college connection
LEARNING IN PRACTICE
A Mutual Acknowledgement and Undertaking is an agreement that a licensed member can enter into voluntarily with the College, in certain cases, to resolve a concern. Undertakings are a helpful tool with an emphasis on the member’ s remediation. Undertakings may include practice restrictions and / or certain tasks to be completed by the licensed member to address the concerns that have been identified by the College. A licensed member is required to complete all areas of the undertaking. The essay below was prepared by a licensed member as part of an undertaking- the essay is presented to enable all licensed members to benefit from the learning opportunity.
MEMBER SHARES LEARNINGS ON MANAGING CONTROLLED DRUGS
A common thread throughout the Veterinarians Act is record keeping, inclusive of drugs. In fact, it is quite specific.
Drug purchases by a member must be recorded with information that notes the date, the amount acquired, the strength, and the price of the purchase. The name of the person making the purchase must be recorded and if the drug is either a controlled substance or a narcotic, a signature is required. Pharmaceuticals dispensed by a member must have similar information recorded and that information must be recorded on the label of the container. Patient files should contain the information if the drug is used in the clinic. If the records are accurate, it is then a simple balancing of the pharmaceuticals ordered, less those that have been dispensed that should then equal the amount in inventory.
Drugs that are narcotics and a controlled drug require even more information: the date used or dispensed, the amount, the strength, patient identification, owner identification, and the signature of the member responsible. These drugs must be protected from loss or theft with the use of a locked cabinet or safe that is under the control of the member.
The drug register for narcotics and controlled substances is expected to be balanced weekly. This requires that products ordered be added to inventory when received and then those products dispensed be subtracted from inventory thus equaling the actual current inventory. The responsibility of balancing the register should where possible, be assigned to rotating auxiliaries. Where this is not possible, due to staff numbers, at least two signatures should be obtained.
What is critical to note is that any discrepancy, aside from a dispensing error which is rectified, must be reported to the police and to Health Canada. A break in or robbery would classify as an external breach. If no
external involvement is evident then the two most likely reasons for internal discrepancies are dispensing errors and employee theft. Precise record keeping should allow for immediate revelation of a dispensing error. The theft by someone in the practice and the assumed use, misuse and abuse of a controlled substance or narcotic is certainly concerning for the practice owner but is again a matter that must be dealt with by the police.
In discussions with police, it is apparent there has been a change in the market of desirable pharmaceuticals inventoried by practitioners. In the late 1970’ s and‘ 80s anabolic steroids had a black market for body builders and athletes as a“ performance enhancing drug”. Equine practices and to a lesser degree small animal practices became a target for people illegally dealing in these drugs.
Today with drug labs synthesizing anabolic steroids and illegal importation there are many easy and simple sources. Police are forced to triage illegal pharmaceuticals and do so based on their potential to be fatal and their potential addictiveness. This has made anabolic steroids less important relative to other drugs.
Today the two drugs with the greatest street misuse that are used by veterinarians are Fentanyl and Ketamine Hydrochloride.
Ketamine has had a legitimate use as an anaesthetic for humans in parts of the world that have limited availability of resuscitation equipment. Throughout the Vietnam War large quantities of Ketamine were used by the United States Army for field surgeries. In Canada Ketamine has been a Schedule I narcotic since 2005 and is used for human and animal anaesthesia. On the street it is known as Special K, Vitamin K, Jet and Super Acid, and is used in powder and liquid form. It is classified as a dissociative anaesthetic which by definition is“ a drug that distorts perception of sight and sound and produces
feelings of detachment from the environment and self”.
Fentanyl, known as the“ King of Opiates” is estimated to be 50-100 times stronger than Morphine. Its legitimate use is in controlling postsurgical and cancer pain in both humans and animals. On the street it is known as Apache, China Girl, or China White and is consumed to produce euphoria, drowsiness, lethargy and mellowness. Small amounts are often mixed with heroin and cocaine to amplify their potency. The most recent statistics indicate that in Ontario between 2011 and 2013 a fentanyl implicated death occurred every three days.
Drugs stolen by employees for their own use or profit present a very serious issue. In human hospitals this is quite common and is known as“ drug diversion”. We, as veterinarians, cannot be naive enough to assume it couldn’ t happen in our practice.
The second obligation for reporting missing Schedule G or N drugs is to Health Canada. This must be done within 10 days of the discovery. Health Canada reviews submitted loss and theft reports and uses the information to inform their risk-based inspection plan and also to determine if any compliance and enforcement action is required by the department, such as inspection of the veterinarian’ s business to confirm inventory levels and appropriate record keeping. In cases where illegal activity is suspected, the matter is referred to law enforcement.
Although Ketamine and Fentanyl are presently the so called favoured drugs, many other drugs used routinely by veterinarians are attractive for those individuals suffering from addiction problems. Managing controlled drugs in a veterinary facility is a critical activity.
Fall 2016 / 7