The severity and longevity of opioid abuse in society has caused a ripple effect in the veterinary world and will continue to be a problem for some time. The purpose of this article is only to shed some light on the complications we deal with every day and will likely have to deal with in the near future in veterinary medicine.
There have always been regulations, guidelines, and the proverbial hoops to jump through surrounding the use of controlled substances; but, new and tighter restrictions are being introduced. It is very difficult to keep up with the new rules as they seem to be popping up daily. One of the regulations that affects pets and pet owners most directly is the handling and prescription filling of certain highly abused medications that are invaluable to your pet and have no effective (non-controlled) substitute. Where we used to be able to fill a prescription in house easily and inexpensively, we are now forced to use outside pharmacies for those prescriptions. You may not think that is too bad; but depending on the medication to be filled, you would also have to pick up a handwritten script and physically take it to the pharmacy. No, I cannot call it in for you. Again, depending on the medication, we are not allowed to place refills on this medication, so you will have to do this every month. Clinics are choosing not to carry certain controlled substances for long term use or chronic disease in their clinics because of the regulations in place. I for one do not carry fentanyl in my clinic at all. We do not supply this very effective pain management tool in our severely injured or post-operative care protocols for our patients. Many clinics also do not. We use other less abusive options, but those too are being taken away because they are being utilized elsewhere in combating the opioid crisis (I will address this item later in the article).
Greater controls on which personnel can have access to controlled substances for administration and filling of prescriptions and the documentation regarding the use of those medications is getting placed under the microscope. I am not saying that these regulations are not effective or unwarranted, but they are making us focus a lot more time and effort on something other than treating your pets. Whereas a licensed veterinary technician (human equivalent to RN), used to be able to draw, administer and document these medications, only the veterinarian with a DEA license is allowed to do those tasks. This means longer wait times for prescription refills, and procedure times are bogged down with inefficiency. For example, when you call in a request for a prescription refill for your pet’s seizure medication, you will need to allow for more time to get that medication approved and submitted. If you give the last dose this morning and waited to call in your refill at noon, it may not be processed until the next business day. Please allow more time so your pets do not miss any critical doses.
In my opinion, this last change, is the biggest: Shortage of critical medication due to demand in the human medical field or changes in the cost of cross over medication that makes medication cost prohibitive for our clients. Currently in veterinary medication, many controlled substances that are crucial in surgical anesthesia, pain management, and critical care of our veterinary patients have been either placed on indefinite back order or the cost of those medications has sky-rocketed to an astronomical amount that we cannot afford to keep them in our clinics. Something as the medications used for stopping a seizure, is so expensive or completely unavailable that we will soon be out of stock and then what will we do? What will your pet do? The anesthetic drugs used in a simple a spay or neuter will add significant cost to the procedure and possibly make owners choose not to perform this commonplace surgery.
How do we as veterinarians continue to provide valuable care and humane surgical procedures for our patients when the tools we employ are being taken away? All because people want to get high? It makes me angry. Few realize the impact this is having on us and our ability to care for their pets. I hear it every day how clients are angry that it took too long to get refills on medications, or the cost of procedures and medications are so expensive, or the duration of time it took to return a phone call. The time commitment applied to veterinarians and the veterinary team is staggering.
I was sitting on my couch watching TV one night when a commercial came on for a “new drug” to help combat the opioid crisis. It was a medication that we commonly used for pain in surgical and medical cases. It is advertised as a step-down drug that is less addictive than other opioids and will help lessen the severity of withdraw symptoms in people addicted to opioids. They gave it a fancy new name and showed happy, middle-class individuals going back to work and living normal lives. I thought to myself: well, there goes that drug. Soon, I won’t be able to order it, or the cost is going to be so high my clients can’t afford it anymore. Will my practice be able to continue to provide surgical services? I sure hope it does not come to that. I would be heartbroken to have to turn people away for procedures I know I can perform, but do not have the drugs available, or only provide services at 3 or 4 times the current cost. Every time I turn around, it’s something new. I worry about where veterinary medicine is going and how we are going to adjust to the current pharmaceutical climate if something does not change soon.