Changes to Antimicrobial Drug Access in Canada: A Rural Veterinary Perspective (Part 1 of 3)
November 24, 2017
It seems change is the norm these days in Canadian agriculture: from changes to livestock identification and dissolution of community pasture systems to the provincial premise identification (PID) program all the way to revisions of federal livestock transportation regulations, the list goes on and on, and is hard to keep up with.
Possibly the biggest topic of questions and discussion this year deals with changes coming to antimicrobial drug use and sales in Canada. As new regulations surrounding access to and use of antimicrobial drugs have been developing, there have been a lot of questions (and some anxiety) in rural veterinary clinics….
- How do we explain these regulations to our clients? Are they going to think these changes are our doing?
- Do we just pretend there are no changes and hope they go away? (not a good option!)
- Do we adopt the changes right away, or would it be better to wait until over the counter access (OTC) through feed companies etc. has been completely phased out?
This is a very trying time to work in a rural veterinary clinic. Like everyone, change is not easy for staff at these clinics, especially when the changes are mandated, and our professional regulators require us to abide by them even if our clients are unaware of, and potentially disagree with, the changes.
Over the next few weeks, with guidance from the Saskatchewan Veterinary Medical Association (SVMA), we will be submitting a series of brief articles to inform livestock producers and pet owners in our area about why these changes are happening, where they are coming from and how they affect rural veterinary clinics along with the clients and patients they serve.
WHAT DO RURAL VETERINARIANS THINK ABOUT THE CHANGES??
Just like everyone else these days, our heads are spinning trying to keep up with regulatory changes, but are rural veterinarians sitting in their tiny little offices, seeking out ways to make clients lives more complicated …. NO WAY! Are they on the front lines of these changes, standing face to face with clients who may be unaware of a changing bylaw or regulation, dreading how they will respond when the changes are explained…. YOU BET!
What an uncomfortable place to be! We know these regulatory changes are necessary. We are not making them, but we do agree with the fundamental need for evolution in how we manage antimicrobials, and we are obligated to comply. We are stuck between the public expectation that we are purely service providers and the regulatory obligation to be professionals. We are balancing the now obvious need for these new regulations, with the task of explaining these complicated things to clients that may either openly embrace the change or strongly object and lash out at us… just because we are the unlucky ones who get to deliver the message. A message filtered down through international, national and provincial legislators and regulators, changing the very relationship between veterinarians and their clients.
We have two choices: one is to cover our ears, continue to mis-use antibiotics, and exacerbate the existing global problem by ignoring the warning signs that how we are using these products is harming us all. The other option is to be a part of the solution, open our minds, and educate ourselves and our clients about all aspects of antimicrobial stewardship in animal care.
WHY DO CANADIANS NEED OVERSIGHT OF ANTIMICROBIAL USE?
The short answer: to ensure antimicrobials retain their ability to save the lives of both humans and animals globally.
The long answer is much more complicated. It involves scientific monitoring by the WHO (World Health Organization) of antimicrobial resistance and the recognition that how we are all currently using these products is affecting future generations. This is leading to the development of national strategies involving federal, provincial and territorial governments, as well as professional organizations, private industry and non-governmental organizations. The strategies are designed to:
- Improve prudent antimicrobial stewardship in both humans and animals,
- Improve surveillance of antimicrobial resistance and antimicrobial use,
- Prevent and control the spread of drug-resistant infections, and
- Stimulate antimicrobial research and innovation.
Along with other countries, Canada is actively building a solid national framework for antimicrobial stewardship and has identified veterinary oversight of this stewardship as a key element. It encompasses the professional involvement of licensed veterinarians in providing guidance or direction for appropriate use of antimicrobials in animals with the objective of ensuring prudent use and minimizing the emergence or spread of antimicrobial resistance.
Effective implementation of the framework is aimed at:
- preventing and controlling the spread of antimicrobial-resistant infections,
- maintaining access to effective antimicrobials for animal health,
- improving animal health and welfare,
- strengthening consumer confidence and public safety and
- meeting the sanitary standards required by our trading partners.
In essence, veterinary oversight is the entire process or mechanism whereby veterinarians, through their education, experience and accountability, provide guidance or direction for appropriate use and distribution of antimicrobials. These actions of the veterinary profession are regulated under provincial authority and each veterinarian is obligated to perform their duties in accordance with their province’s regulation.
The obligations of veterinarians include, but are not limited to:
- Disease Prevention and Control: When contacted by a client, they must work together to obtain enough relevant information so as to be knowledgeable of imminent disease hazards prior to establishing a disease prevention plan and prescribing preventative medication.
- Evidence-Based Diagnosis of Disease: When presented with a sick animal, whether it is an individual or a herd or flock, the veterinarian must take the necessary steps to gather enough relevant medical knowledge and production or performance-related information to establish an evidence-based diagnosis or presumptive diagnosis.
- Prescribing Treatment for Disease: When a disease is diagnosed, reasonably suspected or anticipated the veterinarian must prescribe the most appropriate treatment based on professional evaluation of the evidence at hand. This decision must consider whether antimicrobials are to be used or not. If antimicrobials are to be prescribed, the veterinarian must use professional judgment in determining the correct treatment and may be summarized as “The Eight Rights”:
The right drug, for the right reason, to the right patient, at the right dose, by the right route, at the right time, for the right duration, and with the right records. (gets complicated quickly, doesn’t it?)
- Follow up on Treatment: It is the responsibility of the prescribing veterinarian to ensure that the prescribed pharmaceuticals are used properly. This includes client training and education on appropriate use, handling and storage and being available in the event of treatment failure or adverse reactions.
- Dispensing of Pharmaceuticals: Dispensing is a professional practice activity that is performed by a licensed veterinarian. There are many detailed regulations around how, when and what can be prescribed.
- Keeping Accurate Records: Veterinarians are required to maintain records of all client and patient interactions. This includes all forms of examination and testing undertaken to establish medical need, documentation of all test results, prescribing and dispensing activities as well as the results of treatment.
SO, WHAT ROLE DO RURAL PRODUCERS AND PET OWNERS PLAY?
While veterinarians are bound by professional obligation to follow the regulations set out for them, there is no such obligation for producers and pet owners. There is understanding that owners want to quickly, easily and economically manage anything their animals may face. This is logical, but owners must be aware that proper relationships, examination and diagnosis (also known as a Veterinarian-Client-Patient-Relationship) are necessary for veterinarians to create a safe and effective plan for any antimicrobial use on animals.
As we move forward, producers and pet owners will have a role to play in responsible antimicrobial use as well. This role includes better understanding of the conclusive and definite scientific evidence behind the changes to regulation of antimicrobial use and being willing to establish and maintain the relationship with their veterinarian needed to maintain high quality care for their animals. Changes to how antibiotics are prescribed are coming. We can embrace the admittedly inconvenient, but absolutely necessary changes to how we use antimicrobials and work with regulators by adapting to a safer system that will protect all Canadians, our food supplies and our system of medical care. It is going to take some time for all of these regulations to roll out in full and be implemented, but just like human physicians, veterinary professionals understand the vital importance of changing course before we hit that iceberg.
The Canadian Veterinary Medical Association thanks the writer, Dr. Klea-Ann Wasilow of Maple Creek Veterinary Services, and the Saskatchewan Veterinary Medical Association for permission to share this important information. Download a PDF here.