert staff members, caution clients and supplement the guidance veterinarians provide during office visits.

Drug Storage

Storing different classes of products such as narcotic analgesics, antibiotics and vaccines and medications with similar names and packaging together on a shelf increases the potential for veterinary medication errors.

Instead, store opioids and distinct classes of drugs on different shelves and label each shelf to identify the class of drugs it contains. Plus, keep opioids in a locked cabinet to avoid unauthorized access. Use these additional steps to prevent medication errors.

Use Properly Designed Veterinary Prescription Drug Labels

A label with overcrowded information, inconsistent presentation of drug strength, and use of certain font styles and sizes can cause mistakes. So can abbreviations and leading and trailing zeros. The best option is to stop their use. Although they may save time initially, using them can cause long-term problems. For example, by eliminating extra zeroes (like 5.0 mg) you help prevent pet owners from dispensing 5 mg of a medication incorrectly remembering it as "50 mg”.

Prevent Prescription Leftovers

Dispense medication only in quantities required for the specific treatment to decrease the potential for leftovers that could be misused. In addition, avoid unlimited refills and require regular re-evaluations for chronic conditions before prescribing additional drugs.

Develop an Action Plan

In the unfortunate situation when a pet overdoses on an opioid, make sure you have an action plan in place to follow to minimize the impact.

Importance of Owner Education

Although most pet owners may have heard about the serious public health issue from the increased use of opioids, they may not know about the potential risks of pet opioid medications. It’s important to advise pet owners to:

• Lock up the opioids and store them out of sight
• Properly dispose of unwanted opioids

Lastly, make sure to specify dosage, frequency, duration, and other elements required for effective treatment. Clearly defined prescription and medication instruction labels help guide proper administration once the client arrives home.

Importance of Veterinary Practice Education

Communicating proper identification, storage and labeling steps, and developing an action plan if an opioid overdose occurs, are important safe medication administration practices. But, it’s not just internal situations that require your attention. In fact, there may be situations when a client uses their pet as a way to get opioids for themselves. Here are some warning signs that a client may potentially be abusing opioids:

• Asking for specific medications by name
• Asking for refills for lost or stolen medications
• Being insistent in their request for opioids

Plus, look out for suspicious injuries. In more extreme situations, an owner may intentionally injure a pet in an effort to obtain drugs. If this occurs, it’s appropriate to contact local authorities.

United Ad Label Veterinary Labels

The safe use of opioids in veterinary practices starts with implementing strict processes and protocols. Using veterinary labels including look-alike sound-alike medication instruction, opioid warnings and inventory labels are a few of the steps you can take to ensure opioids are handled properly. UAL provides a complete line of veterinary labels that accommodate the needs of the entire practice.

¹ 2019 National Survey on Drug Use and Health, 2020
² Kenneth Drobatz, DVM, Chloe Korzekwa, Lewis S. Nelson, MD (2019, January 11). Does Opioid Use in Pets Create Higher Risk for Abuse in Humans https://www.pennmedicine.org/news/news-releases/2019/january/does-opioid-use-in-pets-create-higher-risk-for-abuse-in-humans