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To combat the opioid epidemic in America, lawmakers and regulators have severely repressed physician prescribing practices.
According to a new study, a way to get prescription opioids seems to have been overlooked.
Millions of tablets
Veterinarians prescribe large quantities of opioids to domestic animals, raising fears that some people will use Fido or Snuggles to feed their addiction.
The opioid prescriptions of the faculty of veterinary medicine of the University of Pennsylvania increased by 41% between 2007 and 2017, even though the number of annual visits has only increased by 13%, have found researchers.
Penn Vet distributed 105 million tramadol tablets, 97,500 hydrocodone tablets (Hycodan) and nearly 39,000 codeine tablets during the study period, according to the results.
"I think everyone will be surprised by the quantities," said Dr. Jeanmarie Perrone, lead author, director of medical toxicology at the Perelman School of Medicine at the University of Pennsylvania.
Not just for animals
It's very likely that at least some of these drugs will end up being used by humans, said Emily Feinstein, executive vice president of the Center on Addiction.
"I'm sure that in these data, there is a small percentage of people who use their pets and a meeting with a veterinarian as a way to get opioids," Feinstein said.
The US opioid crisis has resulted in approximately 50,000 overdose deaths in 2017, according to the US Center for Disease Control and Prevention.
Americans are now more likely to die from an opioid overdose than from a car or motorcycle accident, a fall, a drowning or an accident. choking due to food, concluded a report released Tuesday by the National Security Council.
Perrone began his study after colleagues from the veterinary school complained that he had received many calls after the normal hours of work of the patients about the execution of his work. pet opioid prescriptions. They asked him for advice on how to handle these requests.
"Before speaking, I asked them to take all their opioid prescriptions in order to get an idea of how often they actually prescribed opioids," Perrone said. "To their shock and shock, there were about 3,000 prescriptions a month."
Perrone thought back to the time when she had her own dog sterilized and the vet handed her a bag of supplies to take care of her recovering dog. She went to get this bag.
"I found a bottle of tramadol that was given to me when my dog was spayed four years ago." He was still in the closet with all the dog equipment, "he said. Perrone.
Follow the general trends
After reviewing Penn Vet's prescribing practices, the Perrone team obtained prescription data kept by the US Drug Enforcement Agency for all Pennsylvania veterinarians.
Between 2014 and 2017, Pennsylvania veterinarians distributed 688,340 hydrocodone tablets (Hycodan), 14,100 codeine tablets, 23,110 fentanyl patches, 171,100 hydromorphone (Dilaudid) tablets, and 7,600 doses. oxycodone (Oxycontin), according to federal data.
The results were published in the journal JAMA Network open now.
The opioid epidemic stems from a change in medical philosophy, in which the role of pain as a symptom to be treated became more important and the risks of opioid dependence were not fully understood, said Feinstein.
"Veterinarians live in the same society as all of us," she said. "It is not surprising to see the same trends in veterinary medicine as in the rest of medicine.All the medicine prescribed more opioids and thought that they were safe."
Beyond the risk that people "buy" drugs, Mr. Feinstein said the numbers suggested that pet cabinets across the country might contain opioids that are ready for misuse.
Better pain management
"If there is someone around you who has a problem with the use of opioids, the remaining pills can become a temptation if they are not locked safely," he said. she said.
Dr. John de Jong, president of the American Veterinary Medical Association, said he was unaware of any data suggesting that what was discovered in Pennsylvania was happening elsewhere.
"In the first place, there is a survey of veterinarians at a veterinary teaching hospital where complex cases are referred and for which further management of the pain is required. often necessary, "de Jong said. "It is inappropriate to extrapolate the results of such practice to primary care practices across the country."
Second, pain management is an emerging field in veterinary medicine, de Jong said.
"The period of this study covers a period of significant growth in the understanding of pain and its impact on veterinary patients," he said. "It is reasonable to expect that, as knowledge develops, efforts to solve related problems will develop, so it is quite possible that this study does not reflect overprescription, but rather a prescription. appropriate for better management of pain in veterinary patients. "
Best tracking
At the same time, veterinarians are beginning to monitor their opioid prescriptions more closely, Jong added.
"It seems that there have been few confirmed cases of homeowners deliberately injuring their pets to get opioids," he said. "We have heard more and more veterinarians say that they suspect that some homeowners are using their medications and asking for refills before the time they should need them, or that they have lost or spilled drugs, but this is anecdotal. "
These findings suggest that veterinarians should be urged as strongly as other physicians to prescribe opioids carefully, said Dr. Harshal Kirane, director of addiction services at Staten Island University Hospital in New York.
"Our national response to the opioid epidemic should leave no room for inconvenience," Kirane said. "These works highlight the fact that contemporary veterinary medicine uses a large volume of opioid drugs, but does not have a systematic framework for setting up safe opioid prescribing practices. the apparent magnitude of opioid drug management in animals is considerably smaller than in humans, powerful opportunity for improvement of practice ".
In the meantime, pet owners should get all the opioids prescribed for their pets and dispose of them safely, said Dr. Scott Krakower, deputy chief of psychiatry at Zucker Hillside Hospital in Glen Oaks, in the state of New York.
"I have the impression that sometimes you do not even think about it.This could make you forget that the drug is in the closet," Krakower said. "Sometimes it's not clearly stated as a human medicine."
Image credit: iStock
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