A prescription for disaster

Mrs. Exen is a devoted dog owner and frugal lady. Her 9-year-old Labrador retriever, Ernie, is the love of her life. As is often the case with retrievers, as he's gotten older he's gotten stiffer. Dr. Ware has examined Ernie on a regular basis and determines that he's experiencing the onset of older-age degenerative joint disease. Mrs. Exen accepts the arthritis diagnosis and starts Ernie on a popular prescription NSAID medication.

The dog responds quickly and Mrs. Exen is happy with his progress. But she's unhappy with the medication cost of more than $2 per day. Dr. Ware explains that these medications are relatively new and there aren't a lot of generic options that are equally effective. Mrs. Exen does some Internet research and finds the NSAID medication she's using cheaper from an online Internet pharmacy. She calls Dr. Ware and asks him to write her a prescription for Ernie's medication so she can buy it from this retailer.

Dr. Ware has been getting an ever-increasing number of requests for online prescriptions for some time. His clinic pharmacy can't match the prices of these online operations that purchase massive amounts of medication for a lower cost. He honors Mrs. Exen's request and writes a prescription for her to mail to the online pharmacy. The medication arrives promptly, and although the packaging looks different, the pill and its strength are exactly the same as Ernie had been taking in the past. Ernie actually looks forward to his medication. The chewable tablet makes the pill easy to administer in addition to its wonderful effectiveness.

The next day Mrs. Exen returns from spending the day at her daughter's house when she discovers that the medication she left on the kitchen counter is now on the floor. Ernie is just finishing enjoying the spoils. The NSAID pills had come in a cardboard package and were enclosed in a blister pack. When Ernie smelled his favorite medication, he promptly ate seven tablets before he was discovered. The dog's normal dose is one-half to one tablet daily. Mrs. Exen calls the after-hours emergency clinic and is told to bring the dog in immediately. Unfortunately, Ernie has already begun to experience gastric upset and hepatic and renal consequences. Six days and $6,200 later, Ernie is ready to go home.

Mrs. Exen is very unhappy. She files an action against the online pharmacy for dispensing an attractive, palatable prescription medication in an unsafe package. But her legal and regulatory complaints do not stop with the online pharmacy; they include Dr. Ware as well. She accuses Dr. Ware of not noting on the prescription to the outside agency that this potentially lethal medication should be dispensed in a childproof and dog-proof container.

Dr. Ware tells his state board that he always dispenses NSAID chewable medications in a bottle with a childproof cap. He adds that the client chose to use an online pharmacy and he has no control over their packaging decisions. Needless to say, Mrs. Exen and Ernie do not return to Dr. Ware, and all concerned learn never to take prescription medication packaging lightly.

Rosenberg's response

The battle between the online pharmacies and the veterinary profession has been raging for years. Internet pharmacies sometimes cut corners and always cut prices-and the pet owner ends up in the middle. While online veterinary pharmacies are a 21st-century fact of life and must be accepted, this doesn't mean they don't have to meet dispensing standards that ensure the health and well-being of veterinary patients. The veterinary profession is doing its best to ensure that these standards are met, but in the meantime, it's important to package all dispensed veterinary pharmaceuticals in a safe manner and advise pet owners they must demand the same safety packaging from their online purchases that they would require of their own veterinarian.

Mrs. Exen paid the price, Dr. Ware was collateral damage, and Ernie the dog was the true victim-and the catalyst for the continuation of veterinarians' battles with internet pharmacies.

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Do you agree with Dr. Rosenberg? Send us an email at dvmnews@advanstar.com to let us know.

Dr. Marc Rosenberg is director of the Voorhees Veterinary Center in Voorhees, N.J. He is a member of the New Jersey Board of Veterinary Medical Examiners.