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JAPhA Pharmacy Today: What do pharmacists know about potential pet poisons
SEPT 6, 2018 | BY NATALIE STILWELL, American Veterinarian

Pharmacists appear unfamiliar with many common pet toxins, according to a recent study in Pharmacy Practice. Researchers administered an online survey to all licensed pharmacists in North Carolina during October and November 2015. Pharmacists were given a list of 25 substances, including 15 true toxins and 10 nontoxins, and they were asked to evaluate the potential toxicity of each for either a cat or dog. Respondents correctly identified 15 of 25 items as toxic or nontoxic, and one-half of pharmaceutical substances were classified appropriately. Most respondents did not recognize the following substances as toxic: macadamia nuts, tea tree oil, loratadine, allium, English ivy, xylitol, grapes, sago palm, or caffeine. In addition, most respondents incorrectly considered African violets to be potentially toxic. Pharmacists provided significantly different ratings for dogs and cats for six potential toxins, of which only acetaminophen has clinically different toxicity levels in the two species. The findings suggest that pharmacists should be given increased veterinary toxicology training and resources, the authors said, stressing that pharmacists should offer "basic triage information" and "refer pet owners to proper veterinary professionals" following suspected toxin exposure.


AVMA: Pharmacists Need Veterinary Schooling
The House of Delegates will consider a resolution calling for the education of pharmacists who dispense animal drugs.

The American Veterinary Medical Association thinks pharmacists should learn more about veterinary drugs as online and brick-and-mortar stores capture a greater share of the pet medications market.

The AVMA board of directors is recommending that the House of Delegates approve a resolution calling for veterinary pharmacology courses in pharmacy school and related continuing education classes for professional druggists.

The idea, one of four resolutions scheduled for discussion in July at the AVMA convention in Boston, aims to reduce pet medication errors and improve communication between pharmacists and veterinarians.

A 2012 survey conducted by the Oregon Veterinary Medical Association found many instances of pharmacists changing prescribed doses of pet medications or substituting a different product without the veterinarian’s authorization. In some cases, the actions led to an animal’s death, the survey found.

The issue has become more pronounced as pharmacies large and small, including mass market retailers Walmart and Target, move into veterinary prescriptions. The market research firm Packaged Facts in 2013 reported that veterinarians still sold a majority of dog and cat medications—an estimated 58 percent—but that sellers on the human side were doing a brisk and growing business.

Besides urging wider education of pharmacists, Resolution 8:

· Encourages pharmacists to consult with “prescribing veterinarians individually to discuss any information needed regarding a prescription to be filled.”
· States that “Licensed pharmacists should have a solid understanding of their roles and responsibilities for counseling and educating clients when filling a veterinary prescription.”
· Urges veterinarians to “avoid unclear abbreviations on prescriptions” and “consider including statements such as ‘no substitutions’ and ‘dispense as written’ on prescriptions to help avoid unintended medication substitutions or alterations of dosages.”.

The pharmacy industry recognizes the potential disconnect between druggists and veterinarians.

A one-sentence policy of the American Pharmacists Association states, “APhA encourages pharmacists and student pharmacists to become more knowledgeable about veterinary drugs and their usage.”

Learning about veterinary drugs is not required of pharmacy students, but a number of schools cover the subject in elective courses, said American Pharmacists Association spokeswoman Michelle Spinnler.

“The University of Florida program has a large post-graduate program and the University of Wisconsin’s pharmacy and veterinary schools have partnered to offer an online course for pharmacists,” Spinnler added.

The American Association of Colleges of Pharmacy has weighed in, too. The group’s Professional Affairs Committee in April issued a final draft report titled “Producing Practice-Ready Pharmacy Graduates in an Era of Value-Based Healthcare.”

“Veterinary pharmacy services are increasing in the United States across all practice settings, and the knowledge and skills necessary to treat our animal patients may be another opportunity for academic and clinical partnerships,” the report reads in part.

Other measures headed to the House of Delegates include:

· Resolution 7: The policy on the use of random-source dogs and cats for research, testing and education would be revised to emphasize the importance of ensuring the animals’ good welfare, said Kimberly May, DVM, MS, the AVMA’s assistant director of professional and public affairs. The AVMA board of directors recommended its approval.
· Resolution 9: The Principles of Veterinary Medical Ethics would be revised slightly “in response to concerns expressed by AVMA legal counsel and other considerations,” the board reported.
· Resolution 10: The New Hampshire Veterinary Medical Association is requesting “a system for voting transparency on all questions and elections addressed by the House of Delegates.”

“Voting transparency will allow all AVMA members to know how representatives voted on all issues and therefore be able to make informed decisions regarding their representation at the AVMA,” the resolution states.

“Transparency helps to remove suspicion and promotes trust on all levels.”

The House of Delegates uses electronic voting. The results are tabulated and reported but are not broken down by delegate.

FTC Open to Wider Veterinary Drug Market
Veterinarians face growing competition from retail outlets, and the trend is likely to continue for better or worse.

A dog owner walks out of a veterinary clinic with a prescription in hand, drives to her neighborhood pharmacy to get her sick terrier’s order filled and leaves with a few generic and brand-name animal drugs.

Such a scenario is uncommon today, but the Federal Trade Commission, in a report issued this week, found that the pet medications market could be more competitive—and better for consumers—if portable prescriptions were the norm, human pharmacies had greater access to veterinary drugs and more generics were available.

The FTC staff report, titled “Competition in the Pet Medications Market,” was the culmination of a three-year review that included industry and public input gathered at a 2012 workshop and from more than 700 written comments.

The FTC acknowledged that the U.S. pet pharmaceutical market—forecast to hit $10.2 billion in sales by 2018—is in flux and has changed dramatically from the days when veterinarians dispensed virtually all prescription drugs.

According to the latest estimates, practitioners sell 58 percent of prescription and over-the-counter medications, brick-and-mortar pharmacies and retailers rake in 28 percent, and the growing Internet and mail-order segment accounts for 13 percent.

The American Veterinary Medical Association conceded that there is no going back.

“The report says what many of us have known for a while: that the pet medications industry is evolving,” said AVMA spokeswoman Victoria Broehm. “As consumers are presented with more choices of where to fill their pets’ medications, we, as veterinarians, hope that the health and welfare of our animal patients is central to that decision.”

A large portion of the FTC report focused on prescription portability—the right of clients in many states to leave a veterinary office with a prescription and have it filled at the pharmacy of their choice. One piece of federal legislation, the Fairness to Pet Owners Act, would mandate that veterinarians nationwide issue a prescription regardless of whether a client requested one.

AVMA believes that such a requirement would be burdensome and unnecessary.

“The AVMA’s Principles of Veterinary Medical Ethics and its guide on ‘Client Requests for Prescriptions’ already encourage veterinarians to write prescriptions when asked by a client,” Broehm said, “and due to the impressive advocacy work by many state veterinary medical associations, 35 states now have similar laws or policies.”

Encouragement and state guidelines may not go far enough, the FTC said.

“Some veterinarians refuse to provide prescriptions to clients when requested,” the report stated. “Furthermore, some veterinarians may try to actively discourage clients from filling prescriptions elsewhere by providing misleading information about non-veterinary retailers, requiring waivers of liability that exaggerate the dangers of purchasing from non-veterinary retailers or requiring extra fees for portable prescriptions.”

The report did not describe all veterinarians that way, noting that over one 12-month period the American Veterinary Distributors Association counted “4 million prescriptions to pet owners to be filled outside of the veterinarian’s office.”

Mandatory prescription writing may be better, the FTC stated, because of what the agency called client reluctance to ask for a prescription “for fear of offending their veterinarian.”

Some veterinarians told the FTC they questioned the ability of human pharmacies to accurately fill veterinary prescriptions and consult with pet owners.

“Many of these concerns relate to pharmacists’ training and knowledge,” the agency stated.

“Some pharmacists themselves acknowledge discomfort in dispensing pet medications when they do not have a strong working knowledge of veterinary pharmacology.”

The FTC added that “pharmacists may be more inclined to secure additional training” as they see greater demand for veterinary drugs.

Besides prescription portability, the staff report looked at how pet medications are distributed, how exclusive agreements keep some drugs out of the retail market and how current practices may limit the development of generic pharmaceuticals.

“Nearly all major manufacturers of pet medications appear to maintain formal policies that restrict sales … to veterinarians and veterinary distributors,” the report stated. “Some stakeholders report that despite these stated policies, large retail pharmacies and stores have been able to purchase pet medications directly from the manufacturers, although no manufacturers have confirmed that they engage in this practice.”

Many pharmacies still have a difficult time obtaining pet medications “directly from manufacturers or their authorized distributors,” the report found. Drugs they do stock often come by way of secondary suppliers who buy excess inventory from veterinarians themselves.

“It remains unclear how many veterinarians are involved in the diversion of pet medications, but it is thought to be substantial,” the report pointed out.

Leakage in the market may benefit pet owners, the FTC noted.

“The existence of this secondary distribution system likely results in lower prices than would otherwise prevail if exclusive distribution were being strictly enforced,” the report stated.

The agency discredited assertions that medications in nontraditional channels could be counterfeit or unsafe, saying no such evidence was presented.

The FTC report found a scarcity of generic animal drugs compared to the wide selection that permeates human medicine.

One of several reasons cited is that health insurance companies on the human side often require the dispensing of less expensive generic drugs when available. A relatively small number of pets, on the other hand, are insured in the United States.

The report noted that veterinarians sometimes prescribe generics out of concern for the ability of pet owners to “afford high-priced branded drugs.” However, some veterinarians may be reluctant to push generics because of a fear of hurting profits or opening the door to retail competitors.

“If a significant number of veterinarians view generics as less profitable, manufacturers may perceive lower potential demand, which could discourage further development of generic products,” the FTC staff noted.

© Copyright 2012 Vet Pharm Consulting, Inc.