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 and Percocet, but they do dispense tramadol, a painkiller; ketamine, an anesthetic; and hydrocodone, an opiate used to treat coughing in dogs. All of these are controlled substances that people abuse.
But even as some states push for veterinarians to assess people’s records, many practitioners maintain they’re unqualified to do so. And while a handful of states require vets to check the prescription histories of pet owners, about two-thirds of states explicitly prohibit it.
“I’m a veterinarian, not a physician. I shouldn’t have access to a human’s medical history,” said Kevin Lazarcheff, president of the California Veterinary Medical Association. The state’s vets have access to a database where they can check on pet owners, but they are not required to do so.
Veterinarians may be uncomfortable seeing information about controlled substances prescribed for their clients, said Lazarcheff, who practices in Oakhurst, Calif.
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.
State prescription drug monitoring programs, or PDMPs, allow physicians and other practitioners to check a patient's medication history. But at least 32 states do not require veterinarians to report any dispensing information on the PDMP, 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 when trying to stop the flow of drugs to abusers while also respecting the role of veterinarians in health care.
Both states enacted laws requiring veterinarians to check the PDMP 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,” 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 hours of continuing education 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 take a dog to multiple vets and get drugs surreptitiously at several offices, Chris Pezzullo, Maine’s state health officer, acknowledged.
Coughing on cue
Some critics say tougher reporting requirements for veterinarians aren’t needed because the amount of drugs they prescribe is small. But Pezzullo said higher dosages are required because the metabolism of animals is faster than that of humans, which makes a pet’s drugs appealing to desperate addicts.
Last year in Virginia, a dog owner took his boxer to six veterinarians to get anti-anxiety pills and painkillers for his own use before he was caught, according to Fairfax County police, who said the owner was eventually charged with prescription fraud.
In Kentucky in 2014, a woman was accused of cutting her golden retriever twice with a razor so she could get drugs. And in the early 2000s, a man in Ohio allegedly taught his dog to cough on cue so the owner could get hydrocodone.
Such cases are believed to be rare, but authorities are working to cut off the supply of abused drugs. The Fairfax County Police Department recently published a brochure showing veterinarians how to spot a "vet shopper."
The clues include: new patients bringing in seriously injured animals, requesting certain medications by name, seeking early refills of prescriptions and claiming that medications had been lost or stolen.
The Virginia Board of Veterinary Medicine issued emergency regulations in June limiting the duration of prescriptions that may be ordered for controlled substances. A vet may provide a seven-day supply and a seven-day refill only after reevaluating the animal.
For chronic conditions, the vet may prescribe an opioid for six months but must see and reevaluate 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 David Brown, director of the Virginia Department of Health Professions.
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