The national opioid epidemic shows its true colors again, reflected in the lengths its victims will go to get their fix. Law enforcement officials and veterinarians are aware: people struggling with addiction are now using their pets to gain access to drugs.
“We’re always aware of the potential for doctor shopping, and in our case, veterinarian shopping,” said Dr. Ken Pawlowski, the President of the California Veterinary Medical Association. “There were a couple of times when we were concerned and suspicious that a client was perhaps trying to obtain medication beyond what their pet needed. There were a couple of instances where we had to reject a request for more medication because [pet owners] would lose the medication or lose the prescription on more than one occasion.”
Susan Curtis, the executive director of the Massachusetts Veterinary Medical Association (MVMA), based in Marlborough, Massachusetts, explained that the problem does not seem to be happening very often in her area yet. However, the MVMA has been prioritizing education in hopes to make sure veterinarians are informed on the subject.
“We are very aware of the potential and have worked with our members to keep them educated and ahead of the issue,” she said. “The incidence of drug seekers coming into veterinary offices is infrequent. It is very obvious when it happens, therefore, we are not seeing it very much.”
Although the practice may happen infrequently, recent reports show that it has been taking place in several different areas of the country and that tramadol is one of the most popular drugs among people who have tried to use their pets to get access to a substance.
Taming tramadol
The addictive synthetic painkiller tramadol has been widely abused in underdeveloped nations and studies show that the drug is just as powerful as morphine. Yet, tramadol is still unregulated — arguably because although the World Health Organization (WHO) highlights the drug has been universally abused, particularly in Middle Eastern countries, the WHO conversely states that data regarding addiction to tramadol shows “a relatively low dependence potential.”
In America, the drug has been the motivator behind different criminal offenses, linked to animals. Last July, a veterinary practice in Cleveland, Ohio, was robbed of its full supply of tramadol after pet owners — who were responsible for the crime — kept requesting more drugs. Then in November, about 100,000 tramadol pills were apprehended in a dog-breeding raid in Oregon.
“Tramadol is one drug that many veterinarians will carry and prescribe, I don’t know if I would say routinely, but will prescribe it as a pain medication for their patients,” Pawlowski said. “It’s probably the most common one. There are also hydrocodone medications, which we will send home with coughing patients and, in some cases, for pain. However, the veterinary versions of those do contain a second medication that would cause side effects in people.”
Multiple medications designed specifically for animals may have the same name as medications designed for humans, but they often have added chemical ingredients that are not approved to be in the human version of a drug that goes by the same name. These added ingredients can cause severe side effects such as vomiting, tremors, and anxiety.
“The idea is that hopefully if somebody tries to abuse those, they will find it that it is not what they were looking for,” Pawlowski said. “In some cases, there may be other medications that we may prescribe, which would generally be picked up at a human pharmacy, such as pain medications for more extreme situations but as a general practitioner, I know these are medications that I would prescribe maybe once every year so if someone came in requesting that, that would be a red flag.”
Regulatory dilemma
Whenever veterinarians issue a prescription for a controlled substance in California, they need to submit a report to the Controlled Substance Utilization Review and Evaluation System (CURES) — a database of controlled substance prescriptions that are classified as Schedule II, III and IV, which serves the public health, law enforcement and regulatory agencies and aims to reduce prescription drug diversion. Pawlowski explained this can often lead to a delicate situation.
“On the human side, [CURES] should help prevent doctor shopping because a human physician can go in and see all the controlled substances that have been prescribed to a person,” he said. “The problem is that now if a person has gotten a controlled substance for their pets, that information goes into the system as well. So, their doctors can see it, but it is not appropriate for veterinarians to go into the human records to see what they have been prescribed because they’re not our patients.”
After the Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996, patients’ medical records and personal information related to health are legally protected and kept private. Thus, veterinarians who access a person’s records because of their pets could be infringing the law, Pawlowski said.
“This puts the veterinarian in kind of an unattainable position,” he said. “Veterinarians prescribing medications to a dog should not go in and look a person’s records so we are put in an awkward position there.”
Prescribing guidelines that look to curb abuse and control dangerous drugs, particularly opioids, have been implemented throughout the country.
Three-way relationship
Pawlowski, who has decades of experience working as a veterinarian — in small animal practices for about 20 years, alongside his wife in the Sacramento region for 15 years, and in different animal hospitals — explained that… (continue reading)
