Add veterinary euthanasia solutions to the list of things, like lumber and microchips, that are hard to come by now.
Generic euthanasia solution
Photo by Dr. John Daugherty
Euthanasia solutions used by companion animal veterinarians have become hard to obtain. Caitlin Denney, office administrator of a practice in Ohio, said the shortage is coinciding at her hospital with heightened calls for euthanasia during the past two months, for reasons that are unclear.
Reportedly brewing for months in the United States, a shortage of pentobarbital-based euthanasia drugs has become a reality, causing veterinary teams to conserve any supplies they have and scout alternatives to the important staple of practice.
At Poland Veterinary Centre in Ohio, office administrator Caitlin Denney said the hospital has switched products multiple times since November because every time she goes to reorder, she finds that the brand she bought before is discontinued or on backorder.
So far, Denney said Tuesday, "I haven't had trouble getting something, but we have to be creative with what we use." As she spoke, she checked the website of the hospital's usual supplier and discovered that the last euthanasia product she ordered, a generic, is out of stock now, too.
Dr. Kathleen Cooney, an authority in end-of-life veterinary care and the founder and education director of the Companion Animal Euthanasia Training Academy based in Colorado, said she learned in January through a chance conversation with a manufacturer that a shortage was looming.
The chemical in low supply is pentobarbital, a barbiturate that she said is imported in powder form by U.S. manufacturers who then mix it into solution. The VIN News Service could not determine whether the scarcity is caused by the ongoing COVID-19 pandemic or other reasons. Representatives of two affected manufacturers — Virbac and Akorn Animal Health — did not return calls or answer email messages. VIN News was unable to connect with an official at a third company, Vortech Pharmaceuticals.
Cooney, who also is chief medical officer of a mobile hospice and euthanasia center in Denver, said she and others who learned early about the anticipated shortage were asked not to spread the word for fear the news would cause hoarding. The caution struck her as reasonable.
"I remember years ago that I was told pentobarbital was potentially going to be on backorder, and I ended up ordering something crazy, like 50 bottles, to support my nine mobile euthanasia veterinarians," Cooney said. "There ended up not being a shortage, but that's the kind of stuff we wanted to prevent, was people [reacting] like me!"
The worst of the current shortage might soon ease: An executive of Vortech, maker of the euthanasia solution Fatal-Plus, said last week that the company had just received a shipment of pentobarbital, according to the American Animal Hospital Association publication NEWStat. The product is expected to be in the hands of distributors for shipment to customers in early June, the report said.
However, it might take weeks, if not months, to work through the demand backlog, Cooney said: "What I have heard is that ... for us to be completely out of this situation might not be until the end of July because there are so many backorders that need to be filled."
The U.S. Food and Drug Administration offered a more cautious statement late Tuesday. Noting that the agency is trying to determine the extent of the shortage, spokesperson Anne Norris said by email: "This is an ongoing process and until the agency learns more, it would be premature to speculate about when the shortage will be resolved."
The FDA's webpage on current drug shortages shows that Euthasol, a solution of pentobarbital sodium and phenytoin sodium made by Virbac, has been short since February. Generic pentobarbital sodium and phenytoin sodium made by Akorn, and Vortech's Fatal-Plus, containing pentobarbital, were added to the list in May.
For the time being, practitioners may need to use alternatives to pentobarbital-based drugs.
Dr. Sharon Gwaltney-Brant, a member of the American Veterinary Medical Association's Panel on Euthanasia, which writes guidelines for the procedure, said that in the absence of pentobarbital, "We have no 100% perfect good alternative. The alternative that has been presented that is probably, of all the options, best, is to heavily anesthetize the animal down to the surgical plane — where they're so out, you could do bone surgery — and administer potassium chloride or magnesium sulfate." (Gwaltney-Brant said that the opinion is hers, not the AVMA's or its panel's.)
The two substitutes are considered suboptimal because in a patient who is conscious, the drugs are very painful upon injection, she said: "For them to cause the heart to stop, they have to be very concentrated, and they have to hit very fast."
By comparison, pentobarbital shuts down the brain first, making the patient unaware of what is happening to the rest of their body, explained Gwaltney-Brant, who also is a toxicology consultant at the Veterinary Information Network, an online community for the profession and parent of VIN News.
For practitioners who have pentobarbital-based drugs on hand, Gwaltney-Brant and Cooney recommend conserving the products by using no more than the labeled dose. "Many veterinarians, myself included, were taught the plus-one rule," Gwaltney-Brant said, meaning that they would add one milliliter or so to the labeled dose to ensure that the injection was lethal as intended.
Some veterinarians are making their euthanasia solution stretch further by blending it with the anesthetic propofol.
Gwaltney-Brant has written an FAQ for VIN members about the pentobarbital shortage that provides information on ways to cope with the shortage and links to more resources.
Cooney said discussions of euthanasia techniques are accessible to a Facebook group formed by the Companion Animal Euthanasia Training Academy. The private group is for animal care and related professionals.
In anticipation of supplies of euthanasia solutions returning to normal in coming weeks, Cooney recommended that veterinary teams check with their product distributors to be sure that any orders they may have placed months ago are still active. "Sometimes orders get canceled if backorders go too long," she noted.
Correction: The story has been revised to reflect that Vortech Pharmaceuticals responded to an inquiry but VIN News did not connect with the company before publication.
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