Kristi Henderson American Veterinary Medicine Association

Thank you all and I also want to thank
the organizers of this event to get such a broad group of minds together
across various disciplines, because it is going to take all of us
to solve this. I was hoping that there would be individuals from the human health care
sector here i’m told that they are not but if i’m wrong is there yes awesome
it is as a veterinarian and I suspect as human health care we’re in
a sticky wicket in that our patients need the medications or the
items in many cases in which you’re finding in in the analysis so whether
it’s prescription selection understanding the pathogen that we’re
fighting or other alternatives so that medications may not need to be necessary
or necessary as long I think that would be welcomed information by both
human and veterinary sectors. So I also want to give a plug, because
the last speaker did mention disposal. You can do that in your local community,
but the DEA is also offering the national take back day, April 30th,
and you can check their website for the local site near you. Whether it’s controlled substances, or
non-controlled, they are collecting them all day. It’s amazing how much that they do picked up so I definitely wanted to give that a plug
hope you’re going to utilize that if you have especially we heard one from what
1967 or ’63 so the pharmaceutical disposal challenges that we face that
you guys have talked about many of these already and you’re aware of most of them
where the veterinarians have the it seems like an impact or where our focus
might be is that the bottom two is the issue that when we’re talking to our
clients or we’re talking to other veterinarians or regulators we are
competing for their time and it attention when so many other items are
also competing for the same amount so sometimes it just doesn’t register with
them or then we get into the bottom bullet, where there either is confusion
and confusion rise because as we’ve already acknowledged the problem is
there we don’t know how to mitigate it yet we need to use the drugs but we
don’t everybody pees everybody poops so there we go, how do we get that out of a system once that it’s there or if we’re trying to protect
ourselves from sunburn or we’ve got flea and tick control on our dogs or cats and
then they get the bathroom and they go swimming so there’s all kinds of
contributors to this then the bottom bullet like I said, I can understand that
confuse to be uninformed it’s very frustrating. The veterinary community when we come across somebody who just doesn’t care so then one of our jobs is
to help them to understand why it’s important to care and when we convey
that to them as a human and then drinking everybody else’s medications or
disinfectants then it starts to register so the impact that veterinarians can
have you see up there a basic list of from the 2012 source book on
demographics on the basics of animal owning households number of dogs number
of cats and birds of horses these are more the companion animals so with them
and even if at in 2012 we were having visits per household per years around 6
million so that’s potentially six million opportunities where we can help
remind the animal owners of the need to dispose of these properly but the best
need not to have to dispose of them is to give the medications through their
complete prescriptions to store them properly if they’re stored properly then
they will be useful longer like a typical one might be clavamox in the
human realm it’s like basically a cousin to augmentin but not as strong but if
it’s mixed with water and it’s to stay refrigerated but if it does not
stay refrigerated and they left it in the car after they left the veterinary
clinic its effectiveness drops dramatically and then they need to
dispose of that and come back in and get another one so or then worst case
scenario drug was not stored properly child gets into the drug or an animal
gets into the drug and then you might have a fatality so we stress that to
them and then that helps with the storage issue the what’s not on here are
some of the production animals the AVMA has been advocating for years that
veterinarian have greater oversight in the use of antimicrobials and other
medications used in production animals and animals in general what you might
not be aware of is the FDA has passed its final rule for the veterinary feed
directive so the medications that are in animal feeds where at one time were some
of them were over the counter they are going to be no longer over the counter
and it is also illegal to use veterinary feed directive off-label so it can only
be used as the directive states the directive is similar to prescription but
not quite a prescription has to be on a veterinarian order and is made up
specifically for a facility so that’s a win and it’s a start of
involving the veterinarians more in the medications that are provided to the
owners you can still go to pet stores farm stores and see over-the-counter
medications just as you can go to any human pharmacy or I won’t send
a chain store so we can matter, which change store I was going to say and
there’s medications that you can get over the counter so both in human and
animals that’s a common ground item that both in art in the veterinary field the
animal owner education is needed and in the human health care the individual
client education is needed because not everything is going to get better with a
drug but I fear that society’s perception is that a drug is needed for
you get better and if a drugs not there
you’re not going to get better or why do you even go to the to the doctor the
veterinarian if they’re not going to give you a drug but antibiotics don’t do
anything against the virus they can help protect against a secondary infection
but sometimes we need to allow our own immune system to tackle the item so
for pharmaceutical disposed our client education one of the main mantras do not
flush and the AVMA partnered with Illinois Indiana Sea Grant actually the
National Sea Grant office represented by the Illinois Indiana Sea Grant and we
have a memorandum of understanding with them and part of that is messaging to
animal owners as a potential to reach people on a daily basis through our
through our membership so art like I said our key messages don’t flush if you can’t flush because some of the agencies were telling you to flush so
anybody from DEA all right so part of the DEA anti diversion because
if any if any traces left in a bottle or there’s pills listed on there and
anybody know what skittling is that’s sad isn’t it somebody does know and
that’s people are going to start dying from that if they’re not already
basically for the rest of you guys basically people in how should I say
this some folks will rate other folks is medicine cabinets put all the pills in a
in a bowl you have a party and you grab a handful of pills and then you pop the
pills and then you have a chemical experiment in your body so that’s what
can i say i die i guess that was a bad enough I shouldn’t even gone there but
that also goes to the store properly, which is the second part follow
prescription labels, which we said to begin with so if you’re if a doctor
prescribes a human medication for so many days at so many times I’ve
been in a car accident I know this is a really good pain that I might
it later and i’ll save it and i’ve done that but i also need to be aware of then
that medicine cabinet could be a risky situation if someone chooses one of my
guests choose to come in and skittle or if it was stored in a different
place and dogs or cats could get into it then i put in there to follow the
disposal instructions your veterinarian will often tell you if you complete the
medication there’s nothing to dispose of your animal is already doing that
through its feces and urine but if you do have to dispose of at least now with
changing regulations a lot of the pharmacies have take back visit drop
boxes at their facilities and also law enforcement does too so those are always
clear options then there’s a national t take back day that is on the 30th if you
don’t have a disposal option in your community and you’d like to start one up
the illinois indiana see grants webpage has a means for you two to do that it
has resources and has information for you to get that started in your area so
with the veterinarians you saw an approximate of the number of
companion animal owning public our membership with the American Veterinary
Medical Association members 88,200 and someone
that can basically then be spokesman for proper disposal once we get the right
information to give to the people there’s gaps that we don’t know where we
are reliant on the knowledge of individuals such as yourselves to find
out what is the fate and transport of this drug and if another drug becomes
completely inactivated with I don’t know let’s say it’s as simple as simple as
ultraviolet light for a day and a half, or something like that or a
change in pH so if we have two drugs equally effective one is inactivated or
broken down by a much simpler means than the other one I think that science would
take over pharmacy companies might have a battle to go out with
with educational outreach that we could give our members and I’m sure that the
human health care would want to give there’s that we can we can make a
difference we just don’t have the information to make that difference yet
so we’re very reliant on you guys to help point us in the right direction
with the members right now some of the things that we do our inventory control
because we have if we get fewer drugs in fewer drugs are going to expire and
fewer drugs will need to be disposed of so that also then sends a message to the
drug makers we are not ordering as much please don’t make as much so hopefully
that’s going to make a difference will also rotate stock as items become
short-dated you can often return items to the manufacturer and they will
replace that with the longer dated item and then reverse distribution so
basically even if you have expired drugs is there a broker in your area or that
you can contract with to send that drug for them to dispose of in a more
environmentally friendly means versus the veterinarian disposing of in the
garbage, or if it’s a controlled drug through a special agent in charge with
the DEA or other means like that we’ve the AVMA has asked folks not to just
dispose of in kitty litter or coffee grounds as was mentioned earlier yes
it’s a deterrent for animals and humans humans to a lesser extent depending on
what the drug is but it doesn’t solve the problem so we are trying to use the
brokers and get it into a more controlled disposal stream all pun
intended versus dumping it into our local stream then there’s also training
and compliance not only with controlled substances, which have a plethora of
their own items but also with drugs that are considered hazardous weather there
hazardous according to EPA so if they’re flammable like I virmac is
flammable I’ve got poor odds so you’ve seen flea control products will in cattle there’s also lice control and
other things you can put on their back some of those items are
flammable if the items are corrosive, some of our lab reagents are corrosive
or disinfectants could be corrosive and so their special training that’s need to
be to handle those items and then to document that then also to train the
employees on what to explain to the owners when they are dispensed a
medication or prescribed a medication so if there are any animal owners out here
in the general public and they you don’t get directions from your veterinarian or
even from your doctor when you receive a prescription then ask them ask
your pharmacist whoever you’re getting the medication from they will probably
say you shouldn’t have any left over you can say just by chance how do I and
hopefully that if it’s a pharmacy they’ll have a drop box in their area
they can just point to that and then veterinarians also do waste segregation,
which I suspect that the human health care also does so might not be able to
see it up there but those are some of the drug types that we’ve been talking
about so all the pharmaceutical waste can be broken into is it a
controlled substance is it a hazardous pharmaceutical like some of
the cancer treatments that we have is it radiologic such as some of the
radioactive iodine for treating cats with thyroid cancer things like that and
then we also have mixed waste so if it’s a combination of those then is there a
broker that is in your area that you can contract with to take each of these or
if they can’t take each of them is there only one that they can take so you might
need two or more waste brokers to handle the waste that your particular facility
is generating so this is just the AMAs policy or the best management practices
for pharmaceutical disposal and the previous slide and what I’ve talked
about already basically summarizes this but if you’re curious to what the
the AVMA policy actually is then that’s up on the screen for you but also
available on the internet but we’re just asking ultimately it used to be
a very long very prescriptive bullet pointed item on do this then this then
this then this across states regulations vary and as new information such as
we’re getting from you guys all the time and we hope to get more information what
we need to do actually changes so we soften the language to back off instead
of being so prescriptive to have more of a performance standard so that folks are
aware of changing changing regulations changing options disposal in their area
not to flush not to burn unless you’re specifically permitted by a regulatory
body, which is not going to happen but to that little statement was because if a
Liam a says do not do this our lawyers have said if you say do not do this then
you might create liability for your members so that’s why we had at the
unless directed by an authoritative how and segregate waist train your employees
and I think that the like I said the veterinary world and then also the human
health care world we we have a common ground and that the problem exists
probably exists both in humans and in animals what can we do to help mitigate
it on our end as much as possible with the information that folks like you guys
are giving us with with regulations that the authorities have and are the
regulations lagging so far behind the time that with the information you’re
giving can we help can a via mayor can end can the human health care sector
help get some of those regulations changed so please utilize us as you can
keep us informed and we’re just very happy to be part of the conversation
some of our key items that we dear the advocacy and our targets are the animal
owners veterinarians and then regulators and policymakers
basically what we talked about but again we’re very glad to be part of this
conversation reaching across disciplines because I think that such a cross sector
is going to be needed to help mitigate this wherever we can I’m very hopeful
that we’ll be able to make a difference on some of these substances and I also
recognize that perhaps we we can’t make a difference and perhaps
there’s going to be alternative so we don’t have to use that compound
that we’re not making a difference on anymore I don’t know what the future is
going to hold I already mentioned that we have an MoU with the Illinois
Indiana Sea Grant we also provide information online through through blogs
and items but as I mentioned just a few minutes ago if you have information and
you need regulators suede somehow if if a VMA can be of use to the effort please don’t hesitate to reach out to us to share the information that you
have to share something that even if it’s we’ve been doing something
for decades and then new studies show that actually this is a problem this is
how you can fix it we need to know that too so please let us know and then we
have also a group in our grd office also works on the hill and can influence
legislators so there’s also that capability to so my comm contact
information is projected on the screen or you can also find it avma org likes
it I am I am tickled to be part of the conversation I’m glad that they’re such
a breadth of knowledge and interests in the room so if you have any questions I
I’d love to try to answer them for you you want to stay up we can have time for
a few questions I didn’t see nann she got jaws out of here what what is the
state of them obviously from that I would take that it didn’t cover what’s
what’s happening I mean I that’s beyond my realm I don’t work with the
pharmaceutical company so I don’t know but as the earlier speaker said the
information based on the item the use for the indication are used for which
they sought approval was based on certain study but the new uses are not
reflected or not being the same so it’s deviating from that I’m I’m not
involved in that so I sorry I can’t answer oh I see I would suspect but I would
defer to the previous speaker because a VMA has not been asked for that and
before this conference I was not aware of that particular so a VMA has not
advocated for that we have advocated for approval processes to be transparent and
complete but we weren’t aware that other situation so perhaps the previous
speaker may I don’t know then I did have one you mentioned one of
the objectives for a VMAs to have education of the patients that do you
have any information about what percentage perhaps of that the nyrians
actually talk to patients about that because I know when I go to that date
emergency mention what to do with medicine right we haven’t Dennis baby
may hasn’t done a study on that but I’m thinking and I am the worst person with
names and I apologize about that and she’s not here but I thought that there
was a gentleman from Washington who had done a study with veterinarians I mean
it’s very local study to ask questions like that and it is not coming to mind
what I will do is I will find that information and send it back to you and
Laura and to share with with the group that sorry I don’t have the answer for
that thanks

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