https://www.cnn.com/2018/08/16/health/opioid-fda-pets-bn/index.html

Comment;

It’s a sad, sorry state of affairs when pet owners harm their pets to try to feed their addiction, something for prescribers to be vigilant about.  
It’s pretty sick that folks will hurt a healthy animal to try to get drugs to abuse, a new classification of Munchausen’s by Proxy…

By Jacqueline Howard, CNN

Prescription and illegal opioids are commonly abused because they are so addictive. 

Opioid medications bind to the areas of the brain that control pain and emotions, driving up levels of the feel-good hormone dopamine in the brain’s reward areas and producing an intense feeling of euphoria.

As the brain becomes used to the feelings, it often takes more and more of the drug to produce the same levels of pain relief and well-being, leading to dependence and, later, addiction.

Oxymorphone hydrochloride – Oxymorphone hydrochloride, under the name Opana ER, was at the center of an HIV outbreak in Indiana in 2015. Some addicts began injecting and shared needles increased the spread of HIV.

In June, the Food and Drug Administration requested that Opana ER manufacturer Endo Pharmaceuticals pull the drug from the market. It was the first time the agency has asked that a opioid pain medication be pulled “due to the public health consequences of abuse.” Endo announced in July that it would pull the drug.

Codeine – Codeine is one of the weakest opioids, often given when painkillers such as acetaminophen or ibuprofen fail to work. Because it decreases activity in the part of the brain that controls coughing, it’s frequently mixed with other liquids to develop cough syrups for colds and flu. It has frequently been used for pain relief after removal of tonsils and adenoids in children. 

After an investigation, the FDA restricted the use of codeine and tramadol in children under 12 and recommend against their use in children between 12 and 18 years of age. Additionally, the FDA has warned breastfeeding mothers not to take these medications due to the risk of serious adverse reactions in breastfed infants.

Heroin – You can’t get heroin by prescription, but many heroin users start off abusing prescription opioids, then turn to this illegal opioid.

CNN’s Chief Medical Correspondent Dr. Sanjay Gupta has reported on recent research that shows today’s typical heroin addict starts using at 23, is more likely to live in affluent suburbs and was likely unwittingly led to heroin through painkillers prescribed by his or her doctor.

According to the CDC, deaths from overdoses of prescription drugs and heroin continue to be the leading cause of unintentional death for Americans, rising 14% from 2013 to 2014.

Fentanyl – Fentanyl citrate, pictured here, is a Class II controlled substance and one of the most powerful opioids on the market. It’s often administered via injection or transdermal patch, or in lozenge form for pain after surgery, for difficult-to-manage chronic pain and for people who have developed a tolerance to other opioids. 

The type of fentanyl usually associated with overdoses is bought on the street in powder or pill form and is often mixed with heroin in a clandestine lab to increase the high it produces. Street names include Apache, China girl, goodfella, jackpot, murder 8, TNT and Tango and Cash.

Hydrocodone – These pills are a more powerful form of codeine, called hydrocodone, and are often mixed with acetaminophen. Hydrocodone is the most frequently prescribed opioid painkiller, according to the U.S. Food and Drug Administration, and the most abused. An overdose of hydrocodone can cause “cold and clammy skin, severely constricted pupils, and slow breathing that can lead to a loss of consciousness and death.”

Oxycodone – Oxycodone is a powerful narcotic pain reliever prescribed for moderate to high pain relief. It’s often given in an extended-release formula for patients who will need to be on pain medications for long periods of time.

Patients are warned not to break, chew, crush or dissolve extended-release tablets because the rush of oxycodone into the system could cause serious health problems, including overdose and death.

Though highly addictive, oxycodone is not thought to be as frequently abused as hydrocodone. OxyContin, Percocet, Percodan and Tylox are some trade-name oxycodone products.

Morphine – Morphine is another powerful opioid often administered via syringe for severe pain. It can come in pill form, usually as extended-release tablets and capsules, and is prescribed only to relieve difficult, chronic pain that cannot be controlled by the use of other pain medications.

As with most opioids, mixing medications, drinking alcohol or taking other meds that contain alcohol, or using street drugs while taking morphine, increases the risk of breathing problems or other serious, life-threatening side effects.

Meperidine – Meperidine is another narcotic analgesic, similar to morphine. It’s often used to help put people to sleep before an operation and to provide pain relief after childbirth. 

The most common brand name is Demerol, which comes in both tablet and liquid forms. It is usually taken with or without food every three or four hours as needed for pain.

As with all opioids, meperidine can cause drowsiness, so never drive a car or operate machinery after taking it until you know how you will react.

Hydromorphone – Hydromorphone is another highly potent prescription painkiller. It’s most commonly known by the brand names Dilaudid, pictured here, and Exalgo. 

Liquid hydromorphone holds the dubious honor of being frequently mistaken for morphine in hospital “wrong drug” medication errors because of the similarity of the names and appearances. 

Methadone – Though methadone is used to relieve severe chronic pain, it’s most commonly known for preventing withdrawal symptoms in patients who were addicted to opioid drugs, as a part of their recovery process.

Methadone has many of the same side effects as other opioids, including weakness, headache, nausea and vomiting, stomach pain, sweating, difficulty urinating, mood changes and vision problems, and difficulty falling asleep or staying asleep.

Buprenorphine – Buprenorphine is a opioid used as an alternative to methadone to help addicts recovering from heroin use. Buprenorphine is different from other opioids because it’s a “partial opioid agonist,” which means that when taken in proper prescribed doses, it should produce less euphoria and physical dependence, and therefore a lower potential for misuse. It’s also supposed to have a relatively mild withdrawal profile.

However, if abused by crushing and snorting or injecting, it can suppress breathing and cause dizziness, confusion, unconsciousness and death.

Subutex, the brand name for buprenorphine, is taken as a tablet placed under the tongue and allowed to dissolve.

The brand Suboxone is a combination of buprenorphine and naloxone, an opioid antagonist. Antagonists block the opiate receptors in the brain, keeping the narcotic from creating the high abusers crave. 

Prescription and illegal opioids are commonly abused because they are so addictive. 

Opioid medications bind to the areas of the brain that control pain and emotions, driving up levels of the feel-good hormone dopamine in the brain’s reward areas and producing an intense feeling of euphoria.

As the brain becomes used to the feelings, it often takes more and more of the drug to produce the same levels of pain relief and well-being, leading to dependence and, later, addiction.

Gottlieb also said there hasn’t been much information about responsible opioid prescribing for veterinary medicine professionals, and so the FDA developed a resource guide on what veterinarians need to know.

The resource includes information on state and federal regulations, alternatives to opioids and how to properly safeguard and store opioids, as well as how to identify if a client or employee may be abusing opioids and take action with a safety plan.

“While each state creates its own regulations for the practice of veterinary medicine within its borders, including regulations about secure storage of controlled substances like opioids, veterinarians should also follow professional standards set by the American Veterinary Medical Association in prescribing these products to ensure those who are working with these powerful medications understand the risks and their role in combatting this epidemic,” Gottlieb said.

Why some are stealing medications from their pets

“Veterinarians are also required to be licensed by the Drug Enforcement [Administration] to prescribe opioids to animal patients, as are all health care providers when prescribing for use in humans,” he said.

“These measures are in place to help ensure the critical balance between making sure animals can be humanely treated for their pain, while also addressing the realities of the epidemic of misuse, abuse and overdose when these drugs are diverted and used illegally by humans.”

The FDA statement came one week after a perspective paper in the American Journal of Public Health called for the veterinary, public health, pharmaceutical and regulatory communities to dedicate time and resources to addressing the issue of prescription opioid diversion in veterinary medicine.

“I was thrilled to see the FDA commissioner make a statement that not only validated our findings but also demonstrates why research is so important for good policy,” said Liliana Tenney, a senior instructor with the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus and deputy director of the Center for Health, Work & Environment, who was a co-author of the paper.

Tenney was unaware of the FDA statement until CNN contacted her for an interview, she said.

The paper included data from a 24-item online survey that 189 veterinarians in Colorado completed in collaboration with a local veterinary society. The survey, which was about the possible abuse and misuse of opioids by pet owners and the role veterinarians play in prevention, was administered in summer 2016, Tenney said.

The survey results showed that 13% of the veterinarians were aware that an animal owner had intentionally made an animal ill or injured — or seem to be ill or injured — to obtain opioid medications.

“This is significant for two reasons. These providers want to ensure the treatment of pets,” Tenney said. “If this is truly the case and pet owners are intentionally harming animals, that’s an animal rights issue. If opioids are being prescribed and aren’t getting to the pets that need them because these drugs are being diverted, that’s a public health issue.”

The survey results also showed that 44% of the veterinarians were aware of opioid abuse or misuse by either a client or a veterinary practice staff member, and 62% believed that they had a role in preventing opioid abuse and misuse.

“We recognize that this … sample, representing 10% of the society’s members, has limited generalizability and cannot be used to extrapolate to all practices. Nonetheless, these data are sufficient to warrant immediate action,” the authors wrote.

American Veterinary Medical Association spokesman Michael San Filippo emphasized in a statement Wednesday that the association has provided resources for veterinary staff to help combat this issue and the association will continue to monitor the situation.

“Though our animal patients are not the ones struggling with opioid addiction, concerns about misuse and diversion are top-of-mind for the veterinary profession, and the AVMA is actively involved in providing resources to practitioners describing alternative ways to treat pain and minimize opioid use,” the statement said.

“While the limited data available suggests diversion from veterinary practices isn’t a widespread problem, that doesn’t mean we should pretend it doesn’t exist,” it said. “In fact, AVMA policy calls for further research to determine the prevalence of veterinary drug shoppers and to further clarify the degree to which veterinary prescriptions are impacting, or not, the human opioid epidemic.

It’s pretty sick that folks will hurt a healthy animal to try to get drugs to abuse, a new classification of Munchausen’s by Proxy…

Dr. Raymond Oenbrink
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