Veterinary Team Best Practices for Handling Opioids

Controlled Substances Best Practices Part 1

This is the first of four weekly posts examining best practices for handling controlled substances in a veterinary hospital. The posts are derived from information in drip.vet's Opioid 411 Anytime course.

Find your state opioid prescribing mandate

Introduction

Now these aren’t laws or regulations but they are good ideas to keep your practice on the right track. First, let’s consider when should we be using opioids and do we need to keep using opioids?

I can tell you after doing the research for this course and in my personal practice of veterinary medicine, I reach for opioids and controlled substances less and less. The risks outweigh the benefits in most cases and every case should include a risk/benefit analysis. The medical benefits of opioids in most canines are just not there. And with the ongoing nationwide opioid crisis, the risks are increasing.

So I consider alternatives to opioids and controlled substances when they are applicable and that allows me to be more judicious with my dispensing and prescriptions. This shift in medicine has caused me to rely on the latest and greatest from my local specialists, like Dr. Christopher Byers, DVM, DACVECC, DACVIM (SAIM), CVJ over at CriticalCareDVM.

Most specialists like that communication from the referring doctors and they will certainly fill you in on the current thinking on opioids and controlled substances for use in your practice.

Ordering

Let’s discuss best practices for ordering in your practice. This step has huge potential for diversion and we want to limit the possibility of those opioids getting out in the supply chain.

The best practice is to have different team members 1) place the order and 2) receive the controlled substance into inventory, do the stocking and do the recording in the log books.

Why? It prevents one person from ordering and then not entering the drugs into inventory. I’ve seen several diversion schemes based on this simple problem in veterinary practices.

Also, order small bottles and lots. If you do keep tramadol on hand, use the 100-count bottles not the 1,000-count. They are easier to count and inventory and there’s less likelihood of a handful of pills coming up missing at inventory.

Use ampules. Now, the ampules are annoying and they’re hard to break but they are designed to reduce diversion because they are essentially one use. For a busy practice manager or practice owner presented with 222 forms at the end of the day, it’s easy and tempting to slap your signature on there and head home. Take the few seconds to review the 222’s, make sure your ordering manager is ordering the appropriate drugs and that it doesn’t have the possibility of diversion.

Remember that the 222 forms are for schedule 2’s and 2N’s, the ones with the highest likelihood of addiction.

Lastly, you may be wondering how those ordering diversion schemes inside a hospital don’t get noticed because someone has to pay for all those drugs. Well the answer often is, no one was checking or paying attention to the invoices, they were just paying the bills. Watch your invoices from your distributors, it’s easy to miss one order in the middle of tens of thousands of dollars in drugs and supplies.

NEXT WEEK IN PART 2: Dispensing and Prescribing

drip.vet's Opioid 411 courses are RACE-approved continuing education covering opioid prescribing by veterinarians in precise detail. This course provides students with a broad range of expert level knowledge on subjects including: The Opioid Crisis in America, DEA Laws and Regulations, Identifying and Stopping Misuse, Opioids in Practice and Best Practices. For more information, click the image below: