Have you been “doctor shopped”?
While there’s been a definite increase in cases of doctor shopping in recent years, reports of pet owners actually injuring their pets in the process are exaggerated.
In fact, only one case of an owner deliberately harming her pet to score drugs has been reported nationally in the past five years, and that’s the story that keeps getting cited in every article about the lengths addicts will go to score drugs from veterinarians.
And we’ll cite it now:
Back in 2014, Heather Pereira, a Kentucky woman, then 23, was convicted of a felony for attempting to obtain a controlled substance by fraud/false statement, and a misdemeanor charge of misdemeanor torture of a dog or cat, according to the Kentucky Department of Corrections.
Pereira admitted to intentionally cutting her dog multiple times with razor blades so her veterinarian would prescribe tramadol for the animal, a drug commonly used for pain management.
Her case is horrifying, but hardly common.
“Nationwide, we do have an opioid crisis,” acknowledges Kevin Fitzgerald, DVM. But as far as reports of people deliberately hurting their pets to get hold of opioids? “That’s rare,” Fitzgerald says, ascribing it to media hype. As a rule, he adds, “People aren’t going to hurt their pets.”
Fitzgerald, one of the featured veterinarians on Animal Planet’s hit reality show, Emergency Vets, from 1997 to 2002, is on staff at VCA Alameda East Veterinary Hospital in Denver, Colorado. He also served on the board of directors of the Rocky Mountain Poison and Drug Center, so he’s familiar with addicts and the lengths they’ll go to in order to obtain drugs.
On average, 115 Americans die every day from an opioid overdose
Fitzgerald says that any time you have drugs on hand, there’s the potential for abuse. And animal hospitals have drugs on hand. Obviously, not all of them will be targets for abuse. For example, Fitzgerald says, “We have antibiotics and antiparasitics. But people aren’t going to take their dog’s worm medicine.”
Typically, when addicts go to a veterinarian, they want tramadol. Which is not technically an opioid, but has opioidlike effects.
What can hospitals do to minimize the possibility of drugs like tramadol getting into the wrong hands?
Firstly, says Fitzgerald, “It needs to be locked up and regularly monitored for its use and distribution. Who’s getting it and how much, who diagnosed it. Have it in a central place in the hospital under lock and key, [keep] logs and really document what you have.”
Secondly, Fitzgerald says hospitals need to train staff to recognize signs that someone is doctor shopping. Fortunately, shoppers can be easy to spot.
“I call them red-flag people,” Fitzgerald says. “They come in, we don't have a doctor/patient relationship with them, we’ve never seen their dog before. They say, ‘Hey, I’m from out of town and we spilled the dog’s tramadol and I need some tramadol.’ They come in and they know the name of the drug they want.” That’s a huge red flag, he says.
Even more worrisome, Fitzgerald says, “They know the dosage they want. ‘Hey, we need 50 mg of tramadol.’ Or they ask for an inordinate amount. [For example], ‘Can I get 300 tramadol? I just don’t like coming back and forth.’”
But while potential abusers can be easy to spot if you know the signs, Fitzgerald says sheer numbers can work against you. “Just in the city of Denver, we have 750 veterinarians at different hospitals, so it’s very difficult for us to see if someone is going across town. It would still be possible for a person to go to three different veterinarians in one day and get three different prescriptions.”
So, what can veterinarians do about that?
“We can limit the amount that we prescribe and ask for rechecks to see if it’s working,” Fitzgerald says. “So, you don’t give anybody 300 tramadol. You give them seven to ten days’ worth and see how [the patient is] doing. If they’re unwilling to do that, that’s another red flag for me.”
He cites prescription drug monitoring programs (PDMPs) as another safeguard when confronted with a pet owner who sets those red flags waving. Currently, 49 states have active PDMPs in place. “We can go to them and they can see if the person has had any previous convictions or has been in a drug treatment program,” Fitzgerald says. “We can see that, ‘oh, that guy has been arrested two times.’”
As far as doctor shopping goes, Fitzgerald believes that veterinarians need to look at their own possible part in exacerbating the problem by making drugs like tramadol too easily available.
The crisis has been a long time coming.
“I think it started in the nineties with both physicians and veterinarians,” Fitzgerald says. “Certainly, we want to do pain management. But were we overdoing it? Or maybe not overdoing it, but were the drugs too easy to get, and prescribed too cavalierly?”
There are no easy answers.
But as Fitzgerald says, “Being aware of [the crisis] is half the battle.”
Photo credit: © iStock/teddyandmia