War on opi­oids moves to vet­eri­nar­i­ans’ of­fices

Walker County Messenger - - Front Page - By Marsha Mercer

Some states are tak­ing the war on opi­oids into vet­eri­nar­i­ans’ of­fices, aim­ing to pre­vent peo­ple who are ad­dicted to opi­oids from us­ing their pets to pro­cure drugs for their own use.

Colorado and Maine re­cently en­acted laws that allow or re­quire vet­eri­nar­i­ans to check the prescription his­to­ries of pet own­ers as well as their pets. And Alaska, Con­necti­cut and Vir­ginia have im­posed new lim­its on the amount of opi­oids a vet can pre­scribe.

Vet­eri­nar­i­ans typ­i­cally do not dis­pense such widely abused drugs as Vi­codin, OxyCon­tin or Per­co­cet, but they do dis­pense Tra­madol, a painkiller; ke­tamine, an anes­thetic, and hy­drocodone, an opi­ate used to treat cough­ing in dogs – con­trolled sub­stances that hu­mans abuse.

But even as some states push for vet­eri­nar­i­ans to as­sess the records of hu­man clients, many vet­eri­nar­i­ans main­tain they’re un­qual­i­fied to do so. And while a hand­ful of states now re­quire vets to check the prescription his­to­ries of pet own­ers, about two-thirds of the states ex­plic­itly pro­hibit it.

“I’m a vet­eri­nar­ian, not a physi­cian. I shouldn’t have ac­cess to a hu­man’s med­i­cal his­tory,” said Dr. Kevin Lazarch­eff, pres­i­dent of the Cal­i­for­nia Ve­teri­nary Med­i­cal As­so­ci­a­tion. Cal­i­for­nia vet­eri­nar­i­ans have ac­cess to a state data­base with prescription his­to­ries and may check on pet own­ers be­fore they pre­scribe for their an­i­mals, but they are not re­quired to do so.

A vet­eri­nar­ian may be un­com­fort­able see­ing alerts about his or her clients’ his­tory with con­trolled sub­stances pre­scribed by their physi­cians, said Lazarch­eff, who lives and prac­tices ve­teri­nary medicine in Oakhurst, Cal­i­for­nia

And if the vet­eri­nar­ian sus­pects a client is abus­ing drugs, what then? “That’s an in­ter­est­ing point,” said Lazarch­eff, be­cause there’s no set pro­to­col. The one time he sus­pected a pet owner of abus­ing drugs, his of­fice called the lo­cal po­lice.

“Where it went af­ter that, I don’t know,” he said.

Un­clear Re­port­ing Re­quire­ments

State prescription mon­i­tor­ing pro­grams, or PMPs, allow physi­cians and other prac­ti­tion­ers to check a pa­tient’s prescription his­tory. But at least 32 states do not re­quire vet­eri­nar­i­ans to re­port any dis­pens­ing in­for­ma­tion on the PMP, ac­cord­ing to the Na­tional Al­liance for Model State Drug Laws.

In the pre-in­ter­net era, most states re­quired vet­eri­nar­i­ans to mail in paper re­ports of nar­cotic pre­scrip­tions. When states switched to elec­tronic sys­tems in the early 2000s, vet­eri­nar­i­ans said their of­fices lacked the tech­nol­ogy to com­ply, and many states re­moved the re­port­ing re­quire­ment for vets, said Pa­trick Knue, di­rec­tor of the Prescription Drug Mon­i­tor­ing Pro­gram Train­ing and Tech­ni­cal As­sis­tance Cen­ter at Bran­deis Univer­sity.

The ex­pe­ri­ences of Maine and New Hamp­shire this year il­lus­trate dif­fi­cul­ties states face try­ing to stop the flow of drugs to drug abusers while re­spect­ing the role of vet­eri­nar­i­ans in health care.

Both states en­acted laws re­quir­ing vet­eri­nar­i­ans to check the state PMP data­base be­fore pre­scrib­ing, but the New Hamp­shire Leg­is­la­ture re­pealed its law af­ter vet­eri­nar­i­ans ar­gued that their pro­fes­sional re­spon­si­bil­i­ties did not ex­tend to the hu­man owner.

“Our pa­tients are pets. They’re not abus­ing the med­i­ca­tion. The own­ers are,” Dr. Jane Bar­low Roy, past pres­i­dent of the New Hamp­shire Ve­teri­nary Med­i­cal As­so­ci­a­tion, said.

Maine, which had 376 drug over­dose deaths in 2016, a nearly 40 per­cent in­crease from 2015, has one of the most strin­gent laws in the coun­try. It re­quires vet­eri­nar­i­ans to check the med­i­cal records of any­one seek­ing an opi­oid or ben­zo­di­azepine (pre­scribed for anx­i­ety and in­som­nia) for an an­i­mal and to no­tify au­thor­i­ties if the pet owner has a ques­tion­able record.

Vet­eri­nar­i­ans also must get three con­tin­u­ing ed­u­ca­tion hours in pre­scrib­ing opi­oids ev­ery two years.

But al­though vet­eri­nar­i­ans in Maine must check the data­base, they can­not en­ter pre­scrip­tions into the mon­i­tor­ing pro­gram. Only phar­ma­cists are al­lowed to do that. So, a pet owner could still take a dog to mul­ti­ple vets and get drugs at sev­eral of­fices with­out the drugs be­ing recorded on the data­base, Maine’s State Health Of­fi­cer Dr. Chris Pez­zullo ac­knowl­edged.

Cough­ing on Cue

Some crit­ics say tougher re­port­ing re­quire­ments for vet­eri­nar­i­ans aren’t needed be­cause vets treat smaller an­i­mals than hu­mans and the amount of drugs they pre­scribe is low. But Pez­zullo said an­i­mal’s me­tab­o­lisms are faster, so higher dosages are re­quired, mak­ing a pet’s drugs ap­peal­ing to des­per­ate ad­dicts.

Last year in Vir­ginia, a dog owner took his boxer to six dif­fer­ent vet­eri­nar­i­ans to get anti-anx­i­ety pills and painkillers for his own use be­fore he was caught. In a widely re­ported case from Ken­tucky in 2014, a woman cut her golden re­triever twice with a ra­zor so she could get drugs. And in the early 2000s, a man in Ohio taught his dog to cough on cue so the owner could get hy­drocodone.

Such cases are be­lieved rare, but au­thor­i­ties are work­ing to cut off the sup­ply of abused drugs. In Vir­ginia, the Fairfax County Po­lice De­part­ment re­cently pub­lished an ed­u­ca­tional brochure for vet­eri­nar­i­ans, ex­plain­ing how to spot a “vet shop­per.”

The clues in­cluded: new pa­tients bring­ing in se­ri­ously in­jured an­i­mals, re­quest­ing med­i­ca­tions by name, like Tra­madol or an­tianx­i­ety Xanax, re­quest­ing early med­i­ca­tion re­fills and claim­ing med­i­ca­tions were lost or stolen.

The Vir­ginia Board of Ve­teri­nary Medicine is­sued emer­gency reg­u­la­tions in late June lim­it­ing the du­ra­tion of pre­scrip­tions for con­trolled sub­stances vet­eri­nar­i­ans and other providers may pre­scribe. A vet may pre­scribe a seven-day sup­ply and an­other seven-day sup­ply only af­ter reeval­u­at­ing the an­i­mal.

For chronic con­di­tions last­ing more than two weeks, the vet may pre­scribe an opi­oid for six months but must see and re-eval­u­ate the an­i­mal be­fore pre­scrib­ing more.

The goal is to de­crease the in­ten­tional di­ver­sion of drugs and de­crease nar­cotics left over in peo­ple’s homes, ac­cord­ing to Dr. David Brown, di­rec­tor of the Vir­ginia De­part­ment of Health Pro­fes­sions.

A Penn­syl­va­nia vet­eri­nar­ian ad­min­is­ters an in­jec­tion to a pa­tient. Some states are ask­ing vets to do more to pre­vent pet own­ers from abus­ing opi­oids in­tended for their pets.© Todd Berkey / The Tri­bune-Demo­crat via The As­so­ci­ated Press

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