States track dispensing to counter drug fraud
Forty-nine states—all but Missouri—and the District of Columbia track controlled substance dispensing to thwart doctor shopping, the seeking of addictive or dangerous drugs from multiple doctors or pharmacists.
About a third require veterinarians to report to state databases when they dispense controlled substances, whereas about 40 require reports from dispensing physicians.
Alabama and Arizona have removed reporting requirements for veterinarians since the start of 2016, while Nebraska has formed a task force on implementing requirements starting in 2018, reflecting debate over whether the risk justifies the reporting burden. By one study's tally, national annual counts of doctor shoppers at veterinary clinics are in the single digits.
Dr. John Kuehn, a Nebraska state senator and large animal veterinarian, said veterinarians have professional obligations to the public to ensure appropriate drug use and help address a public health crisis. He said veterinarians should be aware that their clinics can be a source of abused drugs.
Drug overdose deaths have tripled since 1999, and prescription opioid deaths have quadrupled, according to the Centers for Disease Control and Prevention. States have responded, in part, by implementing prescription drug monitoring programs, or PDMPs, which CDC information indicates have had promising results.
New York and Tennessee, for example, began requiring in 2012 that prescribers check their states’ monitoring programs before prescribing opioids, and in 2013, the numbers of people who saw multiple prescribers for the same drugs declined by 75 percent and 36 percent, respectively.
But one national survey of drug monitoring programs, regulators, and veterinary associations found that, in a typical year, fewer than 10 people were doctor shopping at U.S. veterinary clinics, and “veterinarians are a de minimus source of controlled substances.” The article (J Anim Environ Law 2014;5:1–42) was written by Dr. Robert J. Simpson, then president-elect of the American Veterinary Medical Law Association.
However, Barbara L. Carreno, a spokeswoman for the Drug Enforcement Administration, said doctor shopping is a substantial problem for veterinary clinics, and the DEA is tracking reports.
Dr. Larry Stutts, an Alabama state senator who worked in mixed animal practice before becoming a physician, proposed the legislation that removed reporting requirements for his state's dispensing veterinarians, effective Aug. 1, 2016. He said as a whole, veterinarians play an insignificant role in diversion of narcotics.
Dr. Brad Fields, assistant executive director of the Alabama VMA, also contends that seeking drugs from veterinary clinics requires bringing in an animal with clinical signs and the money to cover examination fees.
Sherry Green, president of the National Alliance for Model State Drug Laws, said those misusing or selling drugs for nonmedical purposes tend to take the path of least resistance for acquiring those drugs. As states close routes to obtaining medications, addicts and sellers will choose others, so she supports requiring reports from all dispensers. She wants further consideration of how states could prevent veterinary clinics from becoming targets without undue burden.
Rhode Island has had about 1,200 overdose deaths since 2011, exceeding the combined deaths from car crashes, shootings, and fires, according to information published by the governor's office in July 2016. The state requires dispensing reports from veterinarians.
Patrick Knue, director of the Prescription Drug Monitoring Program Training and Technical Assistance Center at Brandeis University, noted that, in the minority of states that require veterinarians report controlled substances dispensed, some are unable to identify fraud at veterinary clinics—especially when performed under multiple pet names. With programs that track prescriptions by the owners’ addresses, he said, veterinarians can use that information to see how many prescriptions are going to one residence.
Condensed from Feb. 1, 2017, JAVMA News
Powdered glove ban takes effect
Federal health officials have banned powdered gloves intended for use in surgery or examinations as well as absorbable powders for lubricating surgery gloves.
The prohibition took effect Jan. 18. The ban applies to the use of powdered gloves in both human and veterinary medicine.
The Food and Drug Administration implemented the rule to eliminate risks of inflammation, granulomas, and respiratory allergic reactions, according to a Dec. 19, 2016, Federal Register notice announcing the ban.
“A thorough review of all currently available information supports FDA's conclusion that powdered surgeon's gloves, powdered patient examination gloves, and absorbable powder for lubricating a surgeon's glove should be banned,” the notice states. “FDA has concluded that the risks posed by powdered gloves, including health care worker and patient sensitization to natural rubber latex (NRL) allergens, surgical complications related to peritoneal adhesions, and other adverse health events not necessarily related to surgery, such as inflammatory responses to glove powder, are important, material, and significant in relation to the benefit to public health from their continued marketing.” The notice indicates nonpowdered alternatives are viable and that their use avoids “unreasonable and substantial” risks. Agency officials also expect minimal impact through costs or shortages. “Thus, a transition to alternatives in the marketplace should not result in any detriment to public health,” states the notice.
In spring 2016, the FDA had published the proposal to ban powdered surgery and examination gloves and glove powder. The risks outweigh the minimal benefits of increasing ease of donning and removing the gloves, according to the agency.
Condensed from Feb. 1, 2017, JAVMA News
Avoiding the slippery slope of unethical behavior
The American Association of Equine Practitioners addressed the topic of ethics head-on at its annual convention this past December. Equine veterinarians, especially those at the racetrack and, to a lesser extent, in the show ring, must function in a setting where the pressure to perform—and win—is intense, sometimes creating an environment where medical treatments are timed to a horse's racing or performance schedule rather than geared toward what might be in the horse's best interest.
A well-attended interactive ethics panel, “Can Sport Horse or Racehorse Track Practice Be Ethical?” had sport horse and racetrack practitioners discussing how situations involving ethical shades of gray might be managed in the best interests of horses while preserving client relationships. The case-based, interactive session touched on insurance fraud, health and race scratch certificates, intrathecal and joint injections, tail alterations, and the subject of questionable requests from clients.
Chuck Gallagher (Courtesy of AAEP)
Citation: American Journal of Veterinary Research 78, 3; 10.2460/ajvr.78.3.256
Dr. Thomas Riddle, chair of the AAEP Professional Conduct & Ethics Committee, said the panel was an important first step in improving ethics in equine practice.
“Everyone would agree we want to practice more ethically, but the important thing that came from the panel is that people are reminded they need to consider ethics in the decisions they make daily in practice,” he said. “It's not just going ahead and doing it the way it's always been done.”
The AAEP meeting's keynote speaker, Chuck Gallagher, also talked about ethics. His message boiled down to this: People cheat when they have a chance, but when issues of honesty and rationalization are openly discussed, people dramatically reduce or stop cheating. The lesson, then, is to remove opportunities to cheat and expand ethics training beyond mandatory requirements.
Condensed from Feb. 15, 2017, JAVMA News
Practices encouraged to be proactive about antimicrobials
A report now available from the AVMA Task Force for Antimicrobial Stewardship in Companion Animal Practice provides a framework for instituting a clinic-level approach for judicious antimicrobial use, along with educational materials. The task force said this is an initial step to raise awareness and encourage broad action by companion animal veterinarians to help the profession combat the threat of antimicrobial resistance.
A key focus of the task force was to assemble these core elements of a companion animal stewardship program:
• Each veterinary practice should commit to the reduction in antimicrobial resistance by creating and adopting a clinic-specific plan in which everyone contributes to effective antimicrobial stewardship.
• Antimicrobial stewardship in a practice begins with the appointment of a principal person to lead the program and to support the practice stewardship goals with all available resources.
• Practices should address issues of antimicrobial resistance by taking a proactive approach to antimicrobial use and infection control, using accepted guidelines, recommendations, and expertise.
• Understanding what is working and what is not requires self-assessment and monitoring, with a goal of continual improvement.
Plus, the task force developed activities to help the veterinary profession combat antimicrobial resistance, including developing general do's and don'ts of antimicrobial prescribing and creating educational programs and materials for practitioners and clients. These are available at http://jav.ma/antimicrobialuse.
The AVMA Board of Directors approved the release of the task force's final report this past November as information to the public and allied organizations. However, the document has not been approved as policy by the Board or House of Delegates. The report is available at http://jav.ma/avmareports.
Condensed from Feb. 1, 2017, JAVMA News
Avian-type influenza sickens cats, veterinarian
An avian-type influenza virus had infected 386 cats at a temporary quarantine facility for cats from Animal Care Centers of New York City shelters as of mid-January as well as one veterinarian who was involved in obtaining respiratory specimens from sick cats.
Information from the University of Wisconsin-Madison Veterinary Diagnostic Laboratory indicates the H7N2 avian influenza A virus responsible for the outbreak is a rare subtype found for the first time in domestic cats.
Courtesy of ASCPA
Citation: American Journal of Veterinary Research 78, 3; 10.2460/ajvr.78.3.256
Wisconsin's School of Veterinary Medicine has worked with the shelters and New York City Department of Health to manage the outbreak, including helping set up the quarantine facility during shelter disinfection.
City health department information indicates most cats had mild illness. The virus appears to be very contagious among cats.
The veterinarian's illness was mild. There was no documented human-to-human transmission.
The American Society for the Prevention of Cruelty to Animals, with funding from Maddie's Fund, established the temporary quarantine shelter in the borough of Queens. In early January, the Animal Care Centers and the Mayor's Alliance for NYC's Animals transported more than 450 cats to the temporary shelter from shelters in the boroughs of Manhattan, Brooklyn, and Staten Island. The cats were to be quarantined until testing by the University of Wisconsin veterinary school indicated that they are healthy and no longer contagious, likely 45 to 90 days.
The Animal Care Centers hired a professional cleaning company to service all facilities and planned to resume cat adoptions once the cleaning process was complete.
Condensed from Feb. 15, 2017, JAVMA News
Penn Vet given $5M for equine welfare, wellness professorship
A gift of $5 million will establish the Dr. Harry Werner Professorship in Equine Medicine at New Bolton Center, the large animal hospital of the University of Pennsylvania School of Veterinary Medicine.
The chair endowed by the estate of Seth and Lucy Holcombe is named for their veterinarian and lifelong friend, Dr. Harry Werner, a 1974 Penn Vet graduate. Dr. Werner cared for the Holcombes’ Morgan horses since the early days of his career, working as a veterinarian in Granby, Connecticut.
Dr. Harry Werner (Courtesy of Penn Vet)
Citation: American Journal of Veterinary Research 78, 3; 10.2460/ajvr.78.3.256
The professorship will include teaching, research, and clinical outreach, with an emphasis on equine welfare and wellness important to both the Holcombes and Dr. Werner.
Penn Vet is conducting an international search for candidates, with a goal of awarding the professorship in 2017, according to a Dec. 6, 2016, university press release.
The professorship will be the centerpiece of what the veterinary college intends to build into a broader program in equine wellness and welfare, attracting international speakers and reaching populations of working horses in need, according to the release.
Dr. Werner has dedicated his life and career to the care and welfare of animals through practice and his continued service to veterinary professional organizations. He was the 2009 president of the American Association of Equine Practitioners and is a member of the AAEP Welfare & Public Policy Advisory Council. He is also a member of the AVMA Animal Welfare Committee, is the AVMA liaison to the Unwanted Horse Coalition, and serves on the World Equine Veterinary Association's board of directors.
Condensed from Feb. 15, 2017, JAVMA News
FDA conditionally approves drug for treating lymphoma in dogs
The Food and Drug Administration announced Jan. 3 that it has conditionally approved Tanovea-CA1, or rabacfosadine, as the first animal drug to treat canine lymphoma.
“Across the board, we saw some positive activity in up to 80 percent of all the lymphoma patients that were treated with this medication,” said Dr. Doug Thamm, a veterinarian who led clinical trials at Colorado State University, in a CSU announcement.
VetDC Inc. is the university startup that a decade ago identified rabacfosadine for its potential in treating dogs with lymphoma.
Doses of the drug are given every three weeks, with a total of five infusions. That compares with conventional chemotherapy treatments that require up to 16 weekly visits.
“There are many treatments for lymphoma that are currently available for dogs, but almost all of them are repurposed old human cancer drugs,” said Dr. Thamm, head of clinical development for VetDC. The drugs can be quite effective, but many companion animals need other options for recurring cancer.
“About 95 percent of dogs, sooner or later, will get their lymphoma back, even if drugs work initially,” he said. “So finding new things that we can offer our clients when this lymphoma comes back is incredibly important. Having another drug in our toolbox that we can reach for, that we know can actually be quite effective for some dogs and doesn't have to be given very frequently, is a real win.”
Condensed from Feb. 15, 2017, JAVMA News
American College of Veterinary Pathologists
The American College of Veterinary Pathologists welcomed 81 new diplomates and recognized two dual-certified diplomates following the board certification examination it held Sept. 13–14, 2016, in Ames, Iowa. New diplomates are as follows:
Veterinary anatomic pathology
Katherine Barnes, Sacramento, California
Samuel Beck, St. Albans, England
Kyla Beguesse, Madison, Wisconsin
Pompei Bolfa, Cluj-Napoca, Romania
Kerriann Casey, Davis, California
Caroline Tania Chu, Chicago
Peter Nguyen-Duy Chu, Vacaville, California
Elizabeth Clark, Upper Arlington, Ohio
Lorelei Clarke, Athens, Georgia
Nicholas Crossland, Overland Park, Kansas
Heather Daverio, Northport, New York
Josue Diaz Delgado, College Station, Texas
Jessica Durrant, Littleton, Colorado
Elizabeth Elsmo, Racine, Wisconsin
Ember Epperson, Gainesville, Florida
Natalie Fowlkes, Jarreau, Louisiana
Dayna Goldsmith, Davis, California
Falon Gray, Philadelphia
Shelley Hahn, North Grafton, Massachusetts
Martha Hensel, College Station, Texas
Heather Herd, Stillwater, Oklahoma
Lauren Himmel, Nashville, Tennessee
Gavin Hitchener, Speonk, New York
Kelly Hughes, Fort Collins, Colorado
Jennie Jankovsky, Talbot, Tennessee
Saravanan Kaliyaperumal, Fremont, California
Norman Kreiselmeier, Frederick, Maryland
Joshua Leach, Salisbury, England
Megan McCarthy, San Diego
Mary Lauren Mesich, Maplewood, Minnesota
Shan Naidu, Lafayette, Louisiana
David Needle, Durham, New Hampshire
Maureen O'Brien, College Station, Texas
Jenny Pope, Auburn, Alabama
Matthew Reed, Middletown, Maryland
Ana Rosa Resendes, Nieuwegein, Netherlands
Shannon Roff, Palm Bay, Florida
Margaret Roser, West End, Australia
Maninder Sandey, Auburn, Alabama
Adrienne Schucker, St. Paul, Minnesota
Nozomi Shimonohara, Tokyo
Stephanie Shrader, Phenix City, Alabama
Set Sokol, San Diego
Guillaume St-Jean, St. Hyacinthe, Quebec
Brian Stevens, Rochester, New Hampshire
Matthew Sturos, Fridley, Minnesota
Laetitia Tatiersky, Arthur, Ontario
Holly Taylor, Cameron, Wisconsin
Bradley Turek, Calabasas, California
Tamara Veiga Parga, Knoxville, Tennessee
Sarah Vitosh-Sillman, Beatrice, Nebraska
Kimberly Wahl, Bryan, Texas
Nathan Wienandt, San Antonio
Leslie Wilson, Baton Rouge, Louisiana
Daniel Woodburn, Champaign, Illinois
Wilson Yau, Athens, Georgia
Xixing Zhao, Natick, Massachusetts
Veterinary clinical pathology
Katherine Ann Baker, Louisville, Kentucky
*Catherine Benson, Libertyville, Illinois Nora Berghoff, East Lansing, Michigan
Laura Black, Seattle
Melissa Blauvelt, Sunbury, Ohio
Fiona Brooks, Bath, England
Sabrina Clark, Bryan, Texas
Emma Dickey, Exeter, England
Allison Dusick, Madison, Wisconsin
Marigold Ellen Ernst, Blacksburg, Virginia
Alison Jane Farr, Halifax, England
Eric Fish, Auburn, Alabama
Daniel Heinrich, Buffalo Grove, Illinois
Emma Holmes, Hatfield, England
Lisa Kelly, Athens, Georgia
Kristina Meichner, Athens, Georgia
Brian Meyer, Sun Prairie, Wisconsin
Steve Mills, Edmonton, Alberta
Holly Minard, Columbus, Ohio
Kazuhisa Miyakawa, Chelmsford, Massachusetts
Cheryl Moller, Cary, North Carolina
Lilani Munasinghe, Saskatoon, Saskatchewan
Lauren Radakovich, Fort Collins, Colorado
Adi Wasserkrug Naor, Manhattan, Kansas
April White, Hoover, Alabama
*Stephen Yeomans, St. Ives, Australia
*Drs. Benson and Yeomans were previously certified in veterinary anatomic pathology.
From Feb. 15, 2017, JAVMA News.
Elanco buys Boehringer animal health portfolio for $885M
Elanco U.S. Inc., a subsidiary of Eli Lilly and Company, announced this past October an agreement to acquire Boehringer Ingelheim Vetmedica Inc.'s U.S. feline, canine, and rabies vaccines businesses as well as a fully integrated manufacturing and research and development site for $885 million. The deal will diversify Elanco's companion animal portfolio.
Joining Elanco's U.S. portfolio, which currently includes parasiticides and medications to control pain and treat dermatologic disorders, will be routinely administered vaccines against Bordetella bronchiseptica infection, Lyme disease, rabies, and parvovirus infection, among others. Also included in the agreement are several pipeline assets.
“We understand the unique bond that owners share with pets and are committed to helping those pets live longer, healthier lives,” said Jeff Simmons, Elanco Animal Health president. “With a growing portfolio addressing both prevention and treatment of disease, Elanco can partner with veterinarians and pet caregivers to do just that.”
The acquisition is anticipated to close early this year, subject to approval by the Federal Trade Commission, compliance with antitrust laws, and closing of Boehringer Ingelheim's asset swap with Sanofi.
The sale of BIVI's U.S. pet vaccines business and its Fort Dodge, Iowa, manufacturing site is a required step toward the acquisition of Merial by Boehringer Ingelheim. France-based Sanofi SA and Germany-based Boehringer Ingelheim GmbH announced this past June that they had signed contracts to exchange Sanofi's animal health business—Merial—for Boehringer Ingelheim's consumer health care business.
Condensed from Feb. 1, 2017, JAVMA News
Tuskegee back to accredited status
The AVMA Council on Education has granted the Tuskegee University College of Veterinary Medicine accredited status. The council took this action during its Sept. 25–27, 2016, meeting; Tuskegee made the announcement Dec. 14.
Tuskegee was put on probationary accreditation status after a fall 2013 comprehensive site visit. Probationary accreditation is given to a college that has one or more major deficiencies that have more than minimal impact on student learning or safety. These deficiencies must be corrected within two years, and the colleges must submit reports to the council every six months. Tuskegee was cited for having major deficiencies in five areas and minor deficiencies in two areas.
The COE conducted a focused site visit in January 2016 at Tuskegee and during its March meeting granted a one-year extension for the veterinary college to meet the requirements. At that time, Tuskegee had only one remaining major deficiency, which has since been resolved, as indicated by the change in accreditation status.
“I am proud of our faculty, staff, and especially our students. The attainment of full accreditation status for the College of Veterinary Medicine would not have been possible without their dedication and commitment,” said Dr. Ruby Perry, dean of Tuskegee's veterinary college.
“This has truly been a team effort from within our college to our administration within the university and our dedicated friends and alumni as well.”
Notice of accreditation actions taken by the COE during its fall 2016 meeting is available at http://jav.ma/COEfall2016.
Condensed from Feb. 1, 2017, JAVMA News
