Changes to Antimicrobial Drug Access in Canada: A Rural Veterinary Perspective (Part 3 of 3)
November 24, 2017
WHO REGULATES ALL THIS, AND HOW DO WE KNOW WE ARE MAKING THE CORRECT CHOICES WHEN SELECTING MEDICATIONS?
Imagine if the Veterinary Profession in Canada was unregulated. There would be no required credentials to practise veterinary medicine, no standards to be held accountable to, no requirement to further your education and no accountability if you decided to randomly sell drugs to whoever comes along for whatever they want without knowing who they are or if they even own an animal.
There was a time in history when this would have been acceptable, but that time has long passed. Today, veterinarians are not only accountable to their profession but to the patients and clients they serve as well as the public and consumers. There are guidelines, standards, and regulations for everything they do. Without these to govern the profession there would be chaos. We would have limited trade and consumer confidence in animal commodities and our patient care would not have improved at such a rapid rate.
Veterinarians today practise according to the VETERINARIAN'S OATH:
"As a member of the veterinary medical profession, I solemnly swear that I will use my scientific knowledge and skills for the benefit of society. I will strive to promote animal health and welfare, relieve animal suffering, protect the health of the public and environment, and advance comparative medical knowledge. I will practise my profession conscientiously, with dignity, and in keeping with the principles of veterinary medical ethics. I will strive continuously to improve my professional knowledge and competence and to maintain the highest professional and ethical standards for myself and the profession."
With this in mind, we submit our final article of this series written with the assistance of the Saskatchewan Veterinary Medical Association (SVMA) 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 we serve.
WHY DOES THIS MATTER TO RURAL VETERINARY CLIENTS?
As veterinarians, we understand that our clients may not be aware of the regulations we must abide by and that they may be thinking:
- Our local clinic has changed, it is not like it used to be, there are so many rules.
- Are they the only clinic doing this? Why will the clinic down the road still sell this to me and my local clinic has all these new rules?
- There has never been a veterinarian on my place and there never will be. Are these new rules just being made up to suck money out of my operation?
The best explanation available at the moment, is that we are all in a state of change. New regulations around veterinary dispensing of prescription drugs are rolling out in the near future, and all involved will soon have a clear picture of our obligations moving forward. This is only the beginning of the changes coming to antimicrobial drug access in Canada. All veterinary clinics are required to incorporate the changes into their practice as they come. What we need to remember is that it is important that we comply with these regulations to ensure we not only retain rural access to services and medications, but national access to antimicrobials for use in animal health. Because Health Canada has designated the veterinary profession as a key player in the development of our national antimicrobial stewardship strategy, the regulatory changes will put all Canadian antibiotic use in animals under veterinary oversight.
WHO REGULATES ALL THIS? THE COMPLICATED AND NOT SO EXCITING PART OF THE STORY…
In Canada, veterinary medicine is a provincially regulated profession. In Saskatchewan, the Saskatchewan Veterinary Medical Association (SVMA) is responsible for licensing veterinarians and does so by verification of credentials, compulsory registration with annual renewal, quality assurance programs, oversight of continuing education, inspection and certification of veterinary practices, and a process to receive complaints and discipline licenced veterinarians.
These regulatory activities provide a mechanism to ensure that veterinarians possess the required credentials and are held accountable for meeting accepted professional standards when overseeing the use of antimicrobials.
The prescribing of drugs is both federally and provincially regulated for veterinarians who are entitled to prescribe drugs pursuant to the federal legislation in the Food and Drugs Act, Food and Drugs Regulations, Controlled Drugs and Substances Act, Narcotic Control Regulations, Benzodiazepines and Other Targeted Substances Regulations, and Feeds Act and Regulations.
Within Saskatchewan, veterinarians are regulated by The Veterinarians Act, 1987 and The Pharmacy and Pharmacy Disciplines Act.
Regulatory bodies like the SVMA have the authority to take action in cases where the veterinarian’s conduct falls below the accepted professional standards. There exists a professional conduct committee and a discipline committee to ensure veterinarians adhere to the above acts and regulations. If a veterinarian’s conduct is in question, the actions range from correcting compliance and improved education to expulsion or suspension from the association and thus prevention from practising veterinary medicine. Once all the regulations surrounding antimicrobial drug access have fallen into
place, we will all be accountable to the same standards.
This is why veterinarians must take the responsibility of prescribing treatment for animals very seriously.
HOW DO WE KNOW WE ARE MAKING THE CORRECT CHOICES IN MEDICATION SELECTION?
The simplest explanation I have ever been given about antimicrobial resistance is that we must consider each antibiotic as a non-renewable resource. Each time it is used, one dose is removed forever from usefulness again. This means that each time we use it, we must make it count and not waste it by using it inappropriately, or someone (human or animal) may die.
Medication selection is not as simple as picking a bottle off the shelf when a client stops by a clinic and announces their animal is sick. As we learn more about antibiotic selection, it has become clear that if antimicrobials are to be prescribed veterinarians must use professional judgment in determining the correct treatment which 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.
Veterinarians and pharmaceutical companies invest a vast amount of time and money to ensure we know enough about each of the “The Eight Rights” to make the best possible decision; every single time antimicrobials are used.
The Canadian Veterinary Medical Association also supports using the following when decisions on antimicrobial selection are made:
- Therapeutic Decision Cascade for animal and public safety
- ?This is a flow chart to reference when selecting a medication. The decision cascade balances usefulness to the patient with risk to public health and antimicrobial resistance. It serves as an excellent reminder to choose the highest level of safety possible for both the public and the animal(s) being treated.
- Categorization of Antimicrobial drugs based on Importance in Human Medicine: when selecting a product for use, we must consider its importance in human medicine. There are 4 categories to consider. To safeguard the effectiveness of antimicrobials, we must choose the lowest category of drug that will be effective against the disease we are treating and avoid choosing too high a class or these medications will become ineffective. The categories as outlined by Health Canada are:
- Category 1 - drugs that are very high in importance in human medicine. This category contains antibiotics for which there are no other alternatives for use in human medicine. These are considered the “Big Guns”. If resistance to these antibiotics occurs, there are no other options available to treat infections which may be very severe or fatal. Examples of these antibiotics that are currently labeled for cattle include Special Formula 17900 Forte®, Baytril® and Excenel®. As such, these antibiotics can only be usedby strict label instructions (by label dosage, route and for the conditions listed on the label).
- Category 2 - drugs that have high importance in human medicine. This includes the cattle medications: Trimidox, Zactran®, Draxxin®, Micotil®, Zuprevo™, Cefa-lak® and penicillin’s
- Category 3 drugs are of medium importance. Cattle examples are Nuflor®, Resflor®, CalfSpan™ and Oxymycine LA
- Category 4 contains the ionophores (ex. Rumensin®) which are of low importance as these are not used in human medicine.
So, in closing, we must all do our part to prevent and slow the development of antibiotic resistant bacteria. We must think twice about which antibiotic we are selecting for a given problem. This becomes simpler by using veterinary consultation, using drugs on label, only when needed and with confirmation of the disease we are treating. These changes will encourage us to shift our focus from treatment towards prevention of disease by using good management, nutrition and vaccination programs. Finally, when you have sick animals, we encourage you to consult with your Veterinarian who will help you to make the best possible decision for your pet, your herd and the future.
We look forward to the day when these changes are complete, the regulations are finished and all livestock owners, pet owners, and veterinarians have settled into the new reality of antimicrobial stewardship and access in Canada.
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.