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.