BY: SAMANTHA BARTLETT
The nation’s opioid crisis is a topic of news channels everywhere and has been for the past several years. While the extent of the crisis varies by location, some states report that there have been more deaths from opioid use than automobile accidents. Most states have implemented some type of increased control measures for the prescribing and dispensing of Schedule II opiates; however, addicts are good at finding ways around the system. The latest outlet for opiate addicts has been the veterinary office.
People have caught on to the fact that many controlled drugs in veterinary medicine are the same as those used in human medicine. There have been reports of people deliberately injuring their animals in order to get pain meds such as Tramadol. Others report people are intentionally adopting older pets with arthritis or other issues for the purposes of getting prescription drugs for their own use. While not as common as in human medicine, veterinarian shopping also occurs as people seek more refills of pain meds for their dogs to support their own addictions.
All of this has caused concern both on the legislative and medical sides of the room. Lawmakers are searching for ways to monitor potential abuse of controlled substances between the veterinary and human sides of medicine. Veterinarians are concerned about the potential implications of increased legislation and the impact it may have on their ability to practice appropriate medicine. Some states have responded by requiring veterinarians to participate in their statewide Prescription Drug Monitoring Program (PDMP) where the veterinarian would have to monitor the prescription records of the pet owner and also enter any prescriptions written for the pet into the database. Other states have simply opened up access to the PDMP so veterinarians can use that resource if there is suspected drug abuse by the owner. Still other states have yet to address the roles of veterinarians in helping to control the opioid crisis.
These changes have inspired mixed feelings in veterinarians. Many veterinarians do not feel comfortable being placed in the role of analyzing and owner’s medical records to determine if it is safe to prescribe medication to the pet. Along the same lines, many feel this is influencing their decisions on prescribing medication that the pet may really need. The is creates an ethical dilemma in the minds of many veterinarians and adds to the difficulty of treating a patient that cannot talk and does not always exhibit outward signs appropriate to the degree of pain or illness that is present. In addition, many veterinarians have expressed concerns about the increased load on clinic resources that are already stretched thin to log and monitor these prescriptions. However, many veterinarians also express concern about unwittingly contributing to this growing human health concern because there is no protocol for monitoring and dealing with drug abuse for veterinary prescriptions.
On the other side of the coin, lawmakers express concern about the actual impact veterinary participation in the PDMP is having. Many say it is tough to know the true extent of abuse on the veterinary side since there are no unique identifiers like social security numbers assigned to pets and officials must rely on matching home addresses to determine what medications are going into a household. Another issue is the difficulty integrating veterinary software systems into the monitoring systems. Most practices are having to submit information on handwritten forms to be entered into the system manually so timeliness of reporting can also be an issue.
Approximately 40 of the 50 states have implemented some type of statewide monitoring requirements or have given veterinarians access to the monitoring system for Schedule II prescriptions. In states that have implemented these changes, some are getting pushback from the state veterinary medical associations. For example, Maine’s VMA feels that the burden of checking owner’s prescription records should not be placed on the veterinarians, but it is reasonable to require them to log prescriptions into the system. New Hampshire’s bill requiring veterinary participation in their PDMP was revised and now veterinarians are exempt from that requirement. Missouri remains as the only state with no statewide prescription monitoring system in place although there are some county-wide monitoring systems in place. Of the states that are requiring veterinary participation in the PDMP, many are also offering online training on prescribing and handling Schedule II drugs.
Warning signs of potential drug seeking behavior are new clients that ask for opiates by name, new clients with acutely injured pets, clients that call to ask for refills of a controlled medication but refuse to come in for a recheck exam, and clients that claim medication was spilled or lost and consistently ask for refills too soon. At this point there is no fool-proof or consistent system in place. In the absence of guidelines and protocols, the best advice is to know the signs of potential veterinary/doctor shopping and use your best judgement on each individual basis for prescribing medication. Call the appropriate authorities if necessary.