Maine brings its fight against opioid abuse to veterinarians
Freelance writer Rachael Zimlich worked as a reporter for dvm360 magazine before returning to school to become a registered nurse. She now works at The Cleveland Clinic.
Clinicians must check a state database for pet owner drug abuse before prescribing opioids or benzodiazepinesbut the new law wont prevent them from prescribing those medications even when they suspect abuse.
Veterinarians in Maine are being tasked with policing pet owners for opioid abuse, requiring them to review the prescription record of individuals picking up controlled substances for pets and alerting the state when there's cause for suspicion. That's where the requirement stops, though, as the new law won't prevent veterinarians from prescribing opioids or benzodiazepines, even when abuse is suspected.
Veterinary leaders like Katherine Soverel, executive director of the Maine Veterinary Medical Association (MVMA), says that while the opioid crisis is a public health threat that will take a slew of providers to fight, she doesn't think it's a fight for veterinarians.
“The MVMA believes that veterinarians can be part of the solution. However, as the law currently stands veterinarians are not able to be effective. Veterinarians do not have the human medical exposure, background or professional liability coverage for reviewing and interpreting human medical records as the law currently requires,” Soverel says. “The current law is written with human health providers in mind. This makes sense given that human prescribers and dispensers are the source of the vast majority of drug diversion and abuse. Veterinarians were thrown into the current law without much consideration for the many differences in how veterinary medicine is practiced versus human medicine.”
MVMA would support checking prescription records of animal patients rather than pet owners, she says.
The new law went into effect in March 2017 and expands Maine's Prescription Drug Monitoring Program (PDMP) to include veterinarians. The new law has two requirements-that veterinarians check the state's PDMP when prescribing opioids or benzodiazepines, and that veterinarians earn three hours of continuing education on prescribing practices for opiates every two years beginning in December 2017.
In order to check the PDMP, veterinarians first have to register with the state. From there, they will be required to check the records of anyone seeking an opioid or benzodiazepine for an animal. This will require a birthdate, full name and often a valid photo identification for the pet owner. Prior to issuing a prescription, the veterinarian will have to review three things-the aggregate morphine milligram equivalent prescribed or written for the pet owner, how many prescriptions that individual currently has for controlled substances and how many pharmacies are filling controlled substances for that person.
When a prescription is given, veterinarians must include a Drug Enforcement Agency (DEA) number on the prescription, and no more than seven days' worth of medication can be prescribed for acute pain. In cases of chronic pain management, prescriptions may be written only for 30 days at a time and veterinarians will have to recheck the PDMP every 90 days. The requirements for checking the PDMP do not apply when the opioid or benzodiazepine is administered in the clinical setting.
In cases where a pet owner or requester of a pet medication is found to have a questionable record of prescriptions in the PDMP, veterinarians have to notify PDMP administrators but are not required to confront pet owners, according to MVMA.
Veterinarians who do not follow the new requirement will be subject to a $250 fine for each occurrence, capped at $5,000 per year, according to the law. The state will begin levying fines in October.
The law will also end up costing veterinarians in other ways because of a July 1 requirement that opiate and benzodiazepine prescriptions be sent to pharmacies electronically.
“At this time there are also no e-prescribing software options available to veterinarians that are financially feasible,” Soverel says. “The state has made a waiver available to prescribers that do not have the capability to prescribe electronically, but many members have contacted the MVMA concerned about how they will meet the electronic prescribing requirement.”
The costs, she says, will be passed on to pet owners in many cases.
Amanda Bisol, DVM, legislative chair for the MVMA, says the association opposed the inclusion of veterinarians in the bill.
“The initial proposed legislation did not include veterinarians, but the head of the Department of Health and Human Services (DHHS) in Maine recommended adding us, which we did not know was planned until the public hearing on the bill,” Dr. Bisol says. “We were not as prepared as we could have been, as we thought they would follow the lead of other states in excluding veterinarians.”
Dr. Bisol says the MVMA encouraged veterinarians to contact their legislators about the bill-to no avail.
Connecticut, Maine, New Hampshire, New York, California and Minnesota are among the states that have similar laws, Dr. Bisol says.
Although she was opposed to the bill, Dr. Bisol was involved in a stakeholder group that helped state leaders form the rules of the law and create a module that walks veterinarians through the new rules and the process of checking the PDMP.
Still, she wonders about the point of veterinarian involvement given the fact that animal prescriptions will not be included in the database.
“I think any abuse by clients in the veterinary realm is a small issue and so to include veterinarians and make an already confusing database worse is ineffective. We are not mandated to report in Maine, which means any prescriptions veterinarians dispense directly are not in the database,” Dr. Bisol says. “There is also no set way for pharmacists to add animal scripts and so it is impossible to accurately search a pet at this time.”
Additionally, while the new law doesn't place restrictions on how veterinarians prescribe these medications as a rule, veterinarians are making changes in practice.
“The law does not limit what a veterinarian can do in terms of prescribing, aside from length of time and how often refills can be made. It only requires us to check and report suspicious activity to DHHS,” Dr. Bisol says.
But the new rule is having unintended consequences that may negatively affect pets.
“From instances I have heard, veterinarians are misinterpreting the rules and choosing not to use the medication,” Dr. Bisol says. “The only time a veterinarian would not be allowed to prescribe would be if the owner refused to give their birthdate to the veterinarian so they could check the database. In this case it would be illegal to prescribe as we have to check the database.”
While Dr. Bisol says pet owners have generally been supportive of veterinarians joining the fight against opioid abuse, Soverel says she has heard another side-that some pet owners are uncomfortable with their veterinarian having access to their personal medical information.
“At the MVMA we would very much like to run a survey to better understand how the public feels about this,” Soverel says. “It is those individuals who are uncomfortable who would be less likely to speak up about their concerns, so I think it's hard to say how pet owners feel without a formal survey that ensures anonymity.”
Though it's been difficult to find out exactly what pet owners think about the new law, Dr. Bisol says veterinarians have been clear about their displeasure with the bill for a variety of reasons.
“It's a huge ethical issue that should not be overlooked for a nonhuman medical professional to be reading this database on [human] patients,” Dr. Bisol says, adding she has concerns over the number of people who have access to the PDMP and being able to view her DEA number in the system. “There is absolutely no need for a veterinarian to be a part of policing human doctors and pharmacists for their prescriptions to their patients. … We are not allowed to treat humans and therefore should not have anything to do with their medical information.”
Rachael Zimlich is a freelance writer in Cleveland, Ohio, and a former reporter for dvm360 magazine.