Animal Medicines and the Law


As vets, we regularly get stick over animal medicines. Does my dog need that vaccine? Why did you give my cat that wormer? Isn’t there an alternative treatment with fewer side effects? These are all clinical decisions, and we’re all prepared to debate the risks versus the benefits of any medicine choice. But one of the things that really hurts is where we are constrained by the law, do our best in accordance with the law, and then get slated online or in person for it. My colleague Pete has written an excellent blog about vets fees in general, but he didn’t cover the medicines side. So, in this blog, I’m going to explore the UK’s medicines laws in a little more detail, and try to explain some things that people find confusing… For example, why it is that veterinary drugs are more expensive than human ones, why we can’t prescribe the cheaper human version, or why we can’t accept unused drugs back into stock for a refund.

 

It’s all about the money…

No, it isn’t. There are very few vets who are on commission – for most of us, we earn our salary whether we prescribe something or not. Even when we are, we’re professionals – our duty of care is to the patient in front of us, and there are very few vets who would deliberately break that. Any that do, bluntly, do not deserve to be in this profession. I will happily talk about medications, and if there is a legal alternative that’s cheaper, I’m happy to supply or prescribe it. The trouble is, that isn’t usually the case…

But even if you don’t believe that, remember that apart from anything else my Membership of the Royal College of Veterinary Surgeons is what allows me to earn my living. When I first qualified, it was drilled into us that the easiest way for a vet to be struck off was to breach the medicines laws, and that’s not something I’m willing to do.

 

What laws govern medicines?

There are three key pieces of legislation that govern the use of veterinary medicines in the UK – the Veterinary Surgeons’ Act 1966 (VSA), the Veterinary Medicines Regulations 2013 (VMRs) and the Misuse of Drugs Act 1971 (MDA).

The VSA sets the scene, making the point that prescribing a medicine (i.e. the act of deciding which medicine a particular animal should receive) is an act of veterinary surgery and that therefore, with a few exceptions, only a vet can make that decision.

The VMRs cover the nuts and bolts: how medicines are classified, authorised, sold, supplied, by whom and to whom, and so on, while the MDA covers “Controlled Drugs” (CDs) – those with significant potential for abuse.

 

Myth 1: Veterinary medicines are either prescription or over the counter

There are actually many more classifications than that! In general, we divide veterinary medicines into five categories:

  • POM-V – Prescription Only Medicine, Veterinarian. These drugs may only be prescribed by a vet, and can only be supplied by a vet or a registered pharmacist. The vast majority of medicines used in animals fit into this category. This includes all antibiotics, most painkillers, and many of the most effective flea and worm treatments.
  • POM-VPS – Prescription Only Medicine, Veterinarian/Pharmacist/Suitably Qualified Person. These are drugs, generally, for the prevention, rather than treatment, of disease, in food producing species (defined in the UK to include cattle, sheep, pigs, and horses). They can be prescribed by a vet, or a pharmacist, or a Suitably Qualified Person, or SQP, and are commonly sold at feed merchants, farm stores, and online.
  • NFA-VPS – Non-Food Animal, Veterinarian/Pharmacist/Suitably Qualified Person. Again, these are mostly drugs for preventing disease, but in companion animals such as dogs and cats. Most of them are flea and worm treatments.
  • AVM-GSL – Authorised Veterinary Medicine, General Sales List. These are the least heavily regulated medicines because, in general, they have the least capacity to cause harm, and may be sold by anyone. You can often find them in supermarkets, but they are often the least effective drugs on the market.
  • SAES – Small Animal Exemption Scheme. These are antiparasitic drugs that are used in small pets (cage birds, gerbils, guinea pigs etc) and are exempt from normal medicines laws. Again, can be sold by any person to any person without restriction.

On top of that, there are 5 categories of Controlled Drug, which are potential drugs of abuse, have much more stringent controls on their use, recording, and storage.

Schedule 1 drugs (such as LSD) cannot be used without a Home Office license and are not generally used in veterinary medicine. Schedule 2 includes potent painkillers like methadone or ketamine, and anaesthetics like ketamine; these are very highly controlled. Schedule 3 is for slightly less addictive drugs like the medium-strength opiate buprenorphine, the barbiturates and midazolam; and Schedule 4 is a step lower again, for very weak opiates (butorphanol), diazepam, and hormonal preparations like anabolic steroids. Schedule 5 is for products with very low concentrations of an active ingredient that would otherwise be controlled more tightly, such as the codeine in paracetamol/codeine preparations.

 

Myth 2: Vet medicines are the same price as human ones but vets inflate the prices

Not true at all – in general, veterinary medicines are much more expensive for us to buy than their human equivalents, because the potential market is smaller. It costs many millions of pounds to bring a veterinary drug to market, and the manufacturers want to get their money back – but if a drug is licensed for dogs (say), there are 8 million in the UK, compared to 65 million humans. So the market is only ⅛ the size, so the cost has to go up.

In addition, human drug prices are pulled down by the massive buying power of our NHS (and the state healthcare systems of other developed countries), which makes the drug companies compromise. That isn’t the case in the veterinary world.

 

Myth 3: Vets can prescribe human alternatives but choose not to

Prescribing law in the UK is very, very clear on this. I can indeed prescribe a human drug but ONLY if there is no suitable veterinary alternative. It is a criminal offence to use a human medicine instead of a licensed veterinary one in an animal for reasons of cost. If the patient is allergic to the veterinary form, or they are so big or so small that I can’t dose them accurately, or there simply isn’t a veterinary form, then fine. But just because it’s cheaper isn’t an acceptable reason!

 

Myth 4: Vets refuse to give out prescriptions

Actually, we’re not allowed to. If you want a prescription to buy online, we have to give you one. However, we will specify the specific medication on it (and you’re not allowed to fill it with a human generic, see above!).

The other thing to be aware of is that on the internet it’s buyer beware. I’m aware of a number of incidents of (very convincing) fake medicines being sold by unscrupulous internet sites. Buying online is great – just make sure you’re using a legit company; I’d recommend you choose one accredited by the Veterinary Medicines Directorate’s AIRS scheme.

 

Myth 5: Vets won’t repeat prescriptions because they’re losing money

In reality, the length of time a written prescription can last for is specified in law – 6 months for most drugs, 28 days for the majority of controlled drugs. A prescription for longer than that is not legally valid. In addition, we are required to have carried out a clinical assessment of the patient before prescribing medication, and we are also obliged to make sure that the animal has been seen recently enough that they are genuinely “under our care”. For most vets and most animals, most of the time, that means within 6 months, although for some products we may choose to allow a 12-month period.

However, for unstable or sick patients, or for drugs with a high risk of side effects, we may decide it is safest to see them more frequently to check there aren’t any early, subtle problems that an owner might miss. Money isn’t really a factor for most vets – we’re far more afraid that we might miss something that proves fatal to your pet than that we lose cash!

 

Myth 6: Vets choose not to accept returns

Again, it’s a legal restriction – if we can’t guarantee exactly how the medication has been stored, we cannot ethically redispense it. A medication that has got wet, exposed to too much light, or too hot can be chemically altered (not just fridge stuff – a radiator or a car in summer can easily get hot enough to damage even a tablet in a sealed blister pack). Usually, it “just” doesn’t work properly; however, in some cases it may actually become toxic and harmful. It isn’t worth the risk. Any drugs you return won’t go back on the shelf – they’ll go in the pharmaceutical waste bin (which, by the way, we have to pay to get disposed of safely).

 

The medicines laws are very detailed, and I’ve just skimmed the surface here; however, if you want to know more, talk to your vet! Most practices will be more than happy to explain why their policies and protocols exist.

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18 thoughts on “Animal Medicines and the Law

  1. I understand and appreciate all you say but for example, 32 ml of Metacam costs circa £6 on Vet UK( very reputable, as far as I know) and yet the charge for this- repeat, with no re-examintion, carrying on from initial diagnosis, was £21. How can this be justified?

    1. Mainly because the practice won’t get the drugs in at the same price as the pharmacy. However, the markup structure will be different. For example, the same human drugs often cost a lot more at an independent pharmacy than in a supermarket or a big chain, but that’s because the independent has higher overheads.

  2. I’m curious how it works if the animal has to use human medicine. My cat is asthmatic and has Flixotide which is a human medicine. This costs no more than £30 online, but my vet charges £90. I genuinely can’t see the reason for this, other than the vet making a massive profit. Are they really only allowed to buy it at a more expensive price because they are a vet? Thank you

    1. Actually, it’s the other way round – they’re NOT permitted to buy it at the cheaper price that the NHS and the big human pharmacies negotiate with the manufacturer! As a result, the vet (and thus you) have to pay the full RRP. The online pharmacies that list it are (at least in part) human pharmacies (it’s illegal for a veterinary pharmacy to list it on their website, although they can sell it on request), and are able to take advantage of these discounts.

  3. Ashfield vets at lanchester county Durham see my dog every 6 months for vetmedin 5mg tablets but refuse to give a 6 month prescription as they like to charge every month for prescription even though they only examine the dog every 6 months and he has to be on this for the rest of his life

    1. That is within their rights, I’m afraid. The vet is responsible for the medications they prescribe, and there is no law compelling them to issue a longer prescription – although I think it is very unusual for a vet to refuse to do so.

  4. I was feeling aggrieved because my vet has only given me a 3 month prescription for vetmedin & frusemide when I know he can give me one that lasts 6 months, but your vet sound even worse. However my vet put both medications on separate prescriptions, meaning he can charge me twice!! Money grabbing. I’ve read the blog, however I still 100% believe that it’s all about the money with all vets-I’ve dealt with a few practises over the years. We the owners understand and expect that you are a business and need to make a profit, BUT the mark-up of everything is huge and just pure greedy and you are abusing the fact that owners will do anything to help their pet in need.

    1. I’m really sorry you feel that way – I promise you that it is not “all about the money with all vets” (although I agree it probably is for some). Unfortunately, someone has to pay for the salaries, the building, the support staff and the equipment, and (for historical reasons) most vet practices have chosen to give discounted service fees and put the markup on drugs instead.
      If we really were only interested in the money, we wouldn’t be in this job – the myth of the super-rich vet only ever applied to the owners of big practices and nowadays that era is rapidly passing with increased corporate ownership of practices.

  5. My dog takes epiphen I buy 3 months supply at a time as the vet says they have to do a mesds check before giving any more. When I asked why I was told it was the law ! I am now paying for a consultation fee as well as the tablets every 3mths. Why is this so ?

    1. Epiphen, containing phenobarbital, is a controlled drug under the Misuse of Drugs Act 1971. As a result, the amounts that can be prescribed in one go are much more rigidly controlled. In fact, the RCVS recommend that only 28 days be dispensed at any one time (see their guidance here). Moreover, a prescription for Schedule 3 controlled drugs cannot legally be valid for more than 28 days, so except in extreme circumstances, your dog will need to be seen every time a new prescription is required. Finally, phenobarbital is potentially highly toxic but dogs also develop a tolerance to it, so it’s effectiveness can very quite rapidly over time. As a result, I’m afraid it does sound that your vet is being responsible in how they prescribe – in fact, they’re actually being quite generous!

  6. I run a rescue charity and fund medication for many rehomed dogs. As we’re accountable for the use of donated funds, we buy all repeat medications online from accredited suppliers. We are normally charged between £10-15 for repeat prescriptions (between 3-6 months depending on the drug in question). We have recently received an invoice from a new vet who has charged a prescription fee of £60!! This surely cannot be categorised as “reasonable charge” under RVCS guidelines? On questioning said vet, we’ve been informed that the prescription is a 6 month repeat and therefore they have charged £10 per month. It is my understanding that the prescription charge is an administrative charge and therefore should be the same regardless of duration?

    1. A price per month is not something I’ve ever come across before, I must admit… Might be worth having a chat with the practice to see if this really is practice policy, or a misunderstanding somewhere along the line.

  7. I was intrigued to read Myth no. 3, my vet regularly prescribes the human Gabapentin for my dog, I actually discovered this today, so presumably, he is not able to source a veterinarian alternative, I have also been told that the human drug can cause liver damage to dogs, true or false?

    1. There is currently no veterinary formulation of gabapentin on the UK market so yes, your vet is correctly prescribing the human form on the Cascade.
      There have been a couple of reports of liver damage; most of these seem to be linked to the fact that a few formulations of human gabapentin reportedly have high concentrations of xylitol as a carrier (harmless to humans, toxic to dogs). Avoiding the high xylitol forms should eliminate this as an issue. There are reports of rare live problems in humans too, so yes it is possible, but as far as I know, it’s pretty rare.

  8. Two of my cats are on steroids as all vet tests were negative. When I asked for more my vet said I must take the cats in before she will prescribe more but one was seen 4 months ago, the other just 5 weeks ago. I thought vets only refuse more medication if the animal hasn’t been seen for 6 months?

    1. No – 6 months is the maximum for most medications, but steroids are very powerful, complex drugs with a huge range of effects and side effects, so it’s perfectly reasonable to want to check how the patient is doing after a month or so.

  9. David, you never really answered the qustion from Andrew Robey. My dog is prescribed Metacam and Gabapentin. Can my vet prescribe this medication on one prescription for the full 6 month?
    Obviously this would be my preferred option as it saves me money. I think that Andrew is stating that his vet is only giving a 1 month prescription which clearly costs him more but makes more money for the vet in repeated prescriptions. What are your thoughts?

    1. I’m sorry, that one clearly slipped the net!
      Regarding Gabapentin, there are additional legal controls on this drug as it is a Schedule 3 controlled drug. The advice from the RCVS (the veterinary regulator) is that no more than a month’s worth should be supplied at any one time (except in certain cases of very long standing medications where the dose is known to be stable); a written prescription can only legally last 28 days for this drug as well, and repeat prescriptions are not legal. So, monthly prescriptions or supply is in fact considered the responsible approach to prescribing this drug. For the metacam, there’s no such limit, but it may be that since your vet is doing monthly scripts for the gabapentin, there’s no point doing a 6 months script for it. You could have a chat with them and ask for a repeatable script for the Metacam for 6 months? If your dog’s medication has been stable for some time, and they are likely to be on this long term, it might be worth talking to them about a longer script – perhaps a 3 monthly one?

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