Dr. Steve O'Grady is a member of the United States Equestrian Federation (USEF) veterinary committee and was recently the lead author on a position paper pertaining to veterinary ethics.
The Veterinary Ethics Pertaining to Prescribing and Dispensing Drugs
By Stephen O'Grady, DVM; Stephen Soule, VMD; and Christopher Miller, DVM
Owners, trainers and veterinarians are responsible for the health and welfare of the horse. As with any sport, performance horses need to be treated as athletes. This often entails medical treatment by veterinarians, which allows them to compete in a comfortable manner. Competition in such disciplines as show hunters and jumpers require the horse to have a certain body condition and to be able to move, jump and/or behave in a specified manner. Horses performing in all disciplines need to be sound, which becomes a challenge because of the intense training necessary for competition and the rigorous and repetitive nature of horse shows.
Sports medicine has become a very pro-active group in the veterinary profession which has made great strides in addressing disease processes and injuries that prevent the equine athlete from performing at an optimal level. For any veterinary care to be effective, an interactive veterinary-client-patient-relationship (VCPR) is of paramount importance. This means that the client has agreed to have a veterinary examination performed, seek a diagnosis and then follow a prescribed treatment plan to resolve the problem. Without a VCPR, the dispensing or merchandising of veterinary prescription drugs by veterinarians or others is unethical and is illegal under state and federal law.
A large amount of the veterinary prescription drugs being administered to performance horses is done so without a true VCPR. The drugs are often acquired from or through equine veterinarians, yet given without the approval of the dispensing veterinarian. Horse shows have become very competitive, not only because of the quality of the horses being shown, but also because of the sheer number of horses that are competing. Many horses with significant soundness issues are kept competing with various medications. The strict judging standards that are applied to the show hunters compel them to be quiet and to move and/or jump in a certain manner. This contributes to countless methods or medications being used to achieve these standards. The use of many veterinary prescription drugs is trainer-driven with the hope of gaining a competitive "edge." Often because a medication appeared effective for one horse, it is hoped that it will be similarly beneficial to another.
An example of this is the widespread inappropriate use of Marquis™ (ponazuril), a drug used to treat Equine Protozoal Myeloencephalitis (EPM). EPM is a neurologic disease that requires a complete neurologic examination accompanied by specific diagnostic testing to produce a definitive diagnosis. Ponazuril is an anticoccidial medication that prevents multiplication by the parasite causing EPM. The drug exerts no initial effect on the horse itself, but may prove toxic if administered over an extended period of time. Yet, Marquis™ (ponazuril) is readily available to trainers without a veterinary examination or a definitive diagnosis.
Owners and trainers can often obtain veterinary medications or prescriptions from their attending veterinarians, although a VCPR does not exist for a specific horse. Drugs can be acquired from drug supply firms which have been provided with an "open ended" or multiple refill prescription by a trainer. They also can be acquired from individuals (non-veterinarians working for companies or veterinary clinics) who visit large horse shows and fill clients' prescription needs without documenting the VCPR. Numerous Web sites also are available, which will fill any prescription that they receive. Veterinarians who participate in writing prescriptions or authorizing medication for animals with which they do not have a legitimate VCPR are practicing in an unethical manner and do not represent the standards of equine veterinary practice. The inappropriate use of veterinary prescription drugs can only detract from the overall health and welfare of the horse.