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