Maine veterinarians say new pain meds law puts animals, humans at risk

https://bangordailynews.com/2017/03/29/news/state/maine-veterinarians-say-new-pain-meds-law-puts-animals-humans-at-risk/

LEWISTON, Maine — When one of Gary Stuer’s four-legged patients gets injured, has surgery or is living with cancer, the Bethel veterinarian prescribes pain medicine.

Sometimes that pain medicine is an opioid.

“For years, we’ve had non-steroidal drugs, and we call that pain medication, but it’s like you or I taking ibuprofen,” he said. “For pure pain control, we have to rely on opioid-like drugs.”

But while Stuer likes such drugs for controlling animals’ pain, he doesn’t like what he has to do now to prescribe them.

Namely, check a human’s private prescription records.

“It really, really makes me uncomfortable to have to look at their history of opiates and then make a decision about their animals based on that,” Stuer, who owns the Bethel Animal Hospital, said.

He’s not alone. Veterinarians across the state are frustrated by their role in a new state law that was designed to curb drug abuse by setting limits on opioid prescriptions and requiring doctors to check the state’s controlled substances prescription monitoring database before writing prescriptions.

Vets say the law’s goal is laudable, but in their line of work, the new requirements don’t help and are a hassle at best and potentially dangerous at worst.

“If somehow someone got into it (they could note), ‘Gee, this person has OxyContin. Their house would be a good house to go rob,’” veterinarian Erich Baumann, co-owner of the Animal Emergency Clinic of Mid-Maine in Lewiston, said.

The law, Chapter 488, passed last year as emergency legislation, went into effect Jan. 1. It strictly limits opioid prescriptions for chronic and acute pain, except for people with cancer, in hospice, receiving palliative care or using the medication for addiction treatment. It also requires doctors, including vets, to check the state’s prescription monitoring database before prescribing and to refuse to write a prescription if the patient is over the new state-imposed limit.

Violators can be fined $250 per incident, up to $5,000 per year.

“We’re certainly aware of and sympathetic to the underlying push for this law. The opiate crisis and overdosing is a tragedy,” veterinarian Gail Mason, who co-owns the Bath-Brunswick Veterinary Associates and Portland Veterinary Specialists, said. “We’re responsible people and willing to do our part.”

Not all of Maine’s hundreds of veterinarians prescribe controlled substances, but many do — particularly when treating dogs or cats. They use a range of drugs, including tramadol and buprenorphine for pain, benzodiazepines for anxiety and hydrocodone for persistent coughing.

But Mason and other vets say they haven’t seen a problem with people taking their animals’ medications — possibly because most pet prescriptions are written for a fraction of the amount that would cause significant effects in humans. They say the solution hurts more than it helps.

“In general, definitely, veterinarians seem quite unhappy about it, mostly ethically concerned about checking a human’s information at all,” veterinarian Amanda Bisol, legislative chairwoman for the Maine Veterinary Medical Association and owner of Animal Medical Clinic in Skowhegan, said. “Part of it is because we don’t know anything about human medicine, and it’s actually quite different. The dosages and things for most pharmaceuticals are very different for humans and animals. We’re looking information up (in the database), and we don’t know how to interpret what we’re finding.”

Veterinarians’ other complaints about the law include the following:

— They don’t know whose prescription records they should be searching for within a family, when a pet-sitter brings in or picks up the animal or when the pet is cared for by a rescue organization with multiple volunteers.

— They don’t like the potential liability that comes with being able to access the database.

— They don’t like saying no to treating an animal’s pain.

— The database doesn’t allow vets to enter their prescriptions, so someone could get multiple medications from multiple vets without it being noted anywhere.

“It doesn’t serve any purpose except for me to humiliate a client, violate their privacy and then look at them and try to decide, ‘Hmm, are you a user?’” Mason said. “It’s beyond the purview of our practice as veterinarians, and it’s unreasonable for the law to ask us to do this.”

Some vets want to be excluded from the law completely. Mason wants Maine to do what she’s heard other states have done: have vets log prescriptions into a database and let software flag it if there’s a problem.

“I can’t live with (the current law),” Mason said. “I don’t want to access people’s medical records. I’m not their physician.”

The Maine Department of Health and Human Services is crafting new rules around the law. The department is expected to have those rules done by March 31.

A department spokeswoman declined to comment because the department is in the rulemaking process.

Vets hope the department’s rule changes will address their concerns. If they don’t, the veterinary association plans to push for changes within current law or try to get a new law passed.

In the meantime, some vets have started asking clients for permission to check their medication history when they write an opioid prescription. In Bethel, Stuer and his two associates have done so about 30 times in the past month. At the emergency clinic in Lewiston, Baumann does so several times per shift.

So far, no client has balked at either clinic.

“I still feel like it’s an invasion,” Stuer said.

Mason, however, hasn’t sought her clients’ prescription information and she doesn’t plan to. She believes she’s not alone.

“There are those of us who are not going to comply,” she said. “We’re just not.”

 

Filed under: General Problems