. — Pharmacy regulators in Washington state discussing the problem of retail pharmacists changing veterinary prescriptions without consulting the prescribing doctors expressed a strong desire to focus on and stop the illegal practice.
Members and officers of the state Board of Pharmacy, in an exchange with the Washington State Veterinary Medical Association (WSVMA) on Thursday, acknowledged that pharmacists rarely receive formal education in veterinary pharmacology and physiology, and confirmed that a pharmacist with doubts about a prescription must talk with the veterinarian involved.
At the same time, they said, veterinarians need to step up by filing formal complaints when irregularities occur.
“Discipline has to be complaint-driven,” said board member Dan Rubin. “If there are issues about (veterinarians’) willingness to file a complaint, you’ll have to address those with your profession.”
Veterinarians around the country have been sharing with their professional organizations numerous instances of pharmacists changing dosages and even substituting medications without authorization, ostensibly out of ignorance. As reported
by the VIN News Service in June, the problem isn’t new but appears to be happening more often as pet owners increasingly fill veterinary prescriptions at big-box and other chain pharmacies rather than at veterinary clinics.
The American Veterinary Medical Association (AVMA) last summer sent letters to all state boards of pharmacy to call attention to the problem. A variety of state and regional veterinary medical associations — some prompted by the AVMA letter, others by conversations with their members — have followed up with their respective pharmacy boards and/or pharmacy associations.
In Washington, WSVMA Executive Vice President Candace Joy and veterinarian Dr. Mike Bellinghausen brought the issue to the pharmacy board at a public business meeting this week.
“We realize that most pharmacists are ... following the law whenever they’re dispensing pet medications ... and consulting with veterinarians when they have questions, but there is a small number of pharmacists who aren’t doing this,” Joy said. “Our main concern is patient safety.”
In a recent survey of WSVMA members, 38 percent of 332 respondents said they had experienced pharmacies changing dosages or medications without authorization. Ten percent said they’d had a patient experience an adverse health effect as a result.
How many of those were reported to the state as a formal complaint is unknown. Pharmacy board officials said the agency doesn’t have a “veterinary” category for complaints. However, program manager Doreen Beebe told the VIN News Service that she’s aware of one complaint involving a veterinary prescription that was submitted to the board last fall. She said the complaint has yet to be reviewed by a pharmacy board panel to determine whether it merits a department investigation.
Board member Gary Harris, a pharmacist, said he dispenses medication for dogs and cats. He recalled his own puzzlement the first time he received a prescription for thyroid medication for a dog. “I thought to myself, ‘Whoa, that’s a pretty stiff dose!’ ”
Because of differences in canine and human physiology, dogs may require higher dosages of certain medications than humans on a pound-for-pound basis. Harris said that because he was unfamiliar with the use of the drug levothyroxin in a dog, he called the prescribing veterinarian.
“The vet and I had a 10-second conversation, and now I know what the dose is,” Harris said.
“In my opinion,” he went on, “if it’s a prescription drug and the pharmacist is changing the medication without the authority of the prescriber or changing the dose or refilling the prescription where there are no refills on the prescription, that is practice beyond scope, or unprofessional conduct, and that’s a violation. That should come to our attention.”
Another pharmacist on the board, Elizabeth Jensen, said she does not fill prescriptions for animal patients, but “I feel for pharmacists who do. We get zero training on how to fill prescriptions for animals,” she said. “You’re kind of delving into specialty pharmacy. There is probably a professional obligation to get some sort of training on that.”
She encouraged veterinarians to actively support pharmacists who take the time to be trained for veterinary dispensing. “If a pharmacist does go the extra mile to get educated ... send business their way,” she said.
Jensen also noted that calling physicians is “often a headache” for pharmacists because “it’s often two days later that you hear from them.”
She suggested that the board raise the subject in its regular newsletter to pharmacists, and point out that veterinarians tend to respond to calls more quickly and want
to be called.
Pharmacy board Executive Director Chris Humberson pledged to pursue the issue. “I grew up in Wyoming, interned with someone who was heavily into veterinary medicine, working with cattle ranches and horses,” Humberson said. “I’m very interested in this. ... I think it’s an area that really needs focus.”
From the audience, Jenny Arnold, director of pharmacy practice development at the Washington State Pharmacy Association, and Lisa Hodgson, executive manager of the state Veterinary Board of Governors, offered to partner in an educational campaign.
Veterinary advocates in other states say they, too, have found their boards of pharmacy to be receptive to concerns and interested in solving the problem.
In Kansas, for example, Gary Reser, executive director of the Kansas Veterinary Medical Association, said his organization addressed its state pharmacy board in September. The prevailing response was: “Oh no, that’s not right. It shouldn’t be happening. You’ve got to let us know," Reser said.
The association has since begun urging members to notify the pharmacy board if they have problems with prescriptions filled by outside pharmacies. “We’ll keep reminding them what you should do and how you should do it,” Reser said.
Medication errors, including dispensing errors, also may be reported
to the U.S. Food and Drug Administration (FDA) as adverse drug events. Although the FDA doesn't regulate the pharmacy profession, agency spokeswoman Laura Bradbard said that such reports may spur changes that help minimize confusion. “They can lead to label/package design improvements, and may point to considerations about the product name and other potential sources of error,” she said.