Opioid shortage expected to continue into 2019

Opioid shortages – particularly injectable fentanyl, morphine, and hydromorphone – continue to impact veterinarians’ ability to provide appropriate pain management for patients and are anticipated to last into 2019. The shortage stems largely from upgrades being made to a Pfizer Inc. manufacturing plant. While Pfizer manufactures most of these products, some other drug manufacturers may be considering whether and how they can produce more of these medications to meet patient needs.

The AVMA has been communicating closely with both the U.S. Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA) on this issue. These agencies have assured us that the shortage is not the result of any policy changes. For more information about which medications are in short supply, please visit the FDA’s drug shortage web page.

Following discussions with drug distributors, we understand there are, and will continue to be, limited quantities of these medications available throughout 2018. This situation is impacting both the human and veterinary medical communities. As product becomes available, it is being allocated based on historical need, so it’s more important than ever for veterinarians to keep accurate records and ensure that their distributors have complete information about their order history. Veterinarians also should carefully consider their future needs and plan accordingly.

We will continue to work with the FDA, DEA, drug manufacturers, and drug distributors to advocate for the needs of veterinarians and our patients until this shortage situation is resolved.

In addition, the AVMA has reached out to experts in the fields of anesthesiology and pain management for guidance on alternative therapeutic options to share with our members. We anticipate making this information available shortly as part of a new section on the AVMA website dedicated to the responsible use of opioids.

The AVMA encourages veterinarians experiencing a shortage to report the information to the FDA, and use their professional judgment in treating patients with opioids and available alternatives. Consultation with an anesthesiologist may assist in identifying appropriate alternatives.

7 thoughts on “Opioid shortage expected to continue into 2019

  1. Stokes Pharmacy is now compounding Hydromorphone 2 mg/mL Injection, 10 mL under our DEA Manufacturer License. We thought it would be helpful to share this information as we’ve had many requests and know that the shortage is affecting many veterinarians. For more information, call our pharmacy at 800-754-5222 or go to http://bit.ly/2vROrEc

  2. Here’s the response to my email to the above link:
    “Dear Dr. Highbarger:
    Thank you for contacting FDA’s Center for Veterinary Medicine (CVM). We are not aware of a shortage of opiods for use in animals https://www.fda.gov/animalveterinary/safetyhealth/productsafetyinformation/ucm248095.htm; however, your comments are duly noted.
    CVM Compliance”

    I found this interesting given the obvious shortage… is the AVMA discussing these things with the CVM?

    • Dr. Highbarger, thank you for your comment and bringing this to our attention. We want to assure you that we are in frequent communication with the FDA CVM as well as the Drug Enforcement Administration and other relevant stakeholders on this issue. We believe the response you received from FDA CVM was a miscommunication. The opioid medications in shortage are drug products approved for use in humans and FDA CVM, as well as the division of FDA that handles human drug shortages, is well aware of this shortage situation impacting veterinarians. We will continue to engage in dialogue with FDA and others until this situation is resolved.

  3. Unless you have lost a son to opioid overdose you will not understand that pets can be managed with less potent opiods. Sorry, but humans can deal with a little more pain than needing oxys or roxys and do just fine.

    • Mike ,
      while loss due to an uncontrolled addiction is terrible, do not set yourself up as the authority on anyone or anything else’s pain and ability to adapt. Do not presume higher medical knowledge or a moral authority as you have no right to either. My mother developed an addiction to pain medications following having her back broken in an industrial accident. She decided to quit cold turkey and put herself through hell doing it. Now at 89 she will not even take an aspirin out of fear of going through it again 50 years later. The only pain medication she has used since was a morphine pump when she had a lung removed and as soon as she was fully concious she let herself suffer rather than push that button.
      History repeated in me as I was crushed under a 1400 lb milk cow that charged me, busting us both through a barn wall, a drop of 5 foot onto concrete then the impact of this bovine landing on me then going into convulsions from milk fever. I do not have an addictive personality and have exhibited all my life. I never got addicted to tobacco, though I would go through spells of heavy smoking for months, sometimes a couple of years, quit and not look at it for 5 or more years, then somebody gives me a quality cigar, I’ll fire that puppy up and relax with it. May taste so good I’ll smoke 2-3 a day plus a pipe of flavored tobacco or two for 4-5 months, then quit for years again. But I do have to have my pain medication since I have disc material wrapped around nerve trunks coming out of my lumbar spine. I dont take it regularly, I draw up in a knot from the pain and may lose the ability to even walk for awhile due to blinding pain spasms. Now do I take the maximum dose all the time, no. But in wet, cold weather I may have to take oxycodone 4x a day just to keep moving. Warm dry weather where the pain is not so severe and I’ve increased my tolerance due to having had severe chronic pain for over 18 years, I literally forget to take them until I finally stop for the day and the sharp stabbing pain triggers muscle spasms and I cannot rise by myself to go to the bathroom until I do take one and by then the cascade has built up to the point the pill is of little use, until I’ve gotten back on more regular dosage for a couple of days.
      Physical addiction is actually rare if the medication is used for actual pain control. Psychological addiction is a mental disorder and blaming the medication for it is as patently ridiculous as blaming a gun for a school shooting. Inert physical objects cannot hurt us. It harkens back to personal responsibility and accountability. There is no reason to limit someone else’s relief and quality of life because somebody else may not use a product properly. We have way too many addictive personalities, too weak to face life head on and retreat in “feel good” in pill form. All this does is damage them and as a knee jerk response in our society to not like something, so ban it or limit its availability to someone who doesnt have a problem with it and can use it the way its supposed to be used.
      As a chronic pain sufferer who has tried almost everything, because so many hurdles are put in front of folks who have legitimate needs, and can only get a modicum of relief from opoid medication and a veterinarian with over 3 decades of experience in treating my patients, I do not want someone with no direct knowledge of my situation or my patients’ to throw stumbling blocks in my treatment protocol my physicians and I have developed to keep me functional, and while it doesnt remove all pain or get me high or make me feel good, it takes enough edge from the unremitting pain and helps keep me being able to focus on my life, not curled up in a semi-fetal position, grinding cracks into my teeth to keep from yelling out in pain. I dont want my patients to have to lay around a suffer either. They may not have as many slow twitch pain fibers as we do, so we THINK they dont sit around and ache like we do, we dont know. They may just be shutting down from the pain

  4. Why does the AVMA continue to promote the idea that the opioid shortage is not the result of changing FDA policy? According to the American Pharmacists Association the shortage is the result of the FDA reducing the aggregate production quotas (APQs) for 2018 by 20% (http://www.pharmacist.com/article/dea-mandates-reduction-opioid-manufacturing-2018). Since distribution of opioids prioritizes human needs, a disproportionate share of the shortage is falling on veterinarians, who, I would argue, are not major contributors to the opioid crisis.

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