When pill popping for pets gets out of control
Every animal hospital in the world is a target for this kind of problem. Owners cite behavior issues, severe pain or seizure activity that’s only in evidence in the home environment. They often exit the hospital with a paper script or a bottle of pills for their pets' troubles.
All hospitals keep track of these drugs. Smart hospitals may even let the pharmacist do it for them (at our hospital we refuse to stock phenobarbital, sedatives or opiates in their pill form). Even then, however, it’s entirely possible that the pets will never see the pills. After all, we know humans have a way of taking their troubles to task with drugs veterinarians have prescribed for their pets. (Indeed, one of my client's children once attempted suicide with the dog's seizure medication.)
That’s why we keep careful notes on these cases. We count out the refills and the reception desk red flags owners who ask for more refills than are due them. We perform careful physicals and log serial bloodwork results with the due diligence of a tax attorney. And we trust. We have to. We can only hope the pills are going down the right hatch for the right problem.
Lately, we’ve had a couple of clients whose pill vials were lost or who took it upon themselves to increase their pets doses, necessitating additional refills. On a cases by case basis, we make a determination as to whether we will allow these clients to continue to receive refills on behalf of their pets.
There’s nothing worse than denying a pet a needed medication, but these are red flags for owner abuse of medication. They cannot be ignored or swept under the rug. They require uncomfortable confrontations with owners involving careful questioning with potentially disastrous results when they quickly realize our concern is not merely for their pets.
Some owners get angry and belligerent. And we lose them. No one likes a thinly veiled discussion over potential drug abuse––even when it’s clear we have their best interest at heart. And personally, I can’t abide this kind of stress.
That’s why lately, I’ve taken to referring these clients to specialists, citing a need to have their pet evaluated by a higher authority before more medication can be prescribed. “I’m just uncomfortable with dosing him at a higher level,” I say. Or, “I believe we’ve hit that point we discussed earlier where it’s clear he needs better care than I can provide.”
This way 1) the problem is in the hands of someone with a more objective point of view than mine, 2) I can offer the owner the benefit of the doubt on the drug thing, 3) the pet gets even better care than I can provide by virtue of the specialist’s higher education in the matter at hand and 4) zero confrontation.
That is, until this week’s owner of a storm phobic dog. We’d recommended behavior modification along with a variety of non-sedating alternatives. After a month, the owner claimed nothing worked. A behaviorist was recommended and sedatives were prescribed to add into the regimen only during storms.
But after a month-long supply of sedatives for storm phobia dematerialized in two weeks––and we’d had no storms––I had to wonder. So “no more drugs, I said. not until we can establish a better understanding for what’s happening through the veterinary behaviorist. After all, it’s cruel to keep her sedated her whole life.”
Sounds reasonable, right?
Not for this owner. She didn’t want to take no for an answer, insisting that the dog did not have a behavior problem and did not need to see a specialist. “Well, then, even more to the point,” I said. “I cannot legitimately prescribe a sedative––or any other drug––if either of us is uncomfortable with the goals of this treatment.” Here’s where she took another tack and suggested that the “legal limits” for sedative dosing, as I had explained we’d reached, could be mitigated by writing the script in the name of her other dog.
Then she got angry. Very angry. I don’t think she’ll be back. But she’ll probably get what she wants somewhere else. They always do when they’re so determined. Further, I feel terrible that the dog might be suffering without the [possibly] perfectly appropriate sedatives. In the absence of behavior modification (which I’m not at all sure the owner undertook), most of these cases will continue to suffer.
Yet even if the drugs are truly going to the dog––especially so, perhaps––how can anyone expect a veterinarian to shrug off a patient’s well-being (and risk her license along the way) on an owner’s adamant position with respect to a controlled drug?
Sometimes you just cant win.