The 4 P's

Kelley Detweiler and Peter Weinstein, DVM, MBA, discuss the latest developments surrounding xylazine regulation in the United Kingdom and its implications for the veterinary profession. As the UK prepares to classify xylazine as a controlled substance, they look at the timeline of potential legislative actions in both the UK and the United States. 

If you want to just get a quick, what we call a "sit rep," on what's going on here: the reason the xylazine ban in the United Kingdom is becoming such a hot topic is because, well, xylazine and its crises really started Ground Zero—almost in my backyard in Philadelphia. The United States, as everyone probably remembers, got really hot and heavy on it for a while. It was the biggest thing everyone was talking about as 2023 came to a close. In March, the federal government had legislation passed through Congress, but it was standing still. Meanwhile, the states were off to the races. Florida had already acted, then Ohio, West Virginia, and it just kept going.

But then, all of a sudden, there was nothing. On July 11, 2023, the White House put out the different pillars of what they were going to do. But nothing has really happened at the federal level in the United States. If the US acted, they’d likely make xylazine a Schedule III controlled substance, subject to those penalties, but still protecting licit veterinary use.

While all of that has kind of been "to be continued," the UK has moved forward with their initiative. To give some background, in June 2023, the UK Minister for Crime, Police, and Fire commissioned an Advisory Council on the Misuse of Drugs (ACMD). They were looking for guidance on how to appropriately classify and schedule xylazine under the Misuse of Drugs Act of 1971, which is similar to the Controlled Substances Act in the United States.

As things have continued to get worse in the UK, since xylazine is now an international issue, early in September 2023—right after Labor Day—legislation was laid out in Parliament to ban xylazine as well as 21 other dangerous drugs. This is part of a government cooperative action to prevent drug deaths and crack down on gang-related drug activities. The UK is looking to classify xylazine as a Class C drug.

A Class C drug in the UK is considered the least harmful, but it includes substances like benzodiazepines and steroids. If caught supplying a Class C drug, you could face unlimited fines, up to 14 years in jail, or both. This is significant because the UK tends to act more expediently when moving things into regulatory legislation. They would be the first country to take such a step, potentially positioning everyone else—like the US, Canada, and Mexico—to consider their next move.

Can I add a point? It has nothing to do with xylazine specifically, but it relates to the whole opioid discussion. I've done a lot of different things in my career, and when speaking to Kelley 3 or 4 years ago, I learned about the issues within the veterinary profession regarding controlled substances, substance abuse, and diversion. That really piqued my interest in the need to help the veterinary profession understand the risks—risks to their staff, to themselves as veterinarians, and to their clients.

A lot of what we're doing with the talks we give is really aimed at helping the veterinary profession do a better job of protecting themselves. We want them to understand these risks so we don’t have colleagues and friends becoming victims of substance abuse, which can happen all too easily given the stressors in this profession. The biggest part of the vision and mission Kelley and I share is to help the veterinary profession stay clean—not just from substance abuse, but also from compliance issues with the DEA.

Videos

As the UK leads the charge on banning xylazine, Peter Weinstein, DVM, MBA, and Kelley Detweiler talk about what's next for the US

Updates on xylazine regulation in the US and UK

editorial team is counting down our Top 20 news stories and articles of the year, from January 1, 2024, to November 15, 2024. Rank was determined by measurable audience interest and engagement.

A spotlight is shining on 1 article each day through New Year’s Eve, when the No. 1 

story of the year will be shared. The following article is No. 20 on this list:

written by Abi Bautista-Alejandre, Assistant Editor

Colorado public health officials announced the detection of the state’s first human case of tularemia in 2024, in a resident of Wheat Ridge, Colorado.

 The disease mainly affects rural areas, but has been detected nationwide, save for Hawaii.

and is commonly found in wildlife animals.

 The infection is most frequent in rodents, rabbits, and hares, which often experience significant mortality during outbreaks.

 It is also found in insects like ticks and deer flies. Transmission to humans can occur through bites of infected insects, skin contact with infected animals, drinking or eating contaminated water or food, or by inhaling airborne bacteria through contaminated aerosols or agricultural and landscaping dust.

Approximately 200 human cases of tularemia are reported annually in the United States, with most cases being found in western and south-central states.

 In 2023, 9 human cases were reported in Colorado.

"While tularemia is rare, it is important for residents to be aware of the symptoms and take preventive measures," said Rachel Reichardt, environmental health specialist at Jefferson County Public Health, in a news release.

 "Prompt treatment with antibiotics is effective, so early diagnosis and medical attention are crucial."

Symptoms of tularemia include fever, non-healing skin ulcers at the infection site, swollen and painful lymph glands, inflamed eyes, sore throat, mouth sores, diarrhea, or pneumonia. In cases where the infection is due to contaminated food or water ingestion, symptoms may consist of a sore throat, abdominal pain, and diarrhea. Inhalation of 

can lead to pneumonia, which can cause symptoms such as fever, chills, headache, muscle aches, dry cough, and progressive weakness.

For information about tularemia infection in pets, references, and more, continue reading the full article: 

https://www.dvm360.com/view/case-of-tularemia-reported-in-colorado

Articles

dvm360 is counting down the Top 20 news stories and articles from 2024 with this series of spotlights

2024 veterinary news in review: #20

Jennifer Sheahan, DVM, DACVO, provides additional links veterinary nutrition has to veterinary ophthalmology 

Video interview with veterinary ophthalmologist Jennifer Sheahan, DVM, DACVO 

Is there a link between nutrition and ophthalmology? During this interview with 

, Jennifer Sheahan, DVM, DACVO, shared ocular diseases that can be influenced by genetics or diet related. She also shared how certain conditions, like Cushing's disease and diabetes, can be exacerbated by dietary factors. 

 Probably nutrition influenced ophthalmology condition I see is called corneal lipid dystrophy. So it's on the windshield of your eye, and you get little white circles on the surface, and it's like this sheen, it's circular, [and] it's never painful, okay? I think that's important to know, because the other differential for white lesions on the eye, it has completely different clinical signs, which is called corneal mineral degeneration.

Corneal lipid dystrophy is usually only caused by 3 things on the planet. Okay, so you want to rule out these categories when these pets come in. So the first one is inherited, okay, so there are some known inherited breeds that have this condition, because mommy and daddy had it, so you're likely to have it. So King Charles cavalier Spaniel, the Beagle, the Husky, for example. 

Second category for corneal lipid dystrophy, little white plaques on there is called metabolic so you're like, what exactly are those white plaques? You have to explain to the owners, like, oh, it's, you know, my dog is $4000 from Belgium. Like, you know, nothing should be wrong with my dog. And so you have to say, Okay, let's make sure it's not something metabolic. Metabolic means something in your body cannot process the cholesterol in lipids on the surface of your eye, okay, so they're like fat deposits, so why would you have buildup of fat in your body, then that would then distribute onto your cornea is the thought for category 2. 

Jennifer Sheahan, DVM, DACVO, shares multiple ways nutrition and ophthalmology are linked during her interview with dvm360 prior to her sessions at Fetch Long Beach

How diet can impact canine eye health

Brittany Lancellotti, DVM, DACVD, offered ways veterinarians can help reduce caregiver burden in clients in at interview at the 2024 Fetch Long Beach conference

Tips for relieving caregiver burden in owners of dogs with allergic dermatitis 

According to Brittany Lancellotti, DVM, DACVD, owners of dogs with allergic dermatitis that is well controlled have similar levels of caregiver burden as owners of healthy dogs. At the 2024 Fetch Long Beach conference in Long Beach, California, Lancellotti sat down with 

 and shared ways that veterinarians can help relieve caregiver burden in their clients.

So caregiver burden is something that a lot of pet owners will experience in animals that have allergic dermatitis. This is a chronic disease, and we see higher levels of caregiver burden in owners of pets that have chronic diseases like allergic dermatitis. So, veterinarians can help to relieve caregiver burden through a number of different ways. What we found is that owners of healthy dogs and owners of dogs with allergic dermatitis have similar levels of caregiver burden if the allergic dermatitis is well-controlled. So get that disease under control, figure out the primary triggers and figure out the medications that gets the animal in remission. We also can decrease caregiver burden by simplifying the plan, so using fewer medications—which we can do if we find out what the primary trigger is, that will allow us to use fewer therapies, and simplifying the plan. And then also long-acting treatments like ear medications that stay over the course of several weeks—that could help to simplify the plan and lower that caregiver burden as well.

Brittany Lancellotti, DVM, DACVD, offered ways veterinarians can help reduce caregiver burden in clients in an interview at the 2024 Fetch Long Beach conference

In the United States, the price of prescription drugs is sometimes 2-4 times higher compared to prices in other high-income industrialized countries. Because pet medication can appear to be the same of the clients,

 it can lead to clients starting to wonder if it is safe for them to take their pets medication to save money. Even though it is tempting, Pet Poison Helpline shares they strongly urge against humans ingesting pet medications.

"According to a recent study in JAMA Internal Medicine, some of your dog's drugs may be less expensive than your own similar medication,

" said Renee Schmid, DVM, DABT, DABVT, a senior veterinary toxicologist and director of veterinary medicine at Pet Poison Helpline, in an organizational release.

"While that may make you consider switching to your pet's drugs, there are many factors that make that very dangerous. For example, veterinary-specific medication is often not studied in humans and dosing, metabolism, elimination and other factors can be very different between animals and humans, creating potentially negative outcomes."

According to the release, there are usually significant differences between the medications prescribed to animals versus humans as well dosages are different, despite having same or similar sound names.

 For example, Schmid explained one of the most common types of pain relief medication are NSAIDS. If clients were to ingest their pet’s NSAID pain medication, it could interfere with their own pain medication regimen. These medications are developed based on the unique needs of animals and have been studied extensively for safety in the intended species. She also explained that medication that is targeted for specific organs can be very different between clients and patients.

"There are significant dosing/strength differences in thyroid medication between dogs and humans," Schmid explained. "If a human were to take their pet's medication for hypothyroidism, they would likely ingest an amount high enough to cause elevated thyroid hormone levels and potential life-threatening hyperthyroidism. There can also be dangerous effects from heart medication when it isn't prescribed to you and your specific situation. Medication developed for the treatment of certain heart conditions in pets may be ineffective or cause serious side effects if humans were to take the same medication and dosing."

Schmid also shared that even though she discussed intentionally taking the medications, it can be easy to mix up human and animal medications. Pet Poison Helpline sees multiples cases a year of pet owners accidentally giving human medications to their pets. She recommends keeping human and animal medications in separate locations, and all medication is out of reach from children and animals.

To help keep both clients and patients safe, Pet Poison Help wants professionals to know its parent company, SafetyCall International, is a human and animal adverse reporting and regulatory compliance services.

"There have also been recent news reports suggesting it is safe to administer certain human over-the-counter medications to pets, such as aspirin and Pepto-Bismol," Schmid warned. "Many over-the-counter human medications that may have been used routinely in the past have been replace with safer products that were developed to provide better efficacy and fewer negative effects in animals. Also, dosing amounts vary dramatically depending on the size and age of the pet. We strongly discourage giving your pets any medications or supplements that weren't prescribed by a veterinary professional."

Can I Take My Pet's Medication? News Release. Pet Poison Helpline. December 11, 2024. Accessed December 11, 2024. https://prnmedia.prnewswire.com/news-releases/can-i-take-my-pets-medication-302328153.html

Prescription Drug Prices in the US Are 2.78 times those in other countries. News Release. RAND. February 1, 2024. Accessed December 1, 2024. 

https://www.rand.org/news/press/2024/02/01.html#:~:text=Prescription%20drug%20prices%20in%20the%20United%20States%20are%20significantly%20higher,RAND%2C%20a%20nonprofit%20research%20organization

Haque W, Chencheri S, Virnig BA, et al. Price Comparison of Human and Veterinary Formulations of Common Medications. 

. 2022;182(11):1216. doi:https://doi.org/10.1001/jamainternmed.2022.3938

Pet Poison Helpline is educating clients on the dangers of ingesting their pet's medications 

Can clients take their pet's medication?

During this week's episode of The Vet Blast presented by 

, our host Adam Christman, DVM, MBA, joined by Jessica Vogelsang, DVM, CVJ, Chief Medical Officer, the American Animal Hospital Association (AAHA), sit down to discuss the benefits of telemedicine and social media when it comes to helping pet parents in need by providing them a safe space to ask questions. The duo also explore how telemedicine can help provide veterinary support to those living in areas where there is not a lot of access to care, and Vogelsang's work with the Veterinary Virtual Care Association and AAHA. 

: What got you so involved in that space, because I think it's fantastic.

: So actually, it was sort of this weird interplay between the work I had done on on social media, and at the right time before COVID, I was working for an in home hospice and euthanasia practice. So I was doing that at the same time that my own mother was going through hospice, and I was trying to look at these analogies. Thinking, gosh, you know, these these pet owners need support 24/7, just like we do with people, and we haven't quite figured out how to do that. So how do we do a better job leveraging these platforms? And I think that's still a conversation that veterinary medicine struggles with, is that I think people are so focused on this idea of we don't want technology to take over the importance of the work that we do, instead of looking at it as a tool and a way to be there for people in a way that doesn't ruin your boundaries. We're not asking people to be on call all the time, but how do you trust other people who can help out? 

So that was sort of the impetus for all of that, and the telemedicine group led to joining the veterinary virtual care association. So it's still something I feel super passionately about because when you go on TikTok, that's telehealth. It's providing advice, and all of those things that impact how pet owners take care of of their pets is part of that umbrella, and that's what I think people miss because we're so hyper focused on, well, you can't diagnose bloat and treat it over telemedicine, therefore telemedicine stinks. That's not how it works.

Podcasts

Adam Christman, DVM, MBA, and Jessica Vogeslang, DVM, discuss the role of social media and telemedicine in this week's episode