{"id":31773,"date":"2022-10-10T20:35:24","date_gmt":"2022-10-10T20:35:24","guid":{"rendered":"https:\/\/todaysveterinarypractice.com\/?p=31773"},"modified":"2022-10-10T21:02:11","modified_gmt":"2022-10-10T21:02:11","slug":"safeguarding-controlled-substances-in-the-practice","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/pharmacology\/safeguarding-controlled-substances-in-the-practice\/","title":{"rendered":"Safeguarding Controlled Substances in the Practice"},"content":{"rendered":"

Controlled substances are essential to providing patient care in most veterinary practice settings; however, they are also highly addictive and subject to abuse by humans. Human drug overdose deaths have been steadily climbing since the early 2000s. In 2020, almost 92<\/span>\u2009<\/span>000 people in the United States died from drug overdose, with 56<\/span>\u2009<\/span>516 of those deaths resulting from synthetic opioids other than methadone (primarily fentanyl).1<\/sup><\/span><\/p>\n

Owing to the risks associated with abuse of controlled substances, The U.S. Department of Justice (DOJ) and state governments implement and enforce regulations pertaining to the oversight of these drugs. This article provides some insight into what the regulations are trying to accomplish as well as tips for compliance in veterinary practices.<\/span><\/p>\n

Regulatory Landscape<\/h2>\n

The Controlled Substances Act is part of Title 21 of the United States Code. This act includes a list of all scheduled drugs, and any drug or chemical included on this list is considered a controlled substance (<\/span>BOX 1<\/b><\/span>).2<\/sup> If something is a controlled substance in the United States Code, then it is federally controlled. However, each state has its own controlled substance acts that may include additional drugs\/chemicals, making those controlled substances at the state level. If there is a conflict between the federal and state acts, the more stringent prevails. Practice owners and managers need to review both state and federal regulations for the <\/span>complete details of laws applying to veterinary practices.<\/p>\n

BOX 1 Federal Drug Schedules2<\/sup><\/div>
Schedule I:<\/strong> Drugs\/substances with no established medical use and a high potential for abuse.<\/p>\n

Schedule II:<\/strong> Drugs\/substances with a high potential for abuse but an established medical use. Use of these drugs may result in severe psychological or physical dependence.<\/p>\n

Schedule III:<\/strong> Drugs\/substances with a moderate to low potential for physical and psychological dependence.<\/p>\n

Schedule IV:<\/strong> Drugs\/substances with a low potential for abuse and low risk of dependence.<\/p>\n

Schedule V:<\/strong> Drugs\/substances with a lower potential for abuse compared with Schedule IV.<\/div><\/div>\n

To add to this, gabapentin is well known for its ability to potentiate the effects of opioids, making it a highly diverted drug. Although gabapentin remains a noncontrolled drug at the federal level, states are starting to implement their own requirements for increased gabapentin oversight compared with other noncontrolled medications.3<\/sup><\/span><\/p>\n

Owing to their public health importance, these regulations are strictly enforced, with large fines for noted violations. While veterinarians strive to comply with all regulations, the number of regulations, their variation between states, and their application in the veterinary setting make compliance a challenge. <\/span><\/p>\n

Importance of Compliance<\/h2>\n

In human health care, it is estimated that 10% to 15% of healthcare workers will abuse drugs at some point in their career and that 80% to 93% of diversion goes undetected.4<\/sup> In a human healthcare study, 98% of providers indicated that they were concerned about hospital drug diversion and 70% strongly believed that most diversion goes undetected. However, only 36% believed that undetected drug diversion was a problem at their facility.5<\/sup> These studies indicate that although healthcare professionals are aware that drug diversion is a significant problem, there is often an impression that it\u2019s \u201cover there and not here.\u201d <\/span><\/p>\n

Similar data do not yet appear to be readily available in veterinary medicine. However, similar trends are likely, and several recent reports of drug diversion in veterinary practices have been published.6-9<\/sup> These occurred throughout the United States, with the diverting employees including veterinarians, veterinary nurses\/technicians, and receptionists. With fines up to $14<\/span>\u2009<\/span>502 per recordkeeping violation,10<\/sup> these cases resulted in significant monetary consequences for the practice well beyond those of the lost drugs. <\/span><\/p>\n

Areas of Risk in Veterinary Practices<\/h2>\n

To understand how to comply with controlled substance regulations, it is important to identify what they are trying to prevent: not only diversion, but also various opportunities for diversion. The goal of controlled substance regulations is therefore to make it sufficiently difficult for anyone to divert drugs at any point in a <\/span>drug\u2019s life cycle. For veterinary practices, the period from procurement through when the drug is administered, dispensed, or disposed of is the focus of concern. <\/span><\/p>\n

Depending on the required and optional safeguards that are in place, some tasks during this period may represent an increased risk for diversion, such as:<\/span><\/p>\n