The opioid crisis and drug abuse are affecting veterinarians now more than ever.
When an addict is desperate, they will get drugs any way they can. I’ve had some close calls.
In my bucolic New England town, we were awakened by my dogs going nuts at about 2 in the morning. A bear, I thought. Even the very occasional moose. Fisher cat. Raccoon.
But then I saw headlights in the driveway.
By the time I got downstairs — baseball bat in hand and 2 large barking dogs at my feet — everything was calm again. No lights. No intruder.
I have no idea what I would have done with the baseball bat, by the way. I couldn’t kill a mouse with a bat.
The next day, I learned that about 7 other veterinary hospitals in the area had been broken into, and ketamine and other controlled drugs with street value had been stolen. My dogs, and the fact that I actually lived on the property, probably deterred any intruders from breaking into my hospital.
Unless the thieves were terrified by the sight of me in a bright-pink robe carrying a baseball bat at 2 a.m. That could scare anyone.
On a most serious note now, veterinarians carry a huge responsibility to prescribe and monitor all drugs with extreme care. We are held to the highest standards by the FDA to practice proper prescribing, reporting and control.
Veterinary Standards for Prescription Drugs
Veterinarians must be the watchdogs of monitoring the drugs we use in some important areas.
1. Prescribe opioids or any controlled drugs for our patients only when necessary.
I have tried to stay away from using the drugs with the highest potential for human abuse. I don’t want to keep these drugs in the drug cabinet or worry about prescribing them for a dog but having them be abused by a human.
If I prescribe an opioid, I write a prescription for a tiny amount of the drug with no refills. This means a pharmacy must fill it and there is a proper, documented paper trail.
Vets look to use alternatives to any controlled drug whenever possible. The veterinary world is intensely involved in pain control, but I believe we’ve gone over the top in some of the prescribing. There are often excellent alternatives to opioids to control pain in our patients.
Fentanyl patches are an exception. They are an excellent source of pain control for certain surgical procedures.
- Fentanyl works best if placed on a dog or cat before the surgical procedure.
- The patch can be ordered individually and be placed on the pet in hospital.
- If prescribed, obtained and applied properly, there should be very little possibility of human abuse.
2. Stay current on federal and state regulations on all controlled drugs.
Federal regulations remain constant for long periods of time, but states differ, and a drug’s status can be changed by the state or the feds at any time.
Veterinarians get notices about changes in drug reporting, but it’s up to us to remain vigilant about any changes in any status of any drug.
If we are not responsible about keeping certain drugs in a locked cabinet, keeping computerized records of every use of every controlled drug to be ready for inspection at any time, or keeping our medical records and prescription records up to date, we are at fault.
Clients don’t often comprehend these issues. Even if a client has truly lost a controlled prescribed drug for their pet and requests a refill, we cannot do that.
The client may get angry. Too bad. Could they get an easy refill of that drug from their own physician? No — not from an ethical doctor.
How horrible — some people are actually trying to harm pets to get opioids from their vet:
3. Understand the possibility of overdose or adverse reactions in pets, and know how to treat the overdose.
As with people, animals react individually to any drug.
We use certain controlled drugs for pain, behavior disorders, and thunderstorm, travel or other anxiety issues.
I prescribe at a low dose, warn people of any possible side effects, and ask them to be vigilant and monitor their pets when they take any of these medications.
4. Be aware of the drugs with high human use potential.
Unfortunately, veterinary hospitals are targeted by certain bad actors, and every profession has its share of human beings in trouble.
Let’s take this step by step:
Clients or household members of clients may ask for prescriptions and amounts of specific drugs that raise a red flag these days.
People have told me things like their son lost all the dog’s drugs, or they left the drug in their other house, or blah blah blah. In today’s environment, vets have to gracefully decline a renewal of certain prescriptions.
Dr. Virginia Sinnott-Stutzman, DVM, DACVECC, told The Boston Globe in a September 2018 interview, “People become angry or enraged or belligerent far out of proportion to the level of pain their dog or cat is experiencing.”
“They’re screaming and yelling and using swear words” to demand pain meds that their pets don’t need, she said.
Every profession does its “vetting” of staff, but sometimes you just never know.
Drugs kept in hospital with any potential for abuse must be kept under lock and key. We have rigorous standards for keeping records of the number of pills dispensed or the amount injected to what client on exactly what date. And our medical records must delineate exquisitely why we prescribed said drug.
Even under such rigorous standards, drugs can “go missing,” and the vet is responsible for any discrepancies.
Some vets out there have their own drug addictions, or they are in money trouble.
Veterinarians have to actually forge drug records or write illicit prescriptions to gain access for their own habit or to deviate drugs in any way.
Final Thoughts on How Veterinarians Are Handling the Opioid Crisis
The opioid crisis has produced a scary world out there for any doctor or veterinarian granted the right to prescribe these dangerous drugs.
We are under the scrutiny of federal and state jurisdictions. If there is any discrepancy in our record keeping, our license to practice medicine can be placed in jeopardy or revoked.
If your veterinarian ever gives you trouble about filling or refilling any controlled drugs, don’t give them attitude. Give them respect.