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Thursday, February 2, 2012

Legalities Of Prescriptions

This post is brought on by a case I saw today.  A regular client recently bought a puppy from a pet store (a big rant that I'll save for another time).  The dog developed an upper respiratory infection that was quickly spread to her other two dogs.  Based on recommendations from the pet store, they returned the puppy so they could treat her.  Okay, fair enough.  But then they sent home two potent antibiotics (azithromycin and erythromycin) for her two dogs and two cats.  The big deal is that the pet store sent these antibiotics home with the client without the other pets ever being seen by anyone at the store, let alone a vet.  Additionally the labels only gave a little information, mostly just the medication and how often to give.

Wow.  That is wrong on so many levels, and I'll explain why.  Unfortunately I do see things like this happen from time to time, though normally from breeders and not pet stores.  Most clients don't realize why this is wrong, so let me take some time to illustrate.

Let's start with the legal aspects.  Since I'm here in the US and not aware of laws in other countries, any statements I make here are only related to my home country.  First, it is law in every state that in order to dispense prescription drugs the doctor must have a valid client/doctor/patient relationship.  This means that the doctor must have actually examined the pet in question in a relatively recent period of time.  Some states are more specific, requiring that the patient have been seen within the last 12 months or even more recently.  No doctor can legally send home a prescription drug without having seen the pet.  People who are not licensed doctors cannot legally send home prescription drugs at all.  And you have to be licensed for the right species!  This means that my physician cannot legally prescribe medications for his dogs and I cannot legally prescribe drugs for my kids.

Second, the label is very important and what is on it is mandated by law.  According to prescription laws a drug label must include the following information:  Prescribing doctor's name, clinic name, address, and phone number, patient's name, drug name, drug dosage (including milligrams or concentration), and expiration date.  The drug container or bottle must also be appropriate for medications and some states require child-proof closures.  If all of this information is not printed on the label they are in violation of the law.  I have many times seen a client bring in a new puppy with a small envelope of pills and simply "give one daily" (or something similar) hand-written on the envelope.  Usually this is an antibiotic such as metronidazole, and violates the above laws in many regards.

Okay, so sending home medications without seeing the pet and without proper labeling is illegal.  Are we clear on that?  Good.  But it's not just about the legalities.  There are practical reasons related to quality of medicine.

A growing problem in human medicine has been over-use of antibiotics, resulting in resistant bacteria.  Historically doctors have sent home antibiotics for simple things "just to be safe".  Any bacteria that aren't killed may have some resistance and as they reproduce you end up with the potential of a "super-bug" that common antibiotics won't affect.  This hasn't been as severe of a problem in veterinary medicine, but has caused controversy because of the common use of antibiotics in livestock feed.  Thankfully there has been increasing awareness of this problem in all fields of medicine, and physicians and veterinarians are less likely to send home such medications unless there is a real indication for it.  I've avoided antibiotics in many cases that I just didn't think would need it.  How do you know if a patient needs it unless you examine them?  Sending home random medications can increase the risk of antibiotic resistance.

We are also taught to not go straight for our "big guns".  Depending on the severity of the case, there are a few first-line antibiotics we will pick and then go to other things if that doesn't work.  Why?  Because if we have any bacteria that develop resistance to the potent drugs, we may not have other options.  In the case above, the pet store (apparently based on their vet's recommendation) went straight for some of the biggest "guns" we have, as well as using both at the same time.

In veterinary medicine drugs are dosed based on the patient's weight (unlike human medicine where a 120 pound person will likely receive the same dosage as a 200 pound person).  If you haven't seen the pet recently (or at all) you may have a problem with appropriate dosing.  In the case that prompted this discussion the pet store was under-dosing on one medication and almost over-dosing on the other.  Depending on the medication there is the potential for severe side-effects.

Obviously I have a big problem with breeders, pet stores, and even vets who send home prescription medications willy-nilly.   But there are legitimate reasons for my concerns.  People who do these things demean the profession, break the law, and potentially put pets at risk.