New Research in Opioids: Rutgers Scholar Available to Comment on Opioid Prescriptions by Veterinarians, Managing Opioid Withdrawals in People


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New Brunswick, N.J. (Jan. 11, 2019) – Lewis Nelson, chair of the department of emergency medicine at Rutgers New Jersey Medical School, is available to discuss two new opioids studies he co-authored this week.

High rates of opioid prescriptions by veterinarians may contribute to the opioid crisis in humans, according to a study in JAMA Network Open.

Study highlights:

  • Veterinary opioid prescriptions are still mostly unregulated, especially compared to recent measures for medical prescriptions in humans.
  • Researchers reviewed opioid prescriptions at a multidisciplinary acute care veterinary teaching hospital between January 2007 and December 2017, and found that while the annual overall quantity of prescriptions increased 40 percent, the number of patient visits only increased 13 percent, suggesting a need to regulate veterinary opioid prescriptions.
  • Researchers said the increased use of opioids for pets may be a result of increased concerns about untreated pain in animals, but they called for studies into whether prescriptions for animals are being diverted to people.
  • Based on anecdotes, some states have already taken measures to address this concern, including background checks on animal owners’ opioid history and limiting the number of opioids a veterinarian can prescribe to a single patient. Twenty states also now require veterinarians to report opioid prescriptions just as physicians do.
  • “Although this trend may simply reflect a translation of aggressive pain care from humans to pets, In the wake of the opioid crisis it behooves us to carefully evaluate all sources of opioids and the potential consequences of their increased availability,” said Nelson.

 

Buprenorphine is the preferred medical treatment for managing opioid withdrawals in people, but there should be a process in place for administration, according a study in Annals of Emergency Medicine

Study highlights:

  • In the period immediately following abstinence, patients are at a high-risk for serious health complications or returning to use and abuse with an even greater risk of over-dosing.
  • Symptoms of withdrawal may include nausea, vomiting, diarrhea, rapid heartbeat, sweating, anxiety, cravings, pain, and dizziness. While these symptoms are not generally life-threatening, they can make patients uncomfortable. Withdrawal following the use of naloxone, can precipitate a severe and life-threatening withdrawal syndrome that includes delirium and serious cardiovascular failure.
  • Buprenorphine is the preferred medication among emergency physicians, but a lack of a widely-accepted and organized approach makes it hard for physicians to provide consistent treatment.
  • A prescriber must have a DATA X-waiver in order to prescribe buprenorphine. However, the “three-day rule” allows patients who have been discharged to return to the emergency department daily for three days to receive buprenorphine directly from a healthcare provider while long-term follow up is being arranged.
  • Assuring rapid follow up with an addiction treatment provider is optimal.
  • “A plan for rapid follow-up is recommended, especially if no waivered provider is available,” said Nelson. “This could include a ‘warm handoff’ to a long-term provider, care coordinators, or a recovery coach.  Strong partnerships with other experts in the hospital and in the community encourage continuity of care after a patient is discharged.”

In 2017, more than 70,000 Americans died from drug overdoses, two-thirds of where were due to opioids, according to the Centers for Disease Control and Prevention. In 2018, while some of the nation saw a plateau or decline in opioid use, New Jersey projected up to 3,000 deaths from opioid overdoses. 

Dr. Nelson can be reached by contacting Tiffany Cody at 973-972-3501 or tcody@njms.rutgers.edu.

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