Internet Pharmacies: BUYER BEWARE

By:  Loren W. Noblitt, D.V.M., M.S.
    
     In the past, veterinarians supplied prescriptive and non-prescriptive drugs and medications directly to clients. And while I believe that clinging to the past is no way to invest in the future, the advent of third party online pharmacies really complicates “best medicine” practices for veterinarians and, in many cases, could be putting your pet at risk. I write many prescriptions for clients on a daily basis to be used at “human pharmacies” and don’t think twice about it because I know who I am dealing with. Not so, when it comes to online pet pharmacies. There is much controversy regarding online pet pharmacies and whether they are a good choice for pet owners.
     The advantage to online pet pharmacy for the consumer has been pricing options and the convenience of home delivery, rather than having to visit their veterinarian’s office to fill or refill prescriptions. (By the way: Have you checked out our NEW ONLINE PHARMACY yet? Click Here to Do So!). The disadvantages, most of which are unknown to the consumer, are listed below. For these reasons, Zionsville Animal Hospital is hesitant to endorse their use:

     1.   Lawsuits against Internet pharmacies have been filed for multiple reasons, including selling counterfeit products.

     2.   Products purchased from a veterinarian are guaranteed. If your pet has an adverse reaction, the manufacturer will take responsibility for the cost of care – not true if purchased online or at a pet store.

     3.   Manufacturers sell only to veterinarians, therefore we know the product IS genuine. Online pharmacies buy from many sources (see below), including overseas. Storage temperatures, expiration dates, and the true manufacturer (though the package may look the same) are often UNKNOWN.

     4.   At Zionsville Animal Hospital, we offer product education and oversee your pet’s health. We can address your questions and advise on product use. Our doctors are required by the AVMA to have examined your pet within 12 months prior to dispensing medications or prescriptions for medications, to minimize the risk inherent with any medication.

     At least once per week, I receive a request from an online pharmacy to fill a prescription for a client, such as1-800-PetMeds or Drs. Foster and Smith. Once we’ve determined that a particular pet can safely receive the medication in question, we, the doctors at Zionsville Animal Hospital, have adopted a policy where we literally send the hand-written prescription to the client’s home address for them to mail or fax into the online pharmacy.

     Many online pet pharmacies are NOT legally permitted to buy their merchandise directly from Veterinary Pharmaceutical Companies and therefore often rely on diverted merchandise from unscrupulous veterinary practitioners and/or other “back channels”—whatever that means. The expression, “one bad apple spoils the bunch” is very apropros because it is not illegal for veterinarians to sell their supplies to these companies; however, it IS violating their contracts with many Veterinary Pharmaceutical Companies to sell drugs to online pharmacies and should they be found out, those veterinary practices lose their ability to purchase products from that particular pharmaceutical company in the future.

     I have never personally been propositioned by one of these online pharmacy companies (yet!), but know veterinarians that have—usually under the guise of something like “this opportunity is a simple, confidential, and no-risk profitable exercise.” I found one such veterinarian’s (Dr. Georgina Marquez) comments very interesting, “All I need to do is make one or two phone calls and they will take care of the rest. And it will be done totally confidentially?  Really? This is the way legitimate companies operate?” She goes on to point out that most of these online pharmacies are based in Florida and it’s likely NOT a coincidence—it’s a lot easier to distribute counterfeit medications arriving from the Caribbean when you’re that close to the source.  While online pharmacies can be an inexpensive and convenient alternative to purchasing these drugs through a veterinary office, pet pharmacies are not regulated the same way human pharmacies are.  Dr. Marquez goes on to say, “if the FDA and the DEA have trouble keeping human pharmacies on the level, what do you think the level of control aimed at online veterinary pharmacies is? These online outlets know that the legal ramifications of your pet’s drug reactions can’t touch companies of their size. As long as counterfeits and questionable expiration dates abound in the online pet drug marketplace, its buyer beware all the way.” – Georgina Marquez, DVM

     Some of the Internet sites that sell pet drugs represent legitimate, reputable pharmacies, says Martine Hartogensis, D.V.M., deputy director of the Office of Surveillance and Compliance in FDA's Center for Veterinary Medicine (CVM). But others are fronts for shady businesses operating against the law. The CVM is the regulatory body within the FDA that oversees the manufacturing and distribution of animal drugs. Individual state pharmacy boards regulate the dispensing of prescription veterinary products.

     The CVM is especially concerned that pet owners are going online to buy two types of commonly used prescription veterinary drugs: 1) Non-steroidal anti-inflammatory drugs (NSAIDs) and 2) Heartworm preventives. Both drugs can be dangerous if there is no professional involvement. Veterinarians often prescribe NSAIDs to relieve pain in animals. NSAIDs should not be purchased on the Internet without a veterinarian's involvement because animals should undergo blood testing and a thorough physical examination before starting NSAIDs, they should be monitored by a veterinarian while they are taking NSAIDs, veterinarians should discuss possible side effects of NSAIDs with the owner, and the prescription should be accompanied by a Client Information Sheet that explains important safety information to the owner.

     Heartworm disease is a potentially fatal condition transmitted by the bite of a mosquito that is carrying infected larvae of the heartworm parasite. Dogs, cats (and ferrets) can get heartworm disease. Heartworm preventatives, given monthly, kill the larvae before they become adult worms. The American Heartworm Society recommends using heartworm medication for dogs year-round, no matter where you live in the United States and getting dogs tested yearly to make sure they're not infected with heartworms. "Testing is important even in dogs regularly treated with heartworm preventive products due to the occasional reports of product ineffectiveness," says Hartogensis. An online pharmacy veterinarian cannot draw blood from the animal to perform the test. If the test isn't done, a pet owner could be giving heartworm preventives to a dog that has heartworms, potentially leading to severe reactions such as anaphylactic shock.

     If you are determined to order from an online pharmacy, order from a web site that belongs to a Vet-VIPPS accredited pharmacy. Vet-VIPPS—the Veterinary-Verified Internet Pharmacy Practice Sites—is a voluntary accreditation program of the National Association of Boards of Pharmacy (NABP). NABP gives the Vet-VIPPS seal to online pharmacies that dispense prescription animal drugs and comply with NABP's strict criteria, including federal and state licensing and inspection requirements, protecting patient confidentiality, quality assurance, and validity of prescription orders. Look for the Vet-VIPPS seal displayed on a pharmacy's Web site or check with NABP5 (click on "Accreditation Programs") to find out if a pharmacy is Vet-VIPPS accredited. Because this is a newer program, a small number of pharmacies are currently Vet-VIPPS accredited.

     In summary, many pet owners are seeking lower prices for medications needed by their pets through the use of online pet pharmacies. The best way to assure yourself that the medication you purchase is safe, has been stored properly, is genuine, and has not been diverted—is to purchase the medication directly from your veterinarian. The products we sell on our veterinary website meet all of these criteria and are competitively priced for our clients, eliminating the need for them to search out and be scammed by the less than legitimate online pharmacies that are currently operating.

Sources:

1. The Veterinary Information Network: www.vin.com

2. Dr. Georgina Marquez’s blog article: The Dangers of Veterinary Internet Pharmacies. http://www.animalmedcenter.com/news-and-press/article/the-danger-of-veterinary-internet-pharmacies

3. The Food and Drug Administration’s website link to Buyer Beware: http://www.fda.gov/downloads/forconsumers/consumerupdates/ucm115432.pdf

4. The National Association of Boards of Pharmacy (NABP): http://www.nabp.net/

A Clean Mouth is a Healthy Mouth: February is National Pet Dental Health Month!

        By: Loren W. Noblitt, D.V.M., M.S.

I just love the Orbit gum catch phrase, “Got a dirty mouth?  Clean it up!”  Unfortunately, dogs and cats don’t/can’t chew gum sooooooo – we need to talk about how to best “clean it up” when it comes to their mouths!  Once again, February is upon us, and as you may or may not know, February is National Dental Health Month, in both human beings and animals.  What does this mean for you and your pet(s)?  The benefits to your pet are numerous (and subsequently elaborated upon below) and the benefits to you are a more active, healthy pet and a pet that will, on average, live 2-4 years longer!  PLUS, if you schedule a full dental cleaning with us this month (February), you will receive a 15% discount, JUST BECAUSE IT’S FEBRUARY!  That’s pretty cool!  Keep reading on for more information regarding the many, many benefits your pet will experience from a full mouth dental cleaning…

Dental Disease:

Image courtesy of http://www.avma.org

            Periodontal disease is defined as disease of the periodontal ligaments, gums, and tooth sockets of the jaw that hold teeth in place.  It occurs from plaque that grows on the enamel surface of teeth which then anchors-in bad, anaerobic bacteria.  These bacteria secrete degradative toxins that destroy these supporting structures.  Dental disease is a progressive disease, but can be reversible if caught early enough.  Dogs and cats do not show pain the same ways that we do, and are unlikely to stop eating from mouth pain, even severe mouth pain.

 

Common signs of dental disease in small animals include halitosis (bad breath), crying when mouth or teeth are touched (or chattering in cats), and stained teeth.  Consequences of an infected mouth are not just isolated to the mouth, but can be far-reaching and can include downstream infection in virtually every organ in the body, most commonly the liver, kidneys, and heart.  For this reason, your pet, on average, will live 2-4 years longer with regular dental cleanings and good at-home preventative care.

 

The Dental Procedure:

           Although not mandatory, the staff at ZionsvilleAnimal Hospital prefer to have relatively recent blood work (routine CBC and Chemistry panels) performed to be reasonably sure that your pet is not a risk for anesthesia.  A physical exam is also important in making this decision.  While your pet is under general anesthesia, he/she will have an intravenous catheter placed and fluids hooked up to that catheter from start to finish, as well as a Veterinary Technician monitoring vital parameters such as blood pressure, heart rate, and oxygenation.  Your pet’s teeth are then cleaned with an ultrasonic scaler, focusing on removing not only the debris seen with the naked eye (supragingival calculus and tartar) but also that which lies underneath the gum-line (subgingival calculus and tartar).  Polish is then applied to all teeth.  Your veterinarian will be examining every nook and cranny of the oral cavity and making meticulous notes throughout the procedure.  This is also primetime to make sure that there are no infected, broken, or otherwise worrisome teeth that need extracted, root canal therapy, or some other form of T.L.C.  We also have the ability to take dental x-rays to allow us more incite into the severity (or lack thereof) of every tooth.  Sometimes we find growths in animals’ mouths (i.e., on the tongue or base of the tongue, inside cheeks, gingiva, etc.) that nobody knew about and there is no better time than the present to diagnose and treat these.

 

Preventative Care:

After your pet’s teeth have been professionally cleaned, the focus immediately shifts to preventative care by discussing things like at-home daily tooth brushing (the gold-standard), water additives, Kong toys, and Veterinary Oral HealthCommission (VOHC)-approved products (i.e., products scientifically proven to prevent plaque and tartar formation by 60-75%).  As a general rule, excessively hard toys should be avoided because they are prone to breaking teeth which leads to dental root canal exposure which leads to local and systemic infection.

 

Summary of Key Points regarding Dental Health in Pets:

It's not just about the teeth -- There is plenty of documentation not only in the veterinary field but in human dentistry proving that infection within the mouth will spread to other organs in the body, particularly the liver, kidneys and heart.

Periodontal Disease is more common than you think -- Periodontal disease which affects the gums and supporting structures of the teeth are present in 85% of all patients older than 4 years of age!

Your pet will live longer -- Cleaning your pets teeth and treating dental conditions can result in your pet living 2-4 years longer!

Dental disease is uncomfortable -- Remember, dogs and cats do not show pain the same way that we do. Very rarely, will an animal stop eating because of oral pain. What we do see is that after a dental cleaning/treatment, the pet may become more energetic and playful as the dental cleaning has removed all the harmful bacteria from the mouth and limiting its spread throughout the body.

 

If you’d like to schedule a full dental cleaning, or suspect that your pet may need a dental cleaning, call Zionsville Animal Hospital at 317-873-1833 to make an appointment or schedule a consultation.  If you do so before February is out, you’ll receive a 15% discount – but regardless of when you and your pet come in, he or she will likely be more energetic and systemically healthy as a result!

 

 

Sources:

1. The Veterinary Information Network: www.vin.com
2. The American Veterinary Medical Association (AVMA): https://www.avma.org/Events/pethealth/Pages/February-is-National-Pet-Dental-Health-Month.aspx