Page 88 - JSOM Winter 2017

An Ongoing Series

Clinical Update

The Risk of Opioid Toxicity and Naloxone Use in Operational K9s

1
Lee Palmer, DVM, MS, DACVECC, CCRP, WEMT, EMT-T, NRP, TP-C *; Anais Gautier, DVM 2

ABSTRACT
The increasing use of opioids (e.g., fentanyl, carfentanil) for Today, opioid drug abuse represents one of the largest compo-
illicit drug manufacturing poses a potential life-threatening nents of the illicit drug market worldwide. 1
hazard to law enforcement officers and first responders (e.g.,
EMS, fire and rescue) who may unknowingly come into con- In humans, the increasing misuse of and addiction to both pre-
tact with these drugs during the course of their daily activities. scription and nonprescription opioid drugs reached epidemic
7,8
Similarly, Operational canines (OpK9s) of all disciplines—de- levels in America. As reported by the Centers for Disease
tection (drug, explosive, accelerant), patrol, tracking, search Control and Prevention (CDC), the number of overdose deaths
and rescue, and others—are at risk for accidental illicit opioid involving opioids (both prescription drugs and heroin) qua-
exposure. The most serious adverse effect of opioid exposure drupled since 1999, with more than 90 people dying daily. 7–10
is respiratory depression leading to slow, shallow breathing or This opioid epidemic or crisis, as it is now termed, 8,11 not only
complete cessation of voluntary breathing (respiratory arrest). affects the health of the nation but also incurs a social and
Naloxone, an opioid antagonist, is the antidote for reversing economic burden on society. 7,12,13 The estimated “economic
the effects of an opioid overdose in both humans and OpK9s. burden” of prescription opioid misuse in the United States
This clinical update describes the potential risks associated is $78.5 billion per year; this includes costs associated with
with opioid exposure as well as the use of naloxone as it per- healthcare, lost productivity, addiction treatment, and crimi-
tains to the OpK9. nal justice involvement. 12
Keywords: Operational K9; opioid; naloxone; intranasal; over- Although heroin is the prototypical manufactured illicit
dose; canine medicine opioid with which most of society is familiar, all types of
prescription and nonprescription opioids (natural, semi-
synthetic, and synthetic) are being manufactured and sold
Introduction for illicit, recreational use. 10,11,14 The diversion of phar-
maceutical fentanyl and the clandestine manufacturing of
Opioid drugs may be considered a double-edged sword in the illicit fentanyl and fentanyl-related substances (e.g., carfen-
medical community; they provide both a tremendous benefit tanil, 4-fluorobutyrylfentanyl, furanylfentanyl, acrylfentanyl,
and a large risk to public health. Derived from the compound 3-methylfentanyl, etc.) have dramatically increased during the
opium, opioid analgesics serve a staple in the medical and past few years. 10,14 These compounds are used in place of
veterinary communities for managing acute and chronic pain or to adulterate (“cut or mix with”) other illicit substances
as well as perioperative anesthesia. Interestingly, evidence (e.g., heroin, methamphetamines, cocaine, etc.) as well as
1–3
supporting their absolute benefit for chronic pain manage- to produce counterfeit prescription tablets of other semisyn-
ment has come into question. When taken or administered thetic opioids (oxycodone, hydrocodone, and others). 11,14
4
as prescribed by a medical professional, opioids are consid- Carfentanil, one of the most potent commercially available
ered a relatively safe and warranted medical intervention. synthetic opioids legally prescribed for sedating large zoo
However, since their discovery, opioids have been misused as animals (e.g., elephants), has also entered the illicit drug
well as abused illicitly for recreational drug use. 1,2,5 Illicitly, market and poses a great danger to society. 14,15 A myriad of
opioids are used for their psychoactive effects, causing intense novel synthetic opioids also continue to enter the illicit drug
euphoria and relief of tension and anxiety. Tolerance, physical trade (e.g., W-series opioids, MT-45, AH-7921, U-47700),
dependence, and addiction are adverse events that may occur many of which have been associated with opioid-induced
in people taking opioids, which often leads to drug abuse. deaths in people. 16–21
1,6
*Address correspondence to Lee.Palmer@JSOMonline.org
1 LTC Palmer, Veterinary Corps, US Army Reserves, is an assistant professor, Veterinary Emergency and Critical Care, Wilford and Kate Bailey
Small Animal Teaching Hospital, Auburn University, AL. Dr Gautier is a resident, Small Animal Emergency and Critical Care, Wilford and Kate
2
Bailey Small Animal Teaching Hospital, Auburn University, AL.
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