ArticlePDF Available

Prescription Drug Monitoring Programs Applying A One Size Fits All Approach to Human and Veterinary Medical Professionals Custom Tailoring is Needed

Authors:

Abstract and Figures

In an effort to curb the United States prescription drug epidemic, most states have enacted Prescription Drug Monitoring Programs (PDMP)s to collect data on controlled substances dispensed by medical professionals, some of which include veterinarians. This fifty state survey of PDMPs, concludes that annually there are less than ten veterinary shoppers nationwide that PDMPs could identify and that veterinarians are a de minimus source of controlled substances. This article seeks to assess the need for exempting veterinarians from PDMPs and obtain a snapshot of the current PDMP programs nationwide.
No caption available
… 
No caption available
… 
Content may be subject to copyright.
PRESCRIPTION DRUG MONITORING PROGRAMS 1
PRESCRIPTION DRUG MONITORING PROGRAMS: APPLYING A ONE SIZE
FITS ALL APPROACH TO HUMAN AND VETERINARY MEDICAL
PROFESSIONALS, CUSTOM TAILORING IS NEEDED
Robert John Simpson, D.V.M.*
Abstract:
In an effort to curb the United States prescription drug epidemic, most states have enacted
Prescription Drug Monitoring Programs (PDMP)s to collect data on controlled substances
dispensed by medical professionals, some of which include veterinarians. This fifty state survey
of PDMPs, concludes that annually there are less than ten veterinary shoppers nationwide that
PDMPs could identify and that veterinarians are a de minimus source of controlled substances.
This article seeks to assess the need for exempting veterinarians from PDMPs and obtain a
snapshot of the current PDMP programs nationwide.
I. Introduction:
The United States is admittedly in the midst of a prescription drug abuse epidemic.
1
Since 1990, the number of drug overdoses tripled.
2
From 1997 to 2007, the number of opioid
(prescription painkiller) overdoses quadrupled.
3
The amount of painkillers prescribed and
dispensed in the United States is enormous.
4
In 2010, “[e]nough painkillers were prescribed . . .
to medicate every American adult around-the-clock for one month.”
5
Furthermore, it has been
*© Robert John Simpson, D.V.M., J.D. (expected Dec. 2014 Lincoln Memorial University Duncan School of Law)
Kingston Animal Hospital, P.C., 410 E Race St, Kingston, TN 37763, drrob@4vetcare.com. Dr. Simpson is
currently the President Elect of the American Veterinary Medical Law Association.
1
Leonard Paulozzi et al., CDC Grand Rounds: Prescription Drug Overdoses- a U.S. Epidemic, MORBIDITY &
MORTALITY WEEKLY REP., JAN. 13, 2012.
2
Centers for Disease Control and Prevention, Policy Impact: Prescription Painkiller Overdoses, at 3 (Nov. 2011),
http://www.cdc.gov/HomeandRecreationalSafety/pdf/PolicyImpact-PrescriptionPainkillerOD.pdf [hereinafter Policy
Impact: Prescription Painkiller Overdoses].
3
Jeanmarie Perrone & Lewis Nelson, Medication Reconciliation for Controlled Substances- An “Ideal”
Prescription-Drug Monitoring Program, 366 NEW ENG. J. MED. 2341, 2341 (June 21, 2012) [hereinafter An “Ideal”
Prescription-Drug Monitoring Program].
4
Policy Impact: Prescription Painkiller Overdoses, supra note 2, at 12.
5
Id.
PRESCRIPTION DRUG MONITORING PROGRAMS 2
estimated that 1.8% or 170,000 Medicare part D recipients (including prescription beneficiaries
from both Medicare and Medicaid programs) were prescribed one or more “highly abused
prescriptions”
6
from more than five providers
7
in 2008.
8
Taxpayers paid an estimated $111
million for those presumably abused prescriptions.
9
It has also been estimated that there are over
seven million non-medical prescription users.
10
Thus, prescribers of prescription medications
play a larger role than drug cartels in the new drug epidemic.
11
One of the first federal steps in supporting the implementation of state-run Prescription
Drug Monitoring Programs (PDMP)s emerged in 1993.
12
This federal legislation, aimed at
providing additional safeguards against drug diversion, arose as an effort to combat the emerging
prescription drug problem.
13
PDMPs are state operated databases which “collect, store, and
6
This Government Accountability Office (GAO) study used data from previous drug diversion research to classify
14 groups of drugs as highly abused; those groups are: Amphetamine derivatives; Benzodiazepines; Carisoprodol;
Codeine with Acetaminophen; Fentanyl; Hydrocodone combinations; Hydromorphone; Meperidine; Methadone;
Methylphenidate; Morphine; Non-Benzodiazepine sleep aids; Oxycodone; and Tramadol. U.S. GOV'T
ACCOUNTABILITY OFFICE, GAO-12-104T, MEDICARE PART D: INSTANCES OF QUESTIONABLE ACCESS TO
PRESCRIPTION DRUGS 2-3 (2011).
7
Based upon multiple studies, if more than 5-8 providers are utilized on an annualized basis to obtain controlled
substances, a person is likely to be a doctor or pharmacy shopper. See Barth Wilsey et al., An Analysis of the
Number of Multiple Prescribers for Opioids Utilizing Data from the Cal. Prescription Monitoring Program, 20
PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, 1262 (2011) (comparing their results with those of: Stephen Parente
et al., Identifying Controlled Substance Patterns of Utilization Requiring Evaluation Using Admin. Claims Data, 10
AM. JOURNAL OF MANAGED CARE 783 (2004); and Rolf Winther & Jørgen Bramness, Prescription Shopping of
Addictive Drugs in Norway, 129 TIDSSKR NOR LAEGEFOREN 517 (2009)).
8
U.S. GOV'T ACCOUNTABILITY OFFICE, GAO-12-104T, MEDICARE PART D: INSTANCES OF QUESTIONABLE ACCESS
TO PRESCRIPTION DRUGS 2 (2011).
9
Id at 2-3 (With the patient obtaining prescriptions from five or more providers, for the purpose of this study, it was
presumed that they were obtained for “illegitimate use.” The total cost of these prescriptions was $148 million for
those 170,000 individuals, and 25% of the Medicare Part D is financed through premiums.).
10
Kristin Finklea, Erin Bagalman, & Lisa Sacco, Nonmedical use of prescription drugs occurs when the drugs are
used without a prescription or solely for the feeling they cause, CONG. RESEARCH SERV., R42593, PRESCRIPTION
DRUG MONITORING PROGRAMS (2013) (citing U.S. Dep’t of Health and Human Serv., Substance Abuse and Mental
Health Serv. Admin., Results from the 2010 Nat’l Survey on Drug Use and Health: Summary of Nat’l Findings,
(September 2011), http://www.oas.samhsa.gov/NSDUH/2k10NSDUH/2k10Results.htm#Ch2).
11
An “Ideal” Prescription-Drug Monitoring Program, supra note 3, at 2341.
12
See id. (referencing Domestic Chemical Diversion Control Act of 1993, Pub. L. No. 103-200, 107 Stat. 2333).
13
See An “Ideal” Prescription-Drug Monitoring Program, supra note 3, at 2341.
PRESCRIPTION DRUG MONITORING PROGRAMS 3
distribute” data regarding prescribing and distributing controlled substances.
14
They are
designed to identify and curtail a patient’s use of multiple providers, also termed “doctor
shopping,” to obtain prescriptions for non-medical uses.
15
The hope is that identification of
doctor shoppers will “identify patients at risk for an adverse drug outcome.”
16
Under most state-
run PDMPs, the authorized users are the prescriber, the pharmacist or dispenser, the state
regulatory board, and, under limited circumstances, law enforcement.
17
Since most veterinarians
prescribe and dispense prescriptions, “vet shopping” or “veterinary shopping” is the veterinary
equivalent of “doctor shopping” and/or “pharmacy shopping.”
18
Both federal and state regulatory support is evidenced by funding from federal grants
and state funding. With large startup costs, which can far exceed $1.5 million,
19
and equally
large annual maintenance cost of hundreds of thousands to millions of dollars,
20
the cost of
PDMPs has been a large burden for setup and maintenance in cash-strapped states.
21
The brunt
of the cost of these programs are borne by the taxpayers, insurance companies and
pharmaceutical industries, and the individual patients, prescribers, and dispensers.
22
14
Hallam Gugelmann, Jeanmarie Perrone, & Lewis Nelson, Windmills and Pill Mills: Can PDMPs Tilt the
Prescription Drug Epidemic?, 8 JOURNAL OF MED. TOXICOLOGY 378, 378 (2012) [hereinafter Windmills and Pill
Mills].
15
See id.; Gretchen Peirce et al., Doctor and Pharmacy Shopping for controlled Substances, 50 MED. CARE 494, 494
(2012); Amy Cadwell, In the War on Prescription Drug Abuse, Epharmacies are Making Doctor Shopping
Irrelevant, 7 HOUS. J. HEALTH L. & POLY 85, 89 (2006).
16
Peirce, supra note 15, at 494.
17
Windmills and Pill Mills, supra note 14, at 378.
18
See Peirce, supra note 15, at 494.
19
U.S. GOV'T ACCOUNTABILITY OFFICE, GAO-02-634, PRESCRIPTION DRUGS: STATE MONITORING PROGRAMS
PROVIDE USEFUL TOOL TO REDUCE DIVERSION 3 (2002).
20
See New York’s Prescription Drug Monitoring Program, Nat’l Alliance for Model State Drug Laws (Sept. 18,
2006) http://www.namsdl.org/resources/New%20York1.pdf (stating that New York’s Operating cost is $17 million).
21
See infra § II.
22
See An “Ideal” Prescription-Drug Monitoring Program, supra note 3, at 2342; Finklea, supra note 10, at 8;
Bureau of Justice Assistance, The Bureau of Justice Assistance Prescription Drug Monitoring Program at a Glance,
(Nov. 7, 2007), http://www.bja.gov/Funding/PDMPchart.pdf.; See also Wis. Veterinary Med. Ass’n, Mandatory
Drug Reporting Exemption Saves Wis. Veterinary Small Businesses Over $7 Million: Governor Walker Signs
Veterinary Exemption From PDMP, WVMA VOICE (April 2013),
http://www.wvma.org/index.php?option=com_docman&task=doc_download&gid=160&Itemid=171 (stating that
Wisconsin’s PDMP “would have cost veterinary clinics in Wisconsin over $7 million annually”).; See, e.g., LUCIAN
PRESCRIPTION DRUG MONITORING PROGRAMS 4
Non-electronic and alternative submissions to a PDMP have the largest cost per
submission. Unlike many retail pharmacy software programs which upload PDMP submissions
automatically,
23
veterinary practice management software systems are incompatible with many
state PDMPs’ electronic reporting protocols. Therefore, veterinarians tend to make up the
largest percentage of alternative reporting.
24
Alternative reporting varies from state to state; it
runs the gamut from fax and mailed paper systems to manual data entry in the electronic
database. The cost for programs that allow paper or fax submissions is much higher than that for
a pharmacy able to submit electronically. For example, the additional expense affiliated with
manual data entry was one of several considerations that led to the exclusion of veterinarians
from Kentucky’s PDMP.
25
This article explores the need for veterinary reporting to PDMPs;
whether or not other states should follow Kentucky’s lead and exempt veterinarians from
PDMPs.
II. Veterinarians are not required to report to most state-run PDMP’s.
To evaluate veterinary PDMP impact, a questionnaire was sent to PDMP program
administrators or their representative for each state's PDMP, and they were requested to
participate in the study.
26
For the states that failed to respond to the initial inquiry, an inquiry
was sent to the responsible regulatory body for each state. For those states that failed to respond
to the second inquiry, the state’s Veterinary Medical Association and veterinary board were
GEISE, FISCAL NOTE H.B. 572 S.B. 1070, 108th Gen. Assemb. (Tenn. 2013),
http://www.capitol.tn.gov/Bills/108/Fiscal/HB0572.pdf (There will be no significant state borne fiscal impact of
removing veterinarians from Tennessee’s PDMP because the cost of veterinarians reporting is borne by Tennessee’s
Board of Veterinary Medical Examiners, and any cost savings “will be spread out to licensees of the Board through
decreased licensure fees.”).
23
E.g., Am. Soc’y for Automation in Pharmacy (ASAP) is an organization that writes and disseminates a “Standard
for Prescription Monitoring Programs.” AM. SOCY FOR AUTOMATION IN PHARMACY, http://asapnet.org/index.html
(last visited Jan. 17, 2013).
24
E.g., Controlled Substance Monitoring Database Advisory Comm., Meeting Minutes,
https://health.state.tn.us/boards/Controlledsubstance/index.shtml (last visited Mar. 6, 2013).
25
Discussed further infra § II (discussing the reasoning of Kentucky eliminating the reporting requirement for
veterinarians).
26
See questionnaires sent infra Appendix 1 and Appendix 2.
PRESCRIPTION DRUG MONITORING PROGRAMS 5
contacted requesting their point of contact for the PDMP. As all states had responded to the
inquiry at this point, no further steps were needed to obtain additional information.
Once the data were compiled, states were divided into several categories:
27
(1) States with operational PDMPs currently requiring veterinarians to report: Alabama,
Alaska, Arkansas, Arizona, California, Hawaii, Illinois, Indiana, Michigan, Mississippi, New
Mexico, New York, North Dakota, Oklahoma, Rhode Island, South Carolina, Tennessee,
Washington, and West Virginia;
(2) The following states have operational PDMPs and have not recently required
veterinarians
28
to report: Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Iowa,
Kansas, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, Nevada,
New Jersey, North Carolina, Ohio, Oregon, Pennsylvania, South Dakota, Texas, Utah, Vermont,
Virginia, Wisconsin, and Wyoming;
(3) States with operational PDMPs that once required veterinarians to report, but recently
changed the reporting requirement to exempt veterinarians: Kentucky;
(4) States with no operational PDMP, but with a PDMP that is legislatively enacted but
not yet operational: New Hampshire; and
(5) States with no operational PDMP and no enabling legislation: Missouri.
27
Each state will be discussed individually in Appendix 3. The enabling legislation of the state’s PDMP is the
initial citation for each state.
28
Most states that exclude veterinarians as a dispenser from reporting to their PDMP require retail pharmacies to
report veterinary prescriptions.
PRESCRIPTION DRUG MONITORING PROGRAMS 6
29
A detailed listing of states can be found in Appendix 3. The following section discusses
several notable states:
Mississippi:
30
Unlike other PDMPs, Mississippi recently audited veterinary prescriptions.
31
During this audit, the Mississippi PDMP manager randomly checked the PDMP database for
reported veterinary prescriptions and found no evidence of any “vet shopping” behavior.
32
29
Maps created using DIYMAPS.net map drawing utility.
30
MISS. CODE. ANN. § 73-21-127 (West, Westlaw Next through End of 2012 Reg. Sess.).
31
E-mail from Deborah Brown, PMP Manager, Miss. Bd. of Pharmacy, to author (Dec. 26, 2012, 14:54 EST) (on
file with author) (Mississippi audited veterinary prescriptions in 2011 and found no instances of vet shopping.).
32
Id.
PRESCRIPTION DRUG MONITORING PROGRAMS 7
Furthermore, since implementation in 2005, there have been no requests for veterinary or
veterinary patient data from the Mississippi PDMP.
33
Oklahoma:
34
Those who dispense controlled substances must report to Oklahoma’s PDMP in
real time, within five minutes of dispensing the prescription.
35
Oklahoma’s expedient PDMP
reporting requirement has altered the prescribing habits of veterinarians; many veterinarians have
shifted from directly dispensing a controlled substance to having the owner fill the prescription
at a retail pharmacy.
36
Unlike many other states, Oklahoma has had a known problem with vet shopping.
37
It
has been estimated that there are two to three cases in the entire state per year.
38
The Program
Manager cited one example of vet shopping, but the case described veterinary prescription
diversion, not vet shopping.
39
Therefore, Oklahoma has likely overestimated the prevalence of
vet shopping in that state.
Additionally, Oklahoma differs from many other states in their organizational structure
and control of their PDMP. Oklahoma Bureau of Narcotics and Dangerous Drug Control is a
33
Id.
34
OKLA. STAT. tit. 63 § 2-309C (West, Westlaw Next through Chapter 370 (End) of the Second Reg. Sess. of the
53rd Leg. (2012)), amended by 2012 Okla. Sess. Law Serv. Ch. 206 (H.B. 2941) (West).
35
Interview with Don Vogt, PMP Program Manager, Okla. Bureau of Narcotics and Dangerous Drug Control (Jan.
29, 2013).
36
Id.
37
Id.
38
Id. (This can be explained by Oklahoma’s method of data collection. Oklahoma collects both the patient and the
owner information. This method of data collection in Oklahoma has allowed the state to link prescriptions that
would not have otherwise been linked to the same person. However, it is likely that not all of the cases reported are
cases of vet shopping.).
39
Id. (Mr. Vogt used the following case as an example of the problem of vet shopping and the usefulness of
veterinary reporting to their PDMP: an elderly dog owner was repeatedly prematurely refilling her dog’s
Phentermine. As this had continued, the veterinarian became suspicious and reported the case to the Oklahoma
Bureau of Narcotics and Dangerous Drug Control. Investigation led to the discovery that the roommate was taking
the dog’s medication. This is a classic example of veterinary prescription diversion, but it is not an example of a
case of vet shopping behavior that could be identified by a PDMP. Oklahoma’s PDMP did not initially flag this
individual, an astute veterinarian suspected illicit usage and reported the case to the Oklahoma Bureau of Narcotics
and Dangerous Drug Control. Thus, with the former example used not being a case that could have been identified,
it calls into question if the noted 2-3 cases per year are truly cases of vet shopping behavior that can be identified by
a PDMP and not simply cases of veterinary prescription diversion that does not involve multiple providers.).
PRESCRIPTION DRUG MONITORING PROGRAMS 8
law enforcement agency (as opposed to a regulatory board,) and one of the few resources capable
of quantifying the efficacy of PDMPs.
40
Since the state switched to an electronic monitoring
program in 2006, there has been a 78 percent decrease in doctor/ pharmacy shopping.
41
In 2006,
tens of thousands of people visited five prescribers/ pharmacies; thousands of people visited ten
prescribers/ pharmacies; and hundreds of people visited fifteen prescribers/ fifteen pharmacies.
42
In 2012, hundreds of people visited five prescribers/ pharmacies; twenty people visited ten
prescribers/ pharmacies; and no one obtained prescriptions from fifteen or more prescribers/
pharmacies.
43
Tennessee:
44
There have been no known cases of vet shopping in Tennessee.
45
Tennessee has
found that veterinarians are a de minimis source of controlled substances.
46
The Controlled
Substance Monitoring Program’s annual legislative report, which itemizes the most commonly
prescribed controlled substances by prescriber’s medical field, has consistently excluded
veterinarians as dispensers and prescribers.
47
Although Tennessee’s PDMP does not exempt
veterinarians, it does exempt veterinary prescriptions intended to treat an animal for less than
40
Please note: the figures are quoted from a personal conversation with the PDMP director, and therefore, must be
considered anecdotal. The author has not been able to find a publication to substantiate these claims.
41
Id.
42
Id.
43
Id.
44
TENN. CODE ANN. §§ 53-10-301 to -311 (West, Westlaw Next through end of 2012 Second Reg. Sess.).
45
E-mail from Andrew Holt, Dir., Tenn. Bd. of Pharmacy, to author (Jan. 9, 2013, 12:07 EST) (on file with author)
and Interview with Barry Carrier, Tenn. Bureau of Investigation Drug Taskforce (Dec. 21, 2012).
46
See Tenn. Dep’t of Health Controlled Substance Database Advisory Comm. Bd. of Pharmacy, Amended Rep. to
the Gen. Assemb.: Controlled Substance Database, 107th Gen. Assemb. (Tenn. 2012) available at
http://health.state.tn.us/boards/Controlledsubstance/PDFs/CSMD_2011_Amend_Report.PDF, and Tenn. Dep’t of
Health Controlled Substance Database Advisory Comm. Bd. of Pharmacy, Amended Rep. to the Gen. Assemb.:
Controlled Substance Database, 107th Gen. Assemb. (Tenn. 2011) available at
http://health.state.tn.us/boards/Controlledsubstance/PDFs/CSMD_2010_Report.PDF.
47
See Tenn. Dep’t of Health Controlled Substance Database Advisory Comm. Bd. of Pharmacy, Amended Rep. to
the Gen. Assemb.: Controlled Substance Database, 107th Gen. Assemb. (Tenn. 2012) available at
http://health.state.tn.us/boards/Controlledsubstance/PDFs/CSMD_2011_Amend_Report.PDF, and Tenn. Dep’t of
Health Controlled Substance Database Advisory Comm. Bd. of Pharmacy, Amended Rep. to the Gen. Assemb.:
Controlled Substance Database, 107th Gen. Assemb. (Tenn. 2011) available at
http://health.state.tn.us/boards/Controlledsubstance/PDFs/CSMD_2010_Report.PDF.
PRESCRIPTION DRUG MONITORING PROGRAMS 9
forty-eight hours,
48
and also exempts veterinarians from the human medical provider requirement
to check the PDMP database prior to prescribing a controlled substance.
49
In early 2013, bills were introduced to exclude veterinarians from the reporting
requirement, but those bills failed to pass in the 2013 legislative session.
50
Washington:
51
Currently, Washington state has no method to distinguish between veterinary and
human prescription requests.
52
In 2012, there was an initiative to alter the reporting requirements
of veterinarians.
53
Although the original bill attempted to completely exempt veterinary
reporting,
54
a compromise resulted in a less frequent veterinarian-specific reporting system.
55
Currently, the new veterinary reporting system has not been implemented.
56
Required reporting
to the existing program ended June 7, 2012, but the Washington Department of Health
recommends that veterinarians continue to report to the existing program until the new program
is operational.
57
The first report required from the new program was due October 1, 2013 for
the period of July 1 to September 30, 2013.
58
Kansas:
59
Although Kansas veterinarians are not required to report to the PDMP,
60
the Kansas
legislature mandated a taskforce to study the need for including veterinarians in the PDMP.
61
48
TENN. CODE ANN. § 53-10-305 (a) (West, Westlaw Next through end of 2012 Second Reg. Sess.).
49
TENN. CODE ANN. § 53-10-310 (West, Westlaw Next through end of 2012 Second Reg. Sess.).
50
S.B. 1070, 108th Gen. Assemb. (Tenn. 2013); H.B. 572, 108th Gen. Assemb. (Tenn. 2013).
51
WASH. REV. CODE ANN. §§ 70.225.010 (West, Westlaw Next Current with all 2012 Legis. and Chapters 1, 2, and
3 from the 2013 Reg. Sess.).
52
E-mail from Chris Baumgartner, PMP Dir., Wash. Dep’t of Health, to author (Jan. 9, 2013, 16:27 EST) (on file
with author).
53
2012 Wash. Sess. Laws 1389-90.
54
S.B. 6105, 62nd Leg., 2012 Reg. Sess. (Wash. 2012).
55
Wash. State Veterinary Med. Ass’n, Prescription Monitoring Program (DOH), (June 2012),
http://www.wsvma.org/displaycommon.cfm?an=1&subarticlenbr=560 (last visited Feb. 25, 2013).
56
Id.
57
Id.
58
Wash. State Veterinary Med. Ass’n, Prescription Monitoring Program Update: New rules are expected to take
effect July 1, 2013, (May 10, 2013), http://www.wsvma.org/displaycommon.cfm?an=8 (last visited May 27, 2013).
59
KAN. STAT. ANN. § 65-1685 (West, Westlaw Next through 2012 Reg. Sess.).
60
E-mail from Aimee Grubb, Admin. Specialist, Kan. Prescription Monitoring Program, to author (Dec. 31, 2012,
12:30 EST) (on file with author).
61
KAN. STAT. ANN. §§ 65-1682 to -1695 (West, Westlaw Next through 2012 Reg. Sess.).
PRESCRIPTION DRUG MONITORING PROGRAMS 10
The five-year task force was concluded at the end of 2012 and reported back to the legislature in
the January legislative session.
62
The report concluded that veterinarians should not be required
to report to the PDMP.
63
Furthermore, none of the 365 PDMP data requests from law
enforcement and other regulators involved veterinarians or their animal patients.
64
Massachusetts:
65
Massachusetts has a unique regulation which requires veterinarians to have
prescriptions filled at a retail pharmacy unless it is for a medication required for immediate
treatment, usually less than seventy-two hours.
66
All other prescriptions are sent to a pharmacy
and dispensed there.
67
Furthermore, there have been no known requests for veterinary patient
data submitted to the PDMP by the dispensing pharmacy.
68
Minnesota:
69
The manager of Minnesota’s PDMP, a subdivision of the Minnesota Board of
Pharmacy, recently sent a report to the legislature recommending that veterinarians continue to
be exempted from the reporting requirement.
70
The task force created a report from 1,896 email
surveys sent to licensed veterinarians, with a response rate of 207.
71
The survey showed that
only eleven veterinarians, 5 percent of the respondents, had experienced overt vet shopping.
72
The individuals with experience of overt vet shopping indicated that they have only seen one or
62
KAN. STAT. ANN. § 65-1694 (West, Westlaw Next through 2012 Reg. Sess.).
63
See State Legis. Update April 2013, Dep’t of State Legis. and Regulatory Affairs Am. Veterinary Med. Ass’n
(April 16, 2013), https://www.avma.org/Advocacy/StateAndLocal/Pages/State-Leg-Update-April-2013.aspx.
64
Grubb, supra note 60.
65
MASS. GEN. LAWS ANN. ch. 94C, § 24A (West, Westlaw Next through Chapter 416, except for Chapters 371, 379,
398, 402 and 403 of the 2012 2nd Ann. Sess.).
66
E-mail from Adele Audet, Assistant Dir., Drug Control Program, Mass. Dep’t of Health, to author (Jan. 14, 2013,
16:54 EST) (on file with author).
67
Id.
68
Id.
69
MINN. STAT. ANN. § 152.126 (West, Westlaw Next through the end of the 2012 First Spec. Sess.).
70
E-mail from Barbara A. Carter, Program Manager, Minn. Prescription Monitoring Program, to author (Dec. 26,
2012, 17:23 EST) (on file with author) (referencing Report to the Leg.: Diversion of Controlled Substances
Dispensed by Veterinary Practice, infra note 71).
71
Barbara A. Carter, Report to the Leg: Diversion of Controlled Substances Dispensed by Veterinary Practice,
Minn. Bd. of Pharmacy at 3, 11 (Dec. 1, 2011 approved Jan. 11, 2012),
http://archive.leg.state.mn.us/docs/2012/mandated/120074.pdf.
72
Id. at 5.
PRESCRIPTION DRUG MONITORING PROGRAMS 11
two cases in their careers.
73
Additionally, the report indicated the most commonly prescribed
controlled substance for companion animals was buprenorphine, used for immediate post-
operative pain control, in minimal quantities, and there have been no known cases “where a pet
was used as a means of securing controlled substances that had been dispensed by a
veterinarian.”
74
Of the top three dispensed controlled substances, none were in the top ten
dispensed controlled drugs to the Minnesota PDMP.
75
Additionally, the study by the Minnesota task force surveyed all fifty states’ PDMPs and
determined that twenty-three of the thirty-nine responding states do not require veterinarians to
report.
76
At the time of this multi-state survey, three states, South Carolina, Kentucky, and
Arizona, were re-evaluating the necessity of veterinary PDMP reporting.
77
Kentucky:
78
Until mid-2012, veterinarians were required to report to Kentucky’s PDMP.
79
The
exemption for veterinarians occurred with a change of the PDMP's definition of “Dispenser” to
“Not include an individual licensed to practice veterinary medicine under KRS Chapter 321.”
80
During the last several years [Kentucky] . . . did have a requirement for
veterinarians to report to our PDMP, but feedback from law enforcement was that
there was very little diversion being identified from veterinarian sources. The
effort and costs for the veterinarian practices to report to the PDMP and for us to
process the data was significant, although we did implement a web portal for
reporting at the end of 2011 that eliminated data entry of paper forms. However
the stakeholder consensus was that vet reporting was not necessary, and as a result
our legislature agreed to eliminate the requirement for veterinarians to report,
effective July 20, 2012.
81
73
Id.
74
Id. at 6, 8.
75
Id. at 9.
76
Id. at 7.
77
Id.
78
KY. REV. STAT. ANN. § 218A.390 (West, Westlaw Next through end of 2012 Legis.).
79
902 KY. ADMIN. REGS. 55:110 § 1(3)(b) (Westlaw Next Current with amendments included in the Admin. Reg. of
Ky., Volume 39, No. 11, dated May 1, 2013).
80
Id.
81
E-mail from David Hopkins, Ky. Cabinet for Health and Family Serv., Office of Inspector Gen., KASPER (Ky.
All Schedule Prescription Electronic Reporting) (Jan. 15, 2013, 16:41 EST) (on file with author).
PRESCRIPTION DRUG MONITORING PROGRAMS 12
California:
82
California's financial crisis has led to a suspension of its PDMP.
83
California
contracted its PDMP to a company, Atlantic Associates, Inc., and for the past two years the
California PDMP website has stated, “CA Direct Dispense Application is now available for
reporting. REGISTERED users will be receiving an email shortly with instructions. Your
contiuned [sic] patience is appreciated.”
84
Veterinary practitioners were instructed to keep a
paper copy of what they would have reported for submission once the program is again active.
85
In early 2013, the program resumed operation
86
and gave dispensers until “February 28, 2013 to
conform to the new electronic reporting format.”
87
Although veterinarians have not reported to the PDMP for the past two years and there
are no data from that period, the office of the Attorney General of California declined to respond
to the author’s information request.
88
Wisconsin:
89
Veterinarians were not exempted from reporting to Wisconsin's PDMP.
90
Prior to
the implementation of veterinary reporting, there was resounding support to exclude
82
CAL. HEALTH & SAFETY CODE ANN. § 11165 (West, Westlaw Next Current with all 2012 Reg. Sess. laws, Gov.
Reorg. Plan No. 2 of 2011-2012, and all propositions on 2012 ballots).
83
Sarah Varney, Calif.'s Prescription-Drug Monitoring System Feels Pain From Budget Cuts, NATIONAL PUBLIC
RADIO, (April 10, 2012, 3:43 AM EST), http://www.npr.org/blogs/health/2012/04/10/149943047/calif-s-
prescription-drug-monitoring-system-feels-pain-from-budget-cuts (“California Gov. Jerry Brown announced last
year that, for budget reasons, he was eliminating the Bureau of Narcotic Enforcement, which had long managed the
prescription-drug monitoring program….[T]he state laid off or transferred the nine people who operated the
prescription database. Now there's a lone civil servant - Mike Small, program manager for the Law Enforcement
Support Program - at the Department of Justice keeping it from going dark. Can one person really keep a massive
system - with 200 million entries-going?”).
84
Atlantic Associates, Inc, http://www.aainh.com/index.html, accessed Jan. 14, 2013. See e-mail from Bonnie Lutz,
Att’y, Klinedinst P.C. (Dec. 28, 2012) (on file with author) (stating that Atlantic Associates web page has stated the
same thing for the past two years).
85
Peter Mundschenk, Controlled Substance Utilization Review and Evaluation System (CURES) Reporting, CAL.
VETERINARIAN, March/April 2011, 12 available at http://www.cvma.net/images/cvmapdf/ControlledSubstance.pdf.
See e-mail from Mike Small, Adm’r II, Law Enforcement Support Program, Bureau of Criminal Identification and
Investigative Serv., Cal. Dep’t of Justice, to author (Dec. 27, 2012, 19:41 EST) (on file with author) (denying any
information requested).
86
Grant Miller, Controlled Substance Utilization and Evaluation System (CURES) Reporting Update, Cal.
Veterinary Med. Ass’n (Jan. 2013), http://www.cvma.net/doc.asp?id=21365.
87
Office of the Cal. Att’y Gen., Controlled Substance Utilization Review and Evaluation System (CURES), Cal.
Prescription Drug Monitoring Program (PDMP), STATE OF CAL. DEPT OF JUSTICE, http://oag.ca.gov/cures-
pdmp#ddra (last visited Apr. 9, 2013).
88
Letter from Mike Small, Dep’t of Justice Adm’r II for Kamala D. Harris Cal. Att’y Gen., to author (Dec. 27,
2012) (on file with author).
PRESCRIPTION DRUG MONITORING PROGRAMS 13
veterinarians.
91
This bill was introduced by fifteen senators, cosponsored by forty-nine
representatives, and signed into law by the Governor on March 13, 2013.
92
III. “Vet shopping” occurs, but it is extremely rare.
Based upon the responses from the various states, vet shopping behavior comprises an
extremely small percentage of overall doctor/pharmacy shopping. Where there was an estimated
170,000 Medicare Part D doctor shoppers identified in 2008,
93
less than ten people nationwide
would be identified by a PDMP for vet shopping per year.
When the known cases were adjusted based on state populations, there was an estimated
one case per 30 million people, or 6.5 cases per year, in the United States.
94
With such a low
prevalence of vet shopping, there have only been a few published cases of vet shopping in the
past fifteen years.
89
WIS. STAT. ANN. § 450.19 (West, Westlaw Next through 2011 Act 286, published April 26, 2012).
90
E-mail from Brad Dunlap, Spec. Agent-in-Charge, Wis. Dep’t of Justice, Div. of Criminal Investigation, to author
(Dec. 28, 2012, 9:38 AM EST) (on file with author) (Wisconsin's PDMP will become operational at the end of
January 2013).
91
S.B. 7, 2013-2014 Leg. (Wis. 2013).
92
Assemb. B. 3, 2013-2014 Leg. (Wis. 2013) (legislative history available at
http://docs.legis.wisconsin.gov/2013/proposals/ab3).
93
U.S. GOV'T ACCOUNTABILITY OFFICE, GAO-12-104T, MEDICARE PART D: INSTANCES OF QUESTIONABLE ACCESS
TO PRESCRIPTION DRUGS 2 (2011) (170,000 doctor shoppers were identified in a 2008 retrospective study of
medicare part D payouts.).
94
In Michigan, there have only been a “handful” of vet shopping cases in the past 10 years. E-mail from Michael
Wissel, Pharmacy Serv. Manager, Bureau of Health Professions, Health Investigation Div., to author (Dec. 26, 2012,
10:54 EST) (on file with author). This imprecise measure of cases was taken as if there had been five known cases
in the past ten years or one case every other year (0.5 cases per year). In Ohio, there have been two known cases in
the past ten years (0.2 cases per year). See Burke, infra note 94; Mehling, infra note 102. Oklahoma has
approximately two to three cases per year (2.5 cases per year). See Vogt, supra note 35. That equates to 3.2 cases
per year for a total population of 98,352,909 (the population of all states with no known cases (Hawaii, Illinois,
Indiana, Kansas, Kentucky, Massachusetts, Minnesota, Mississippi New Mexico, North Carolina, North Dakota and
Tennessee) and states with known cases (Michigan, Ohio, and Oklahoma) or 6.5 cases per year nationally.). See
U.S. Census Bureau, 2010 census, Population Map, http://www.census.gov/2010census/popmap/.
PRESCRIPTION DRUG MONITORING PROGRAMS 14
A. “Dolly” and her canine friends were used as a method for their owners to vet shop.
Veterinarians are not required to report to Ohio’s PDMP, yet three known vet shopping
cases have occurred in Ohio in the past decade. “Dolly” was a small dog with purported anxiety
problems, which were well-regulated with Diazepam.
95
Diazepam, also known as Valium® or
Diastat®, is a benzodiazepine, a Class IV controlled substance.
96
It can be used in dogs as a fast
acting anti-anxiety medication for situational anxiety (i.e., anxiety related to thunderstorms,
fireworks, loud noise phobias, etc.).
97
Dolly's owner made a monthly trip to all five of Dolly's
95
John Burke, Drug Diversion in Veterinary Medicine, PHARMACY TIMES, October 1, 2002, available at
http://www.pharmacytimes.com/publications/issue/2002/2002-10/2002-10-7007.
96
DONALD PLUMB, PLUMB'S VETERINARY DRUG HANDBOOK 304-07 (7th ed. 2011) (Valium® (Roche) and Diastat®
(Valeant)).
97
Id.
PRESCRIPTION DRUG MONITORING PROGRAMS 15
veterinarians and all individual veterinary offices were prescribing Dolly’s anti-anxiety
medication.
98
The same publication that described Dolly’s case described another desperate drug-
addicted owner who went to the extreme of training his dog to display clinical signs of an
ailment to obtain the desired medication.
99
This dog was trained to cough on command.
100
The
owner took his pet to several veterinarians to obtain cough syrup with hydrocodone.
101
This
exemplifies one rationale for a much lower incidence of veterinary prescription diversion and vet
shopping than what occurs in human medicine; the drug addicted animal owner needs to have a
pet, or access to a pet, demonstrating clinical signs to obtain a prescription for the desired
medication.
In a case similar to Dolly's, an Ohio dog owner obtained a different anti-anxiety
medication from three different veterinarians for thunderstorm phobia.
102
A veterinarian
reported the owner when he continued to consistently obtain medications throughout the year
when no thunderstorms were occurring in that part of Ohio.
103
The publication discussing Dolly
and her canine friend is one of only two published case studies involving vet shopping.
104
98
Burke, supra note 95.
99
Id.
100
Id.
101
Id.
102
Telephone Interview with Gregg Mehling, Vice President Nat’l Ass’n of Drug Diversion Investigators of Ohio
and Lorain Cnty. Drug Task Force (Dec. 31, 2012).
103
Id.
104
Id.
PRESCRIPTION DRUG MONITORING PROGRAMS 16
B. The little brown dog with an identity crisis.
The second published case of vet shopping occurred in Greensboro, North Carolina.
105
In
that case Molly Lackey Murrow became “addicted” to a medication prescribed by her physician
to treat her migraines, Butorphanol or Stadol®, which has the same active ingredient as a
commonly used canine medication, Torbutol®.
106
Torbutol® is used for analgesia, sedation, and
as an antitussive (cough suppressant) property.
107
During the course of one year and 180
veterinary visits to a total of twenty-four veterinarians, Ms. Murrow obtained “7,568 dog-sized
doses” of Torbutrol®.
108
This was an expensive proposition; her out-of-pocket veterinary
expenditures likely were in the range of $2,000 to $55,000.
109
Not only was this an expensive proposition, it was complicated.
110
Her scheme involved
seven aliases with numerous aliases for her dog, including “Tots,” “Pixie,” and “Tippy.”
111
Ms.
Murrow falsified records stating that the dog had been prescribed Torbutrol® prior to a fictitious
move from Louisiana.
112
Several vets became suspicious and attempted to verify the “records.”
113
Upon learning of the fraudulent nature of the “records,” the veterinarians contacted the Drug
105
Paula Christian, Woman Feeds Addiction with Dog’s Prescription; a Pet Owner Admits to Abusing Painkillers
Prescribed to Her Terrier by; Veterinarians in Three Counties, NEWS & REC. (Greensboro, N.C.), Jan. 9,1999, at
A1 [hereinafter Woman Feeds Addition with Dog’s Prescription].
106
Id.
107
Butorphanol, Stadol ® (Bristol-Myers Squibb) or Torbutrol ® (Fort Dodge) are partial opiate agonist and class
IV controlled substances with a low risk of physical dependence. DONALD PLUMB, PLUMB'S VETERINARY DRUG
HANDBOOK 131-35 (7th ed. 2011).
108
Christian, supra note 105.
109
The wide range of cost is due to a number of unknown factors: the dog was reported to be a Chihuahua-Terrier
mix (likely weighing between 2-10 kilograms(kg) or 4.4-22 pounds); the antitussive dose range for Torbutrol is
0.05- 1 milligram(mg) per kg (total dose of 0.1 10mg) up to every six hours; DONALD PLUMB, PLUMB'S
VETERINARY DRUG HANDBOOK 131-35 (7th ed. 2011); the cost of the Torbutrol® to the veterinarian (for the
purpose of this estimation current price of various milligram dosages of Torbutrol® from a popular veterinary
distributor); and the expenditure associated with diagnostics and a minimum of 24 physical examinations. See
KAREN E. FELSTED, THE VETERINARY FEE REFERENCE (2011) (containing the average prescription markup and
physical exam charges).
110
Christian, supra note 105.
111
Id.
112
Id.
113
Id.
PRESCRIPTION DRUG MONITORING PROGRAMS 17
Enforcement Agency, and the DEA set up surveillance at several local vet offices.
114
Ms.
Murrow was arrested and later pled guilty to “falsely obtaining Torbutrol[®].”
115
IV. Vet shopping is but a small percentage of veterinary prescription diversion, other
methods of veterinary diversion that would not be detected by a PDMP.
Of the few officers or agents in prescription drug task forces that have ever seen a case
involving an animal prescription or a veterinarian in their careers,
116
the vast majority were cases
of diverting pet medication from a single provider, where the owners obtain prescriptions
allegedly for their pets and take it themselves.
117
There are various methods of fraudulently
obtaining prescription veterinary medications: “the racehorse scam;”
118
“the guard dog scam;”
119
“the overweight house pet scam;”
120
among others.
Most of the diverted prescriptions are prescribed for the animal’s legitimate medical
problem. For example, one notable case involved a dog with cancer-associated pain.
121
Ultram®, also known as Tramadol, is a non-opioid pain medication, which was prescribed and
dispensed to this dog for cancer-associated pain.
122
The owners were emotionally distraught
from dealing with a painful dying pet, a marital separation, and finalizing their divorce.
123
They
had shared custody of their beloved pet, resulting in canine custodial exchanges from the wife to
114
Id.
115
Id.
116
This is derived from the responses of the survey and discussions with many agents and officers in the field of
prescription diversion.
117
Mehling, supra note 102.
118
This occurs when there is a horse owner who approaches a veterinarian for the purpose of obtaining large
quantities of a controlled substance, which would be an appropriate dose for a horse, to aid in “calming [the owner's]
. . . high spirited horse during transport. Preventing Prescription Fraud, MO. TASK FORCE ON MISUSE, ABUSE AND
DIVERSION OF PRESCRIPTION DRUGS 9 (5th ed.), available at
http://health.mo.gov/safety/bndd/doc/PreventingPrescriptionFraud.doc (accessed Dec. 28, 2012).
119
This occurs when an owner of a guard dog requests stimulants for their guard dog to “mak[e the]... guard dogs
more alert and aggressive.” Id. at 11. Aside from the drug diversion and potential dog bite liability, increasing
aggression should never be the goal of a veterinarian. The same premise has been used to “improve” a show dog's
performance. Id.
120
This occurs when an owner of an overweight house pet requests amphetamines or anabolic steroids to aid weight
loss. Id.
121
Mehling, supra note 102.
122
Id.
123
Id.
PRESCRIPTION DRUG MONITORING PROGRAMS 18
the husband.
124
After one such exchange, the husband opened the bottle of Tramadol to
medicate his canine companion, he thought the tablets looked very different than the previously
prescribed Tramadol.
125
He thought that they looked like 81mg Aspirin.
126
The husband took
the prescription to his veterinarian’s office and asked if there was a mix up with his dog’s
prescription.
127
The veterinarian confirmed the husband’s suspicion that the tablets in the
Tramadol bottle were, in fact, Aspirin.
128
The veterinarian explained that they do not keep
Aspirin in the pharmacy on-site, so the alleged prescription error or drug diversion did not occur
at the veterinarian’s office.
129
The husband was unconvinced that the veterinarian’s office did
not exchange the medication, so he notified the police of the prescription diversion.
130
After an initial investigation, the police found no evidence that there was diversion by the
veterinarian’s office.
131
The wife was questioned and ultimately confessed to switching and
abusing her dog’s Tramadol; she was charged with deception to obtain dangerous drugs and
cruelty to a companion animal (for denying the pain medications that were prescribed for her
painful dog).
132
This type of prescription diversion is virtually undetectable and typically would
not raise any red flags with even the most sophisticated PDMP.
Another form of veterinary prescription diversion that is undetectable with most PDMPs
occurs when a dispensing prescriber sells prescriptions for illicit purposes.
133
For example, a
124
Id.
125
Id.
126
Id.
127
Id.
128
Id.
129
Id.
130
Id.
131
Id.
132
Id.
133
Although this form of prescription diversion is not detectable under most PDMPs, the Drug Enforcement Agency
has methods of detecting abnormally large purchases of controlled substances. Interview Barry Carrier, Tenn.
Bureau of Investigation Drug Taskforce (Dec. 21, 2012).
PRESCRIPTION DRUG MONITORING PROGRAMS 19
veterinarian was diverting prescriptions and selling them for illegal use.
134
In addition to selling
prescription medications, including his drug of choice prescription narcotics, this veterinarian
was growing and distributing marijuana.
135
Additionally, this veterinarian was addicted to
prescription painkillers.
136
Most PDMPs are not designed to detect controlled substances
distributed to the dispenser; they are designed to detect controlled substances dispensed from a
dispenser directly to the end user/ patient.
137
Therefore, unless a PDMP has a method of
detecting the quantity of controlled substances distributed to the dispenser, a dispenser can avoid
suspicious data in the PDMP database by simply not reporting the dispensed prescription. Thus,
a state-run PDMP will not flag a dispenser diverting and selling controlled substances unless
there was prior knowledge of a problem. Some states, however, have enacted legislation to fill in
this gap.
138
V. PDMPs are designed for human patients and are only loosely applicable to
veterinarians.
Most state PDMPs are not able to easily differentiate human prescriptions from animal
prescriptions. Under the ASAP 0.5/1995,
139
a commonly used format for reporting, the data
reported includes
140
: the dispenser’s information (Drug Enforcement Agency [DEA] number and
134
Id.
135
Id.
136
Id.
137
See Appendix 4.
138
E.g., Addison Sharp Prescription Regulatory Act of 2013, S.B. 0676, 108th Gen. Assemb. (Tenn. 2013).
139
Am. Soc’y for Automation in Pharmacy (ASAP) is an organization that writes and disseminates a “Standard for
Prescription Monitoring Programs.” AM. SOCY FOR AUTOMATION IN PHARMACY, http://asapnet.org/index.html
(last visited Jan. 17, 2013).
140
Individual states have different required and optional fields. See Appendix 4 for a list of required fields for the
states that require veterinarians to report to their PDMP.
PRESCRIPTION DRUG MONITORING PROGRAMS 20
zip code); patient information (last name, first name, date of birth, sex,
141
address, and patient's
customer number
142
); prescriber information (DEA number); and prescription information (date
filled, metric quantity, National Drug Code (NDC) number,
143
number of days supplied, if the
medication was compounded or not, number of refills, date prescription written, prescription
origin code, diagnosis code).
144
The required fields vary from state to state.
A. Who is the patient?
According to most PDMPs, the information added to the database is for the “patient,” and
when the patient is an animal, the pet owner's name is not collected.
145
Unfortunately, it is not
always clearly communicated to the dispenser who the “patient” is for the purpose of reporting;
therefore, some respondents may identify the owner’s name as the “patient,” while others
identify the pet’s name as the patient.
For example, at the inception of Tennessee’s PDMP, in late 2006 and early 2007, there
was great confusion as to who is the “patient.” Initially, Tennessee veterinarians were told to use
the animal’s name. “For example, use 'Fido' Smith for the patient name.”
146
A newsletter from
the Tennessee Veterinary Medical Association (TVMA) to its members stated:
141
In Tennessee, until 2011, this is the only field that could delineate between human and animal prescriptions.
However, it was an optional field. The field values were: “1=Male; 2=Female; and 3= Animal.” Tenn. Controlled
Substance Database: Data Reporting Manual, Effective December 2006 (Optimum Tech. Dec. 2006) at 9.
Furthermore, when Tennessee updated to ASAP 2009 v 4.1 this animal delineation was not included. Tenn.
Controlled Substance Database: Data Reporting Manual, Effective December 12th 2011 (Optimum Tech. Dec. 2006)
available at http://health.state.tn.us/boards/Controlledsubstance/PDFs/TNDataCollectionManual_v1.2.pdf at 11
(where the fields were changed to “1=Male; 2=Female; and U= Unknown”).
142
This number can vary by state. For example, in Tennessee, “If a patient is an animal, then the board shall use the
owner’s social security, driver’s license number, telephone number, or number ‘000-00-0000’ (does not have data)
or number ‘999-99-9999’ (refusal to provide data) as the patient identifier in the database.” TENN. COMP. R. &
REGS. 1140-11-.03(6) (2013).
143
Nat’l Drug Code Directory, U.S. Food and Drug Admin. (Jan 17, 2013),
http://www.fda.gov/drugs/informationondrugs/ucm142438.htm (“Drug products are identified and reported using a
unique, three-segment number, called the National Drug Code (NDC), which serves as a universal product identifier
for human [and animal] drugs.”).
144
Tenn. Controlled Substance Database: Data Reporting Manual, Effective December 2006 (Optimum Tech. Dec.
2006) at 9.
145
Only a handful of states have the ability to report both the owner and the patient’s information. See Appendix 4.
146
Telephone Interview with Arlene Carmon, technical support with Optimum Tech. (Dec. 27, 2006).
PRESCRIPTION DRUG MONITORING PROGRAMS 21
Throughout the manual, it refers to data like the patient's name and the patient's
address. For veterinarians, the Board of Pharmacy would like to have the
CLIENT information. So you would not be reporting that “Rover” Jones received
60 tablets of 15mg Phenobarbital, but rather that Jane Jones received that
medication.
147
At an informational session in early 2013, a veterinarian inquired who is the “patient”
that is to be reported to the PDMP.
148
Veterinarians were informed that “the animal is
technically the patient and should be the name that is reported.”
149
Yet, the Tennessee rules and
regulations state, “‘Patient’ means a person, animal or owner of an animal who is receiving
medical treatment from a prescriber.”
150
Thus, the patient name reported to the PDMP could be
that of an agent who presents the animal, the animal itself, or the owner.
151
Therefore, if a
person takes a pet to multiple vets to obtain controlled substances, there would likely be multiple
entries that cannot be cross-referenced. Furthermore, unless the data clearly identifies that the
patient is an animal,
152
a prescription for the owner’s pet may be entered identically to a
prescription written by a physician for the owner.
153
Hence, much conflicting information is
disseminated to veterinarians regarding the manner in which the animal patient is entered into the
PDMP databases.
B. Animal prescriptions can easily be linked with the owner's prescriptions.
Animal prescriptions entered into the PDMP database utilizing the owner’s name, phone
number, or social security number as the patient identifiers will link the animal’s and the owner’s
147
Letter from Tenn. Veterinary Med. Ass’n (Jan. 2007) (copy available at
http://www.docstoc.com/docs/4205131/News-from-Tennessee-Veterinary-Medical-Association-Controlled-
Substance-Database) (referring to Tenn. Controlled Substance Database: Data Reporting Manual, Effective
December 2006 (Optimum Tech. Dec. 2006)).
148
Andrew Holt, Dir. of the Tenn. Bd. of Pharmacy, Webinar to the Tenn. Veterinary Med. Ass’n: Controlled
Substance Database Requirements for Veterinarians (Jan. 3, 2013).
149
Id.
150
TENN. COMP. R. & REGS. 1140-11-.01(1)(o) (2013).
151
Id.
152
There is an optional field in some states which allows for the differentiation of an animal from a human patient.
See supra note 141.
153
See supra note 142 (discussing the patient identifier).
PRESCRIPTION DRUG MONITORING PROGRAMS 22
prescriptions. An animal owner will potentially be unable to obtain an appropriate medication
for themselves due to a pet or multiple household pet’s prescriptions entered into the PDMP.
Thus, a problem arises, distinguishing legitimate prescriptions obtained for one’s pet and those
that may be fraudulently obtained.
The problem is further compounded by the increasing frequency of legislation that
requires prescribers to check the PDMP database prior to prescribing a new prescription. For
example, as of April 1, 2013, human prescribers in Tennessee are required to check the PDMP
database prior to writing a new prescription.
154
Thus, an animal’s legitimate prescription present
under the owner's name could lead the owner’s physician to believe that the owner is doctor
shopping when in reality the prescription in the PDMP database is for the owner’s pet, and the
owner would then have a problem obtaining a legitimate prescription from his or her
prescriber.
155
Alternatively, an owner could be subjected to an unnecessary and costly drug test
prior to obtaining a legitimate prescription.
156
This problem is one of the reasons Kentucky eliminated its requirement for veterinarians
to report to their PDMP:
The change was made because law enforcement in Kentucky indicated that
controlled substances dispensed by veterinarians were not a significant source of
abused or diverted drugs. While there was agreement that veterinarian dispensing
was the source in some situations, it was not common. The Cabinet for Health
and Family Services that houses our PMP supported the change because the cost
of compliance was greater than the advantages of having that data, and the pet
data sometimes showed up in the owner PMP reports.
157
154
TENN. CODE ANN. § 53-10-310 (e) (West 2012).
155
For example, when searching Tennessee's PDMP, the information that is used for the search is last name, first
name, and date of birth. TENN. DEP'T OF HEALTH, Controlled Substance Monitoring Database Program: Frequently
Asked Questions, http://health.state.tn.us/boards/Controlledsubstance/faq.shtml (last visited Jan. 16, 2013).
156
E.g., TENN. CODE ANN. § 53-11-308 (g) (as amended by 2013 Tenn. Pub. Acts 430) (Physicians of patients on
multiple different types of long term controlled substances “shall consider mandatory urine drug testing.”).
157
E-mail from David Hopkins, KASPER Program Manager, Ky. Cabinet for Health and Family Serv., to author
(Jan. 2, 2013 at 08:57 EST) (on file with author).
PRESCRIPTION DRUG MONITORING PROGRAMS 23
An alternative to Kentucky’s approach would be to separate prescriptions by the prescriber's
DEA number. Unfortunately, that would be an extremely labor intensive process to ensure that
the prescribers DEA numbers are linked to their profession. Some states have enacted other
methods of distinguishing human from non-human patients, which are described in Appendix 4.
C. What is in a name?
An animal’s name is fungible, unlike human names. Pets do not have driver’s licenses or
any other type of governmental identification. Even if an animal has a permanent identifier, such
as a microchip or an alphanumeric tattoo, it is not common practice for a veterinarian to ensure
the presenting client is the client on record with the microchip company at the time of
treatment.
158
These permanent forms of identification are typically only used in the event that
the pet becomes lost or a client presents a pet that they found.
159
Thus, the pet’s name recorded
by the owner is considered the pet’s name. An unscrupulous owner that is vet shopping could
have a different name for the same pet at many different veterinarians’ offices and a different
name for themselves, thus, escaping any flag affiliated with vet shopping.
D. Date of birth is also known as a guessed field.
The exact date of birth, which is a required field in most PDMPs, is not always known for
veterinary patients, which presents a distinct problem. Approximately 44% of dogs in the United
States are mixed breed.
160
; therefore, many canine patients do not come with breed registration or
known lineage.
161
The exact date of birth is unknown, and the date of birth used is typically a
158
Implantable RFID microchips give a numerical or alphanumerical string typically 9-15 digits in length. These
numbers are initially registered to the purchaser, typically the veterinarian, and then the owner may register the
identifier with the manufacture or a third party. See Microchipping of Animals, AM. VETERINARY MED. ASSN (Oct.
2, 2009) , https://www.avma.org/KB/Resources/Backgrounders/Documents/microchipping_bgnd.pdf.
159
See id.
160
AM. PET PRODUCTS ASSN, Dog Ownership, in 2009-2010 APPA NATL PET OWNERS SURVEY 53, 53-63 (2010).
161
Robert Simpson, Kathyrn Simpson & Ledy VanKavage, Exploring the Bond: Rethinking Dog Breed
Identification in Veterinary Practice, 241 J. AM. VETERINARY MED. ASSN 1163, 1163 (2012).
PRESCRIPTION DRUG MONITORING PROGRAMS 24
guess.
162
Veterinarians have been told to “put your best guess and make sure the dates match
your records.”
163
In the author's experience, it is extremely common for an owner to put the animal’s age in
years on the new client form in lieu of a definitive date of birth (even when the exact date of
birth is known). Most, if not all, veterinary practice management software systems allow the
user to either put in a date of birth or the age in years, month, or days. Thus, if the date is
January 1, 2013 and the owner tells the veterinary hospital that the animal is three years old,
without further inquiry, the default date of birth will be January 1, 2010. A vet shopper would
merely have to give an age of their pet in years to avoid being flagged in the database. For
example, if he owner goes to a different veterinarian the next day and tells that veterinarian's
office that the pet is three years old, then the date of birth would be January 2, 2010 and so on.
The owner could go to five different veterinarians on subsequent days and the reported date of
birth could be different at each of the offices, potentially leading to each of these entries not
being linked with one another. Several states have used various methods to solve this problem,
such as requiring a default date of birth for pets, putting the pet under the owner’s date of birth,
etc.
164
VI. Conclusion
Just a quarter century ago, it was believed that pain medication was unnecessary and even
harmful for animal patients, because postoperative pain could encourage animals to lie still.
165
Today, it is recognized that withholding pain medications in these circumstances is archaic, and
162
Id.
163
Telephone Interview with Ricco (surname unknown), technical support with Optimum Tech., in Columbus, Ohio
(Dec. 26, 2006).
164
See Appendix 4.
165
Karen Overall, Proceeding of the dogs trust meeting on advances in veterinary behavioural medicine London;
4th - 7th November 2004 Veterinary behavioural medicine: a roadmap for the 21st century, 169 VETERINARY J. 130
(2005); Bernard Rollins, Animal pain: what it is and why it matters, 15 J. ETHICS 425-37 (2011), available at:
http://philpapers.org/rec/ROLAPW (last accessed May, 29 2013).
PRESCRIPTION DRUG MONITORING PROGRAMS 25
veterinarians frequently prescribe pain relief for surgeries perceived even as routine (e.g. spay or
neuter).
166
As prescription pain management is now viewed as an integral part of veterinary
practice, its use is increasing. This increase of controlled substance prescriptions in veterinary
medicine would lead one to jump to the conclusion that veterinary prescription diversion would
rise to the epidemic problem equivalent to that seen in human patients, but that is not the case.
The available data show that vet shopping is essentially non-existent. PDMPs that
require veterinarians to report identify less than four vet shoppers per 100 million individuals
annually.
167
Hence, vet shopping in the United States is not statistically significant. When one
compares the total number of prescription diversions that occur with human patients to the
handful that occur with veterinary patients, one can see that the incidence of veterinary
prescription drug diversion is infinitesimal. Thus, inclusion of veterinary reporting to PDMP’s is
totally superfluous.
In addition to the lack of need for veterinarians to report to PDMPs, the inclusion of
veterinary data in PDMPs can lead to consternation and a decreased efficacy of the PDMP.
PDMP data for a veterinary patient may be input into the system identical to that of the owner,
which can be challenging for a medical provider to differentiate the veterinary data from that of
the owner and possibly lead to the deprivation of the appropriate therapy for a patient, be it
human or animal. Excising the extraneous veterinary data from PDMPs will allow for better
analysis of the PDMP prescription diversion data.
There is no compelling reason to continue to require veterinarians to report to PDMPs,
and states that currently require veterinarians to report to their PDMP should follow Kentucky’s
166
Overall, supra note 165.
167
See supra note 94.
PRESCRIPTION DRUG MONITORING PROGRAMS 26
lead and exempt veterinarians from their PDMP. Veterinarians should be exempted from all
state-run PDMPs.
PRESCRIPTION DRUG MONITORING PROGRAMS 27
Appendix 1 (text of email sent to states requiring veterinarians to report to the state's
PDMP)
I am in the process of researching the prevalence of vet hopping to illegally obtain controlled
substances and the efficacy of controlled drug monitoring programs in the various states which
require veterinarians to report dispensed controlled substances.
In most states there is a process by which law enforcement may request access to the controlled
substance database. The information that I am attempting to obtain is how many requests were
submitted overall and how many of those request pertained to veterinary patients.
If you cannot provide this information, it would be greatly appreciated if you can point me in the
direction of an individual who can assist in this matter.
Thank you for any assistance that you can give.
PRESCRIPTION DRUG MONITORING PROGRAMS 28
Appendix 2 (text of email sent to states that do not require veterinarians to report to the
state's PDMP):
I am in the process of researching the prevalence of vet hopping to illegally obtain controlled
substances and the efficacy of controlled drug monitoring programs in the various states which
require veterinarians to report dispensed controlled substances.
My research has shown that your state has a prescription monitoring program, but veterinarians
are not currently required to report. Can you please confirm that your state does not require
veterinarians to report.
However, if your state does require veterinarians to report, I am attempting to obtain the number
of law enforcement requests to access the controlled substance database and how many of those
request pertained to veterinary patients.
If you cannot provide this information, it would be greatly appreciated if you can point me in the
direction of an individual who can assist in this matter.
Thank you for any assistance that you can give,
PRESCRIPTION DRUG MONITORING PROGRAMS 29
Appendix 3: Individual discussion of each state:
(1) Several states with operational PDMPs which currently require veterinarians to report.
Alabama:
168
Like many states, Alabama is not able to distinguish law enforcement requests for
information pertaining to veterinary patients from those for human patients, but “[a]s of
12/31/2012, the Alabama PDMP has received a total of 4, 931 requests from Law Enforcement
personnel.”
169
Alaska:
170
Veterinarians have not been the subject of any PDMP data request made by a law
enforcement agency.
171
Arizona:
172
There have been no known cases where an investigation targeted either a veterinarian
or their patient.
173
Arkansas:
174
Arkansas's PDMP became operational March first, 2013.
175
California:
176
See discussion supra § II.
Hawaii:
177
Although there is a requirement for veterinarians to report to their PDMP, there has
been very poor compliance with the requirement in Hawaii.
178
The poor compliance is likely due
168
ALA. CODE §§ 20-2-210 to -220 (West, Westlaw Next through the end of the 2012 Reg. and First Spec. Sess.).
169
E-mail from Donna Jordan, Program Manager, Ala. Prescription Drug Monitoring Program, to author (Jan. 2,
2013, 18:31 EST) (on file with author).
170
ALASKA STAT. ANN. § 17.30.200 (West, Westlaw Next through Legis. passed during the 2012 2nd Reg. Sess. and
Third Spec. Sess. of the 27th Leg.).
171
E-mail from Brian Howes, Program Manager, Alaska Prescription Drug Monitoring Program, Alaska Bd. of
Pharmacy, to author (Dec. 20, 2012, 15:40 EST) (on file with author).
172
ARIZ. REV. STAT. ANN. §§ 36-2601 to -2611 (West, Westlaw Next through the Second Reg. Sess. of the Fiftieth
Leg. (2012), also includes election results from the November 6, 2012 Gen. election).
173
E-mail from Dean Wright, Prescription Monitoring Program Dir., Ariz. State Bd. of Pharmacy, to author (Dec.
20, 2012, 16:49 EST) (on file with author).
174
ARK. CODE ANN. §§ 20-7-601 to -614 (West, Westlaw Next through 2012 Fiscal Sess. and the Nov. 6, 2012,
election, including changes made by Ark. Code Rev. Comm. received through 11/1/2012).
175
E-mail from James Myatt, Ark. Dep’t of Health, Div. Pharmacy Serv. and Drug Control, to author (Dec. 20,
2012, 16:03 EST) (on file with author).
176
CAL. HEALTH & SAFETY CODE ANN. § 11165 (West, Westlaw Next Current with all 2012 Reg. Sess. laws, Gov.
Reorg. Plan No. 2 of 2011-2012, and all propositions on 2012 ballots).
177
HAW. REV. STAT. § 329-101 (West, Westlaw Next current with amendments through Act 329 of the 2012 Reg.
Sess.).
178
E-mail from Eric Ako, Exec. Vice President, Haw. Veterinary Med. Ass’n, to author (Jan. 11, 2013, 21:31 EST)
(on file with author).
PRESCRIPTION DRUG MONITORING PROGRAMS 30
to the difficulty of using the PDMP system.
179
It is unknown if there have been any cases of vet
shopping in the state.
180
Illinois:
181
It is unknown if there is a problem with vet shopping.
182
There have been attempts in
the past to have veterinarians excluded based upon the costs to the veterinarian, the cost to the
state, and the lack of an apparent problem.
183
Indiana:
184
Of the 9,856 law enforcement requests to Indiana’s PDMP in 2012, 178 related to
prescriber information and 9,678 related to individual patient information.
185
Unfortunately,
those requests cannot be separated by profession or species.
186
Furthermore, Indiana has found that the majority of the veterinary data collected has
significant flaws and lacks utility.
187
The data submissions are inconsistent; some, but not all,
submissions list the pet as the patient.
188
Many of the veterinary prescriptions reported do not
list the NDC number, so the database does not report what was prescribed.
189
Michigan:
190
Over the past ten years, veterinary reporting has been dwarfed by that of the
human medical profession.
191
The majority of the reports are for Phenobarbital.
192
There have
only been a “handful of investigations.”
193
179
Id.
180
Interview with unidentified investigator, Haw. Narcotics Enforcement Div. (Jan. 9, 2013).
181
IL ST CH 720 §§ 570/100-603 (West, Westlaw Next through P.A. 97-1144 of the 2012 Reg. Sess.).
182
E-mail from Chedister Lane, Project Manager at IL Prescription Monitoring Program, to author (Jan. 3, 2013,
15:54 EST) (on file with author).
183
Interview with Chedister Lane, Project Manager at IL Prescription Monitoring Program (Jan. 25, 2013).
184
IND. CODE ANN. §§ 35-48-7-2.9 to -11.5 (West, Westlaw Next through 2012 Second Reg. Sess.).
185
E-mail from Taya Fernandes, Quality Assurance Coordinator, Ind. Prescription Monitoring Program, to author
(Dec. 21, 2012, 13:00 EST) (on file with author).
186
Id.
187
Indiana requires veterinarians to report, but the information gathered is unusable. E-mail from Marty Allain,
Gen. Counsel & INSPECT Dir., Ind. Prof’l Licensing Agency, to author (Dec. 21, 2012, 13:00 EST) (on file with
author).
188
Id.
189
Id.
190
MICH. COMP. LAWS ANN. §§ 333.7333 to .7333a (West, Westlaw Next through P.A.2012, No. 398, 405, 409-425,
427-435, of the 2012 Reg. Sess., 96th Leg.).
191
E-mail from Michael Wissel, Pharmacy Serv. Manager, Bureau of Health Professions, Health Investigation Div.,
to author (Dec. 26, 2012, 10:54 EST) (on file with author) (stating “Our electronic system has been here now for 10
PRESCRIPTION DRUG MONITORING PROGRAMS 31
Mississippi:
194
See discussion supra § II.
New Mexico:
195
As of August 2012, New Mexico requires veterinarians to report to its PDMP.
196
There have been no requests regarding veterinary patients.
197
New York:
198
In 2012, there were approximately 4,400 law enforcement and regulatory agency
requests for data contained within New York’s PDMP.
199
When these agencies obtained the
requested information, they were required to serve a subpoena to the Department of Health.
200
Almost all of these contain a non-disclosure clause.
201
Thus, there is no way of tracking or
differentiating veterinary from non-veterinary patients.
202
The non-disclosure has hampered
prior PDMP research efforts.
203
North Dakota:
204
Veterinarians are statutorily required to report, but with no penalties for failing
to report, veterinarians do not report.
205
Furthermore, of the 36,113 information requests to the
PDMP in 2011, none were known to pertain to veterinarians or their patients.
206
Oklahoma:
207
See discussion supra § II.
years and vet involvement has been minimal, and also much work as they must [sic] often report the phenobarbital
on paper and we have only seen a handful of investigations.”).
192
Id.
193
Id.
194
MISS. CODE. ANN. § 73-21-127 (West, Westlaw Next through End of 2012 Reg. Sess.).
195
N.M. CODE R. § 16.19.20.1-.48 (LexisNexis 2013).
196
E-mail from Larry Loring, State Drug Inspector, N.M. Bd. of Pharmacy, to author (Dec. 27, 2012, 10:35 EST)
(on file with author) (New Mexico added veterinarians to require them to report to their PDMP Aug. 2012).
197
Id.
198
N.Y. PUB. HEALTH LAW § 3331 (McKinney 2013 through L.2012, chapters 1 to 500, 502 to 504) (Additional
provisions of N.Y. Pub. Health Law § 3343 will take effect Aug 2013.).
199
E-mail from Terence Leary, Dir., Bureau of Narcotic Enforcement, N.Y. State Dept. of Health, to author (Jan. 16,
201 21:09 EST) (on file with author).
200
Id.
201
Id.
202
Id.
203
E-mail from Joanne Brady, Senior Staff Associate, Anesthesia Research Operations, Columbia Sch. of Pub.
Health, to author (Jan. 23, 2013, 16:54 EST) (on file with author).
204
N.D. CENT. CODE ANN. §§ 19-03.5-01 to -10 (West, Westlaw Next through the 2011 Reg. and Spec. Sess. of the
62nd Legis. Assemb.).
205
E-mail from Howard Anderson, Exec. Dir., N.D. Bd. of Pharmacy, to author (Dec. 26, 2012, 16:12 EST) (on file
with author).
206
Id.
PRESCRIPTION DRUG MONITORING PROGRAMS 32
Rhode Island:
208
There have not been any known cases of vet shopping in Rhode Island.
209
South Carolina:
210
Due to the data collected, South Carolina’s PDMP is unable to separate
human versus non-human patients.
211
Tennessee:
212
See discussion supra § II.
Washington:
213
See discussion supra § II.
West Virginia:
214
Currently, there is no way to distinguish between veterinary and human
prescription requests.
215
Although there are 60,000 patient profiles run each month, there have
been no known cases vet shopping.
216
207
OKLA. STAT. tit. 63 § 2-309C (West, Westlaw Next through Chapter 370 (End) of the Second Reg. Sess. of the
53rd Leg. (2012)) (amended by 2012 Okla. Sess. Law Serv. Ch. 206 (H.B. 2941) (West)).
208
R.I. GEN. LAWS ANN. § 21-28-3.18 (West, Westlaw Next current with amendments through chapter 491 of the
2012 Reg. Sess.).
209
E-mail from Matthew Raymond, Prescription Monitoring Program Specialist, R.I. Dep’t of Health, to author
(Jan. 2, 2013, 14:01 EST) (on file with author).
210
S.C. CODE ANN. § 44-53-1640 (Westlaw Next through End of 2012 Reg. Sess.).
211
E-mail from Cheryl Anderson, PMP Dir., S.C. Dep’t of Health and Envtl. Control, to author (Dec. 27, 2012,
10:52 EST) (on file with author).
212
TENN. CODE ANN. §§ 53-10-301 to -311 (West, Westlaw Next through end of 2012 Second Reg. Sess.).
213
WASH. REV. CODE ANN. § 70.225.010 (West, Westlaw Next Current with all 2012 Legis. and Chapters 1, 2, and
3 from the 2013 Reg. Sess.).
214
W. VA. CODE ANN. §§ 60A-9-1 to -8 (West, Westlaw Next current with laws of the 2012 First Extraordinary
Sess.).
215
E-mail from Michael Goff, CSMP Adm’r, W. Va. Bd. of Pharmacy, to author (Jan. 8, 2013, 17:09 EST) (on file
with author).
216
Id.
PRESCRIPTION DRUG MONITORING PROGRAMS 33
(2) States with operational PDMPs, which currently do not require veterinarians to report,
which can be subdivided into: (a) Do not require veterinarians to report
Colorado:
217
Connecticut:
218
Delaware:
219
Florida:
220
Georgia:
221
Veterinarians have been exempted from Georgia's reporting program.
222
Idaho:
223
Iowa:
224
Kansas:
225
See discussion supra § II.
Louisiana:
226
217
COLO. REV. STAT. ANN. § 12-42.5-403 (West, Westlaw Next Current with Chapters 1-4 and 6 of the First Reg.
Sess. of the 69th Gen. Assemb. (2013)); see E-mail from Tia Johnson, Complaint Intake Coordinator for Bd. of
Social Work Exam’r, Addiction Counselor Program, and State Grievance Bd., Bd. Member, Domestic Violence
Offender Mgmt. Bd., to author (Dec. 31, 2012, 10:47 EST) (on file with author); and e-mail from Wendy Anderson,
Program Dir., Colo. Dep’t of Regulatory Agencies, Div. of Professions and Occupations, Bd. of Pharmacy, to author
(Dec. 31, 2012, 11:24 EST) (on file with author) (Veterinarians do not report to the state’s PDMP.).
218
CONN. GEN. STAT. ANN. § 21a-254 (West, Westlaw Next Current with enactments from the 2012 February Reg.
Sess. and June 12 Spec. Sess.); see e-mail from Xaviel Soto, Program Manager, Conn. Dep’t of Consumer
Protection, Med. Marijuana Program/Prescription Monitoring Program, to author (Jan 3, 2013, 13:54 EST) (on file
with author).
219
DEL. CODE ANN. TIT. 16, § 4798 (West, Westlaw Next Current through 78 Laws 2012, chs. 204 - 409 and
technical corrections received from the Delaware Code Revisors for 2012 Acts); E-mail from David Dryden, Dir.
Office of Controlled Substances, to author (Dec. 26, 2012, 19:00 EST) (on file with author); see e-mail from
Samantha Nettesheim, PMP Adm’r, Div. of Prof’l Regulation, to author (Dec. 27, 2012, 10:45 EST) (on file with
author) (Delaware’s PDMP does not collect prescription data for veterinary patients.).
220
FLA. STAT. ANN. § 893.055 (West, Westlaw Next through Ch. 268 (End) of the 2012 2nd Reg. Sess. and the 2012
Extraordinary Apportionment Sess. of the Twenty-Second Leg.); see e-mail from Rebecca R. Poston, Program
Manager, E-FORCSE Florida's Prescription Drug Monitoring Program, to author (Dec. 27, 2012, 08:59 EST) (on
file with author) (Florida does not require veterinarians to report to their PDMP.).
221
GA. CODE ANN. §§ 16-13-57 to -65 (West, Westlaw Next through the 2012 Reg. Sess.).
222
See GA. CODE ANN. § 16-13-65(a) (West, Westlaw Next through the 2012 Reg. Sess.); e-mail from J. Ronnie
Higgins, Spec. Agent in Charge, Ga. Drugs and Narcotics Agency, to author (Dec. 26, 2012, 18:14 EST) (on file
with author).
223
IDAHO CODE ANN. § 37-2726 (West, Westlaw Next through End of 2012 2nd Reg. Sess. of the 61st Leg.); see E-
mail from Teresa Anderson, Program Info. Coordinator, Idaho Bd. of Pharmacy, to author (Dec. 26, 2012, 17:29
EST) (on file with author); and e-mail from Mark D. Johnston, Exec. Dir., Idaho State Bd. of Pharmacy, to author
(Jan. 2, 2013, 18:10 EST) (on file with author) (Idaho does not require veterinarians to report to their PDMP.).
224
IOWA CODE ANN. § 124.554 (West, Westlaw Next current with Legis. from the 2012 Reg. Sess.); see e-mail from
Therese Witkowski, Exec. Officer, Iowa Bd. of Pharmacy, to author (Dec. 26, 2012, 17:50 EST) (on file with
author) (Veterinarians in Iowa are exempt from reporting to the PDMP.).
225
KAN. STAT. ANN. § 65-1685 (West, Westlaw Next through 2012 Reg. Sess.).
PRESCRIPTION DRUG MONITORING PROGRAMS 34
Maine:
227
Maryland:
228
Massachusetts:
229
See discussion supra § II.
Minnesota:
230
See discussion supra § II.
Montana:
231
Nebraska:
232
Nevada:
233
“[T]he Nevada P[D]MP data obtained from veterinarians would not justify the burden
to the [veterinary] practices,”
234
so veterinarians do not report to the Nevada PDMP.
235
New Jersey:
236
226
LA. STAT. ANN. §§ 40:1002-1014 (West, Westlaw Next through the 2012 Reg. Sess.); see e-mail from Joe
Fontenot, Compliance Officer / Prescription Monitoring Program Manager, La. Bd. of Pharmacy, to author (Dec. 20,
2012, 16:03 EST) (on file with author) (Veterinarians are not required to report to the PDMP.).
227
22 ME. REV. STAT. §§ 7245-7252 (West, Westlaw Next current with Legis. through the 2011 Second Reg. Sess.
of the 125th Leg.); see e-mail from John Lipovsky, Prescription Monitoring Program Coordinator, Office of
Substance Abuse and Mental Health Serv., to author (Jan. 3, 2013, 11:41 EST) (on file with author) (Veterinarians
fall into the category of prescribers who also administer/dispense.).
228
MD. HEALTH-GEN. CODE ANN. §§ 21-2A-01 to -10 (through all chapters of the 2012 Reg. Sess. and the First and
Second Spec. Sess. of the Gen. Assemb.); see e-mail from Michael Baier, PDMP Coordinator, Md. Alcohol and
Drug Abuse Admin., to author (Jan. 10, 2013, 08:39 EST) (on file with author) (Veterinarians do not report to
PDMP.).
229
MASS. GEN. LAWS ANN. ch. 94C, § 24A (West, Westlaw Next through Chapter 416, except for Chapters 371,
379, 398, 402 and 403 of the 2012 2nd Ann. Sess.).
230
MINN. STAT. ANN. § 152.126 (West, Westlaw Next through the end of the 2012 First Spec. Sess.).
231
MONT. CODE ANN. §§ 37-7-1501 to -1514 (West, Westlaw Next Statutes are current with all 2011 laws, 2011
Code Comm’r changes, and 2010 ballot measures); see E-mail from Donna Peterson, Program Manager, Mont.
Prescription Drug Registry, to author (Dec. 27, 2012, 12:18 EST) (on file with author) (Montana does not require
veterinarians to report to their PDMP.).
232
NEB. REV. STAT. §§ 71-2454 to -2455 (through the 102nd Leg. Second Reg. Sess. (2012)); see e-mail from
Joseph Acierno, Deputy Chief Med. Officer, Neb. Dep’t of Health & Human Serv., Div. of Pub. Health, to author
(Dec. 28, 2012, 12:21 EST) (on file with author) (Veterinary prescriptions directly dispensed by the veterinarian are
not required to report to the PDMP.).
233
NEV. REV. STAT. ANN. § 453.1545 (West, Westlaw Next through the 2011 76th Reg. Sess. of the Nev. Leg. and
technical corrections received from the Legis. Counsel Bureau (2011)).
234
Barbara A. Carter, Report to the Leg.: Diversion of Controlled Substances Dispensed by Veterinary Practice,
Minn. Bd. of Pharmacy at 9 (Dec. 1, 2011 approved Jan. 11, 2012),
http://archive.leg.state.mn.us/docs/2012/mandated/120074.pdf (referencing a Nevada task force report).
235
E-mail from Lisa Adams, Program Adm’x, Nev. Controlled Substance Task Force, to author (Dec. 26, 2012,
19:49 EST) (on file with author).
236
N.J. STAT. ANN. § 45:1-46 (West, Westlaw Next current with laws effective through L.2012, c. 80 and J.R. No.
5.); see e-mail from James Mielo, Prescription Monitoring Program Adm’r, N.J. Div. of Consumer Affairs, to author
(Dec. 27, 2012, 09:24 EST) (on file with author) (Veterinarians do not report dispensed prescriptions, but
prescriptions that are dispensed at an outside pharmacy are reported.).
PRESCRIPTION DRUG MONITORING PROGRAMS 35
North Carolina:
237
Veterinarians do not report dispensed prescriptions, but prescriptions that are
dispensed at an outside pharmacy are reported.
238
From those prescriptions filled at an outside
pharmacy, there have been no requests for veterinary or veterinary patient data.
239
Ohio:
240
Oregon:
241
Pennsylvania:
242
Currently, veterinarians are not required to report to Pennsylvania’s PDMP, but
there is pending legislation that if passed would require veterinarians to report.
243
This proposed
legislation has been tabled.
244
South Dakota:
245
Texas:
246
237
N.C. GEN. STAT. ANN. § 90-113.70 (West, Westlaw Next statutes and Constitution are current through the end of
the 2012 Reg. Sess.).
238
E-mail from Johnny Womble, Program Consultant, Controlled Substances Regulatory Branch, N.C. Dep’t of
Health and Human Serv., to author (Dec. 27, 2012, 12:05 EST) (on file with author).
239
E-mail from William Bronson, Controlled Substances Regulatory Branch, N.C. Dep’t of Health and Human
Serv., to author (Dec. 28, 2012, 15:49 EST) (on file with author).
240
OHIO REV. CODE ANN. § 4729.79 (West, Westlaw Next through all 2011 laws and statewide issues and 2012
Files 70 through 157 of the 129th GA (2011-2012)); see e-mail from Danna Droz, Prescription Monitoring Program
Adm’r, Ohio State Bd. of Pharmacy, to author (Dec. 27, 2012, 09:10 EST) (on file with author) (Veterinarians are
not required to report to Ohio’s PDMP.); see also supra § III (Known instances of vet shopping.).
241
OR. REV. STAT. ANN. §§ 431.960-978 (West, Westlaw Next through End of the 2012 Reg. Sess. and ballot
measures approved at the Nov. 6, 2012 Gen. Election. Revisions to Acts made by the Or. Reviser were unavailable
at the time of publication); see e-mail from Todd Beran, Program Coordinator, Or. Prescription Drug Monitoring
Program, to author (Jan. 2, 2013, 10:39 EST) (on file with author) (Oregon does not require veterinarians to report
information to their PDMP.).
242
PA. CODE 28, § 25.131 (Westlaw Next through Pa. Bulletin, Vol. 43, Num. 3, dated January 19, 2013).
243
E-mail from Steven R. Wheeler, Chief of Criminal Investigations, Pa. Office of Att’y Gen., Criminal Law Div.,
to author (Jan. 3, 2013, 08:57 EST) (on file with author) (referencing H.B. No. 317, Reg. Sess. 2013-2014 (Pa.
2013)).
244
Pa. Gen. Assemb., House Bill 317 Bill Info.,
http://www.legis.state.pa.us/cfdocs/billinfo/BillInfo.cfm?syear=2013&sind=0&body=H&type=B&bn=317 (last
visited April 11, 2013).
245
S.D. CODIFIED LAWS §§ 34-20E-1 to -20 (Westlaw Next through the 2012 Reg. Sess., 2012 Gen. election results,
and Supreme Court Rule 12-10); see E-mail from Kari Shanard-Koenders, Prescription Drug Monitoring Program
Dir., to author (Dec. 27, 2012, 12:35 EST) (on file with author) (stating veterinarians are specifically excluded from
reporting by the definition of dispenser, referencing S.D. CODIFIED LAWS § 34-20E-1(7)).a
246
TEX. HEALTH & SAFETY CODE ANN. § 481.074 (Westlaw Next through the end of the 2011 Reg. Sess. and First
Called Sess. of the 82nd Leg.); see e-mail from Sherry Wright, Program Supervisor, Tex. Prescription Program, to
author (Dec. 31, 2012, 16:33 EST) (on file with author) (Texas only requires reporting of veterinary prescriptions
when they are filled at a pharmacy.).
PRESCRIPTION DRUG MONITORING PROGRAMS 36
Utah:
247
Vermont:
248
Virginia:
249
Wisconsin:
250
See discussion supra §II.
Wyoming:
251
(b) Historically required veterinarians to report;
Kentucky:
252
See discussion supra § II.
(3) States with no operational PDMPs, which can be subdivided into
(a) Legislatively enacted but not yet operational,
New Hampshire:
253
Veterinarians are not excluded from reporting to New Hampshire's PDMP,
which has enabling legislation.
254
(b) No enabling legislation.
Missouri: Although Missouri is receiving pressure from numerous sources,
255
it is the only state
that has yet to adopt any form of a PDMP.
256
247
UTAH CODE ANN. §§ 58-37f-101 to -801 (West, Westlaw Next through 2012 Fourth Spec. Sess.); E-mail from
Marvin H. Sims, CSDB Adm’r, Utah Dep’t of Commerce, Div. of Occupational & Prof’l Licensing, to author (Jan.
7, 2013, 14:55 EST) (on file with author) (Veterinarians that dispense directly are not required to report, but a retail
pharmacy may submit an animal prescription.).
248
VT. STAT. ANN. tit. 18, §§ 4281-4287 (West, Westlaw Next through the laws of the Adjourned Sess. of the 2011-
2012 Vt. Gen. Assemb. (2012)); see e-mail from Meika DiPietro, Program Manager, Vt. Prescription Monitoring
System, Vt. Dep’t of Health, to author (Dec. 28, 2012 09:02 EST) (on file with author) (Veterinarians are not
required to report to Vermont’s PDMP.).
249
VA. CODE ANN. §§ 54.1-2519 to -2526 (West, Westlaw Next Current through End of 2012 Reg. Sess. and End of
2012 Sp. Sess. I.); see e-mail from Ralph Orr, Program Dir., Va. Prescription Monitoring Program, to author (Dec.
26, 2012, 17:25 EST) (on file with author) (Veterinarians are specifically excluded from Virginia’s PDMP.).
250
WIS. STAT. ANN. § 450.19 (West, Westlaw Next through 2011 Act 286, published April 26, 2012).
251
WYO. STAT. ANN. § 35-7-1060 (West, Westlaw Next through the 2012 Budget Sess.); see e-mail from Mary
Walker, Exec. Dir., Wyo. Bd. of Pharmacy, to author (Dec. 29, 2012, 10:15 EST) (on file with author) (Only retail
pharmacies are required to report to Wyoming’s PDMP. (referencing Wyo. Pharmacy Act Rules & Regulations
Chapter 8 Section 2 (a))).
252
KY. REV. STAT. ANN. § 218A.390 (West, Westlaw Next through end of 2012 Legis.).
253
N.H. REV. STAT. ANN. §§ 318-B:31-38 (West, Westlaw Next through Chapter 1 of the 2013 Reg. Sess., not
including changes and corrections made by the State of N.H., Office of Legis. Serv.).
254
Id.; E-mail from Jay Queenan, Exec. Sec’y / Dir., N.H. Bd. of Pharmacy to author (Dec. 21, 2012, 17:11 EST)
(on file with author).
PRESCRIPTION DRUG MONITORING PROGRAMS 37
255
Cameron Hardesty, Dir. Kerlikowske Visits Mo.; Urges Adoption of Prescription Drug Monitoring Program, the
Whitehouse Office of Nat’l Drug Control Policy (Aug. 17, 2012, 11:17 AM),
http://www.whitehouse.gov/blog/2012/08/17/Dir.-kerlikowske-visits-missouri-urges-adoption-prescription-drug-
monitoring-pro.
256
E-mail from Michael Boeger, Adm’r, Mo. Bureau of Narcotics & Dangerous Drugs, to author (Dec. 26, 2012,
18:01 EST) (on file with author).
PRESCRIPTION DRUG MONITORING PROGRAMS 38
Appendix 4: Required fields for the states that require veterinarians to report to their
PDMP:
Since all PDMPs require information regarding the prescribing veterinarian, this
information is omitted from the following discussion.
Alabama: There is no guidance on entering information regarding an animal patient.
257
However,
it does state that the PDMP is funded by a $10 annual charge for each prescribing practitioner in
the state.
258
Alaska: “Last Name (Veterinarians should enter the owner’s last name); First Name
(Veterinarians should enter the animal’s name or, if the name is unknown, the animal’s species
(e.g., feline)); Address (Veterinarians should enter the owner’s address); and Date of Birth
(Veterinarians should enter the animal’s approximate date of birth. If DOB is unknown, enter
January 1 of the approximate birth year).”
259
However, no such guidance exists in the enabling
statute.
260
Arizona: “First and last name of the person or, if for an animal, the owner of the animal for
whom the controlled substance is being dispensed, and the person's or, if for an animal, the
owner's: Full address, including street, city, state, and ZIP code; Gender; Telephone number;
Date of birth; Species (human or veterinary patient); Identification Number; Identification
Number Identifier.”
261
257
HEALTH INFO. DESIGNS, L.L.C., Dispensing Practitioner’s Implementation Guide, Ala. Dep’t of Pub. Health,
Prescription Drug Monitoring Program, 6-7 (April 2013),
http://adph.org/PDMP/assets/ALPDMP_DispensersImplementationGuide.pdf; ALA. CODE §§ 20-2-210 to 220
(2013); ALA. ADMIN CODE r. §§ 420-7-2-.11 to .13 (2013).
258
Dispensing Practitioner’s Implementation Guide, Ala. Dep’t of Pub. Health, Prescription Drug Monitoring
Program, supra note 257, at 5.
259
HEALTH INFO. DESIGNS, L.L.C., Dispensing Veterinarian’s Implementation Guide, Alaska Bd. of Pharmacy
Prescription Drug Monitoring Program, 6-7, A-1A-12 (April 2013),
http://www.alaskapdmp.com/Files/AK%20PDMP_Dispensing_Veterinarians_Implementation_Guide.pdf.
260
ALASKA STAT. § 17.30.200(b)(4) (2013); ALASKA ADMIN. CODE tit. 12 §§ 52.855-.890 (2013).
261
HEALTH INFO. DESIGNS, L.L.C., Dispensing Practitioner’s Implementation Guide, Ariz. Bd. of Pharmacy
Prescription Drug Monitoring Program, 3-4 (April 2013),
http://www.azpharmacy.gov/pmp/pdfs/manual%20(practitioners)(asap%204.2)%2004-01-2013.pdf; ARIZ. REV.
PRESCRIPTION DRUG MONITORING PROGRAMS 39
Arkansas: “Last Name (Veterinarians should enter the owner’s last name); First Name
(Veterinarians should enter the animal’s name or, if the name is unknown, the animal’s species
(e.g., feline)); Address (Veterinarians should enter the owner’s address); and Date of Birth
(Veterinarians should enter the animal’s approximate date of birth. If DOB is unknown, enter
January 1 of the approximate birth year).”
262
“‘Patient’ means the person or animal who is the
ultimate user of a controlled substance for whom a lawful prescription is issued and for whom a
controlled substance is lawfully dispensed.”
263
California: California’s PDMP requires the owner’s name, the animal’s name, and the species is
a veterinary patient.
264
However, the PDMP enabling statute gives no guidance.
265
Hawaii: No guidance regarding entering an animal patient’s data is provided by the enabling
legislation or governing rules/regulations.
266
Illinois: No guidance is provided by the enabling legislation.
267
However, the governing
rules/regulations provide: “‘Patient ID’ means the identification of the individual receiving the
medication or the responsible individual obtaining the medication on behalf of the recipient or
the owner of the animal.”
268
Additionally, prescriptions in Illinois are required to “[b]ear the full
STAT. ANN. § 36-2608(A)(2) (2013) (“The name, address and date of birth of the person or, if for an animal, the
owner of the animal for whom the prescription is written.”).
262
HEALTH INFO. DESIGNS, L.L.C., Dispensing Veterinarian’s Implementation Guide, Ark. Dep’t of Health
Prescription Drug Monitoring Program, 6-7, A-1A-12 (April 2013),
http://www.arkansaspmp.com/files/AR%20PMP_Implementation%20Guide%20for%20Dispensing%20Veterinarian
s.pdf.
263
PHARMACY SERV. BRANCH, CENTER FOR HEALTH PROTECTION, Rules and Regulations Pertaining to Ark.
Prescription Drug Monitoring Program, 3 (March 1, 2013),
http://www.healthy.arkansas.gov/aboutADH/RulesRegs/PrescriptionMonitoringProgram.pdf.
264
ATLANTIC ASSOCIATES, Cal. PDMP Direct Dispense Application Instruction Manual
http://www.aaicures.com/Atlantic_Associates_CACures_Instructions.pdf at 6-7 (last visited May 27, 2013).
265
CAL. HEALTH & SAFETY CODE § 11165(d)(1) (2013) (“Full name, address, and the telephone number of the
ultimate user or research subject, or contact information as determined by the Secretary of the United States
Department of Health and Human Serv., and the gender, and date of birth of the ultimate user.”).
266
See HAW. REV. STAT. § 329-101 (2013); HAW. CODE R. § 23-200-17 (LexisNexis 2013).
267
See 720 ILL. COMP. STAT. 570/316 (2012).
268
77 ILL. ADMIN. CODE tit. 77, § 2080.20 (2009).
PRESCRIPTION DRUG MONITORING PROGRAMS 40
name and address of the patient, or in the case of veterinary treatment, the full name and address
of the animal owner, as well as the species or common name of the animal being treated.”
269
Indiana: Minimal guidance is provided by the enabling legislation, “As used in this chapter,
‘patient’ means an individual who has requested or received health care services from a provider
for the examination, treatment, diagnosis, or prevention of a physical or mental condition.”
270
Michigan: “Customer ID: Use the pet owner's identification (driver's license or Michigan I.D.
card) for all controlled substances dispensed for animals; Birth Date: Use the pet owner's date of
birth; Patient First Name: Use the pet owner's first name; Patient Last Name: Use the pet owner's
last name.”
271
Mississippi: The data submission guide is silent on when a patient is an animal, but it states to
use a driver’s license number etc. as the patient ID.
272
The statute and regulations are likewise
silent on the definition of “patient.”
273
New Mexico: “Last Name: Enter last name (of owner if animal); First Name: Enter first name
(pet’s name if animal); Middle Name: (if animal, enter species type -dog, cat, etc.); DOB: (if
269
77 ILL. ADMIN. CODE tit. 77, § 2080.70 (2009). See 77 ILL. ADMIN. CODE tit. 77, § 2080.100 (2009) (The
reporting requirement is further clarified by “[r]ecipient's (or animal and owner's) name and address.”).
270
See IND. CODE § 35-48-7-5.6 (2012).
271
MAPS Info. for Veterinarians, LARA: Mich. Dep’t of Licensing and Regulatory Affairs,
http://www.michigan.gov/lara/0,4601,7-154-35299_63294_63303_55478_55487---,00.html (last visited May 27,
2013); see MICH. ADMIN. CODE r. 338.3162b (2013) (“The patient identifier, … If the patient is an animal, positive
identification of the animal's owner that meets the requirements of R 338.3102(1)(f)(iv).”); MICH. ADMIN. CODE r.
338.3102(1)(f)(iv) (2013) (“Any 1 of the following: (A) A Michigan driver's license number. (B) An identification
number obtained from a photo identification card issued by the state of Michigan. (C) The number zero. Zeroes
shall be entered as the identification number, if the positive identification presented by the patient or the patient's
agent or caregiver does not include a license number or an identification number, as listed in subparagraphs (A) and
(B) of this paragraph.”); but see MICH. COMP. LAWS ANN. § 333.7333a (West 2012) (where no guidance is
provided).
272
RELAY HEALTH, MS PMP Data Submission Dispenser Guide 9 (Jan. 06, 2011),
http://web.archive.org/web/20120724160035/http://pmp.relayhealth.com/MS/Documents/MS_PMP_Dispenser_Sub
mission_Guide_v1rE1.pdf (“MS PMP prefers six forms of Patient ID in PMP data -- Driver’s License, other State
Issued ID, Military ID, Passport, Social Security Number, and Cardholder ID.”)
273
MISS. CODE ANN. § 73-21-127 (2013); 30-20 MISS. CODE R. § 3001:XLIII (LexisNexis 2013) (stating that “[t]he
recipient's name” needs to be reported).
PRESCRIPTION DRUG MONITORING PROGRAMS 41
animal, enter default date of 01/01/2001); GENDER: Click arrow and select response; Street,
City, Zip: (if animal, enter owner’s information).”
274
New York: The data submission guide is silent on when a patient is an animal.
275
The statute
and regulation are likewise silent.
276
North Dakota: There is no guidance on what information is to be used when the patient is an
animal contained within the implementation guide.
277
However, the statute defines patient as
“‘Patient’ means an individual or the owner of an animal who is the ultimate user of a controlled
substance for whom a prescription is issued and for whom a controlled substance is
dispensed.”
278
Oklahoma: The dispenser is to report the owner’s name and information and the animal’s species
and name.
279
Rhode Island: There is no guidance given regarding PDMP submission.
280
South Carolina: Where there is little guidance found in the statute or regulation, the
implementation guide provides, “Animal’s first name is to be entered for patient’s first name;
Owner’s last name is to be entered for patient’s last name; Animal’s date of birth (DOB) is to be
274
N.M. Prescription Monitoring Program (PMP) Dispensing Practitioner Manual,
http://www.rld.state.nm.us/uploads/FileLinks/3d17c8b8a4b14830badb0d31e94473eb/PMP_Dispensing_Practitioner
_Manual.pdf, at 6 (04/17/2013). See N.M. CODE R. § 16.19.29.7 (C) (2013) (“‘Patient’ means the person or animal
who is the ultimate user of a drug for whom a prescription is issued and for whom a drug is dispensed.”)
275
NEW YORK STATE DEPT OF HEALTH, BUREAU OF NARCOTIC ENFORCEMENT, Official New York State
Prescription Program Electronic Data Transmission (July 2008)
http://www.health.ny.gov/professionals/narcotic/electronic_data_transmission/docs/manual_of_instructions.pdf.
276
N.Y. PUB. HEALTH LAW § 3343 (McKinney’s 2013); N.Y. COMP. CODES R. & REGS. tit. 10 § 80.71, .73 (2013).
277
HEALTH INFO. DESIGNS, L.L.C., Dispenser’s Implementation Guide, N.D. Bd. of Pharmacy, Prescription
Monitoring Program, 3-4 (Feb. 2012), http://www.nodakpharmacy.com/pdfs/dataSubmissionMethods.pdf.
278
N.D. CENT. CODE § 19-03.5-01 (8) (2013). See N.D. ADMIN. CODE 61-12-01-01 (9) (2013).
279
OKLAHOMA BUREAU OF NARCOTICS AND DANGEROUS DRUG CONTROL, INFO. TECH. DIV., Official Oklahoma
State Prescription Monitoring Program and Pseudoephedrine Electronic Data Transmissions Manual of
Instructions, 9-11 (Jan. 20, 2011),
http://web.archive.org/web/20121115033527/http://www.ok.gov/obndd/documents/Oklahoma%202009%20PMP%2
0Transmission%20Manual%20v5.0.pdf. But see OKLA. STAT. tit. 63 § 2-309C (2012) (as amended by 2012 Okla.
Sess. Law Serv. Ch. 206 (H.B. 2941) (West)) (silent on animal patients); OKLA. ADMIN. CODE § 475:45-1-2 (2013)
(silent on animal patients).
280
31-2-1 R.I. CODE R. 1.0-4.0 (LexisNexis 2013) (the rules and regulations regarding the PDMP); R.I. GEN. LAWS §
21-28-3.18(d)(2) (2013) (the enabling legislation for their PDMP).
PRESCRIPTION DRUG MONITORING PROGRAMS 42
included for patient’s DOB (if not known, provide best estimate of DOB); Animal’s gender is to
be entered for patient’s gender; Owner’s full address, including city, state, and ZIP code.”
281
Tennessee: The Tennessee rules and regulations state, “‘Patient’ means a person, animal or
owner of an animal who is receiving medical treatment from a prescriber.”
282
Washington: A system has yet to be implemented for veterinary reporting, thus at this time
information regarding the patient cannot be provided.
283
West Virginia: The enabling legislation and regulations are silent on how to deal with an animal
patient.
284
281
HEALTH INFO. DESIGNS, L.L.C., Dispenser’s Implementation Guide S.C. Dep’t of Health & Envtl. Control,
Prescription Monitoring Program, 6 (April 2010),
http://web.archive.org/web/20131001005548/http://www.scdhec.gov/administration/drugcontrol/sc-dispensers-
implementation-guide.pdf. See S.C. CODE ANN. § 44-53-1630 (4) (2013) (“‘Patient’ means the person or animal
who is the ultimate user of a drug for whom a prescription is issued or for whom a drug is dispensed, or both.”).
282
TENN. COMP. R. & REGS. 1140-11-.01(1)(o) (2013); OPTIMUM TECH., INC, Tenn. Controlled Database Data
Collection Manual, (May 21, 2013), https://www.tnrxreport.com/docs/DataReportingManualforTN.pdf (where this
regulatory guidance is lacking from the data collection manual).
283
See 2013 Wash. Legis. Serv. Ch. 19 (H.B. 1609) (WEST) (amending WASH REV. CODE §
70.225.020(4)(c))(“The department, in collaboration with the veterinary board of governors, shall establish
alternative data reporting requirements for veterinarians that allow veterinarians to report.”).
284
W. VA. CODE. § 60A-9-4 (2012); W. VA. CODE R. § 15-8-3 (2013).
... 22,23 Besides the range of POA products available, veterinarians are a unique source for POAs as they largely fall outside of control systems applied to human medicine. 24 For instance, many North American subjurisdictions (ie, provinces/states) do not require veterinarians to report their POA-prescribing 24,25 Ad ditionally, many veterinary clinics retain large quantities of POAs on-site as the principal dispensers of these drugs; furthermore, there are no limits on the amounts of POAs veterinarians can prescribe, which may aid the availability of large POA amounts for diversion or misuse. 25,26 In this context, there have been reports of veterinarians pilfering POAs for personal use, and threequarters of a sample of US-based veterinarians indicated that they had worked with someone they knew had a substance abuse problem. ...
... 22,23 Besides the range of POA products available, veterinarians are a unique source for POAs as they largely fall outside of control systems applied to human medicine. 24 For instance, many North American subjurisdictions (ie, provinces/states) do not require veterinarians to report their POA-prescribing 24,25 Ad ditionally, many veterinary clinics retain large quantities of POAs on-site as the principal dispensers of these drugs; furthermore, there are no limits on the amounts of POAs veterinarians can prescribe, which may aid the availability of large POA amounts for diversion or misuse. 25,26 In this context, there have been reports of veterinarians pilfering POAs for personal use, and threequarters of a sample of US-based veterinarians indicated that they had worked with someone they knew had a substance abuse problem. ...
... In 2014, a fifty state survey of Prescription Drug Monitoring Programs (PDMP) found that there were less than ten veterinary shoppers identified nationwide by the various state programs [10]. While the number might be small, it should be noted that not all states require veterinarians to participate in PDMP thus it could be underreported [11]. ...
Article
Full-text available
Background: The opioid crisis continues to grow in the United States with 46,700 drug overdose deaths due to opioids in 2017 alone. Vet shopping, the practice of soliciting veterinarians for prescription medications, has been receiving national media attention in recent years. A 2014 review of Prescription Monitoring Drug Programs found less than 10 veterinary shoppers nationwide. Still much is unknown about the role of vet shopping and the opioid crisis. This study sought to understand the practice of vet shopping through the eyes of veterinarians practicing in Appalachian counties within the states of Kentucky, Tennessee, and Virginia, United States. Results: Fourteen veterinarians were asked a set of 13 questions related to vet shopping. Results indicated that 13 veterinarians in the study had heard of the phenomenon of vet shopping and eight veterinarians had personally encountered vet shopping in their practices. Qualitative analysis of the interviews identified six key themes including a need for interprofessional communication and how important a valid veterinary-client-patient relationship is within the profession. Conclusions: The study hopefully sheds some light on how often vet shopping is encountered in practice, concerns of veterinarians regarding vet shopping, and potential areas for improvement. Keywords: Vet shopping, Opioid, Veterinarians, Attitudes, Practice, Prescription drug misuse
CSDB Adm'r, Utah Dep't of Commerce, Div. of Occupational & Prof'l Licensing, to author EST) (on file with author) (Veterinarians that dispense directly are not required to report, but a retail pharmacy may submit an animal prescription.)
  • H Marvin
  • Sims
Marvin H. Sims, CSDB Adm'r, Utah Dep't of Commerce, Div. of Occupational & Prof'l Licensing, to author (Jan. 7, 2013, 14:55 EST) (on file with author) (Veterinarians that dispense directly are not required to report, but a retail pharmacy may submit an animal prescription.).
Bureau of Narcotic Enforcement
  • Terence Leary
199 E-mail from Terence Leary, Dir., Bureau of Narcotic Enforcement, N.Y. State Dept. of Health, to author (Jan. 16, 201 21:09 EST) (on file with author).
First and last name of the person or, if for an animal, the owner of the animal for whom the controlled substance is being dispensed, and the person's or, if for an animal, the owner's: Full address, including street, city, state, and ZIP code; Gender
  • Arizona
Arizona: "First and last name of the person or, if for an animal, the owner of the animal for whom the controlled substance is being dispensed, and the person's or, if for an animal, the owner's: Full address, including street, city, state, and ZIP code; Gender; Telephone number;
  • Pa Code
242 PA. CODE 28, § 25.131 (Westlaw Next through Pa. Bulletin, Vol. 43, Num. 3, dated January 19, 2013).
Currently, veterinarians are not required to report to Pennsylvania's PDMP, but there is pending legislation that if passed would require veterinarians to report. 243 This proposed legislation has been tabled
  • Pennsylvania
Pennsylvania: 242 Currently, veterinarians are not required to report to Pennsylvania's PDMP, but there is pending legislation that if passed would require veterinarians to report. 243 This proposed legislation has been tabled. 244
Sess.); e-mail from J. Ronnie Higgins, Spec
  • Ga See
  • Code
  • Ann
See GA. CODE ANN. § 16-13-65(a) (West, Westlaw Next through the 2012 Reg. Sess.); e-mail from J. Ronnie Higgins, Spec. Agent in Charge, Ga. Drugs and Narcotics Agency, to author (Dec. 26, 2012, 18:14 EST) (on file with author).
Dep't of State Legis. and Regulatory Affairs Am), https://www.avma.org/Advocacy/StateAndLocal/Pages/State-Leg-Update
State Legis. Update April 2013, Dep't of State Legis. and Regulatory Affairs Am. Veterinary Med. Ass'n (April 16, 2013), https://www.avma.org/Advocacy/StateAndLocal/Pages/State-Leg-Update-April-2013.aspx. 64 Grubb, supra note 60. 65 MASS. GEN. LAWS ANN. ch. 94C, § 24A (West, Westlaw Next through Chapter 416, except for Chapters 371, 379, 398, 402 and 403 of the 2012 2nd Ann. Sess.).
Dispensing Practitioner's Implementation Guide, Ariz. Bd. of Pharmacy Prescription Drug Monitoring Program
  • Info Designs
INFO. DESIGNS, L.L.C., Dispensing Practitioner's Implementation Guide, Ariz. Bd. of Pharmacy Prescription Drug Monitoring Program, 3-4 (April 2013), http://www.azpharmacy.gov/pmp/pdfs/manual%20(practitioners)(asap%204.2)%2004-01-2013.pdf; ARIZ. REV.
1545 (West, Westlaw Next through the
  • Nev Rev Stat
  • Ann
NEV. REV. STAT. ANN. § 453.1545 (West, Westlaw Next through the 2011 76th Reg. Sess. of the Nev. Leg. and technical corrections received from the Legis. Counsel Bureau (2011)).
§ § 19-03.5-01 to -10 (West, Westlaw Next through the 2011 Reg. and Spec. Sess
  • D Cent Code
  • Ann
D. CENT. CODE ANN. § § 19-03.5-01 to -10 (West, Westlaw Next through the 2011 Reg. and Spec. Sess. of the 62nd Legis. Assemb.).