Informal ketamine register

Re: Informal ketamine register

Mark Holmes — Tue, 28 Sep 2010 15:26:20 GMT

[quote user="Michael Woodhouse"]I have asked before where this is 'illegal' and no-one can show me where.[/quote]

So have I but I keep getting told it is. The VSA says that lay people cannot treat animals but I don't interpret this as treating but administering treatment that I have given. It seems to be the RCVS that interprets it as illegal as far as I can see.

Re: Informal ketamine register

Michael Woodhouse — Tue, 28 Sep 2010 13:40:28 GMT

[quote user="Mark Holmes"]people are not forced into prostitution with all its attendent risks.[/quote]

I'd legalise that and tax it too!

[quote user="Mark Holmes"]I fail to see why as a vet I am not able to train and declare a lay person competant. If it wasn't illegal there wouldn't have been an issue to get shocked by. [/quote]

I have asked before where this is 'illegal' and no-one can show me where. I have read the VSA and its amendments a few times and at no point can I find that is is illegal to delegate IV catheters or blood sampling to a trained lay person - as happens in the NHS!

[quote user="Mark Holmes"]I do think is dangerous though to start referring to our "monopoly"[/quote]

Agree 100%.

Re: Informal ketamine register

Mark Holmes — Tue, 28 Sep 2010 13:08:10 GMT

Wynne,

A few years ago I spent time working at an Ostrich farm and the interesting thing about ostriches is that you cannot use electrical fencing as they don't have sufficient capacity to learn not to keep running into it. I am certainly not a bleeding heart do bladder and am most definately right of centre politically but we have been running into the same fence for years with regards to the mis use of drugs and I would like to think I have greater intelligence than an oversized flightless bird.

I am more interested in what will work than having some politically based ideological approach based upon its legality. Take heroin or diamorphine for example. The government takes control of the market by providing it with safeguards on the NHS. The demand on the blackmarket drops, the profit goes out of the business. No profit and there is little incentive to supply an illegal drug with the penalties involved in being caught. The supply to new users is choked off. Crime falls, people are not forced into prostitution with all its attendent risks. The police have more time to focus on fighting drug use rather than just containing it.

People were only shocked about the panorama program because of the way it was presented, and the fact that unqualified was deemed to mean incapable when it was clear that the blood sampling performed was done perfectly competantly. I fail to see why as a vet I am not able to train and declare a lay person competant. If it wasn't illegal there wouldn't have been an issue to get shocked by. When I first became involved in the veterinary world 20 years ago it was normal practice for adequately trained lay staff to perform these duties. I have not seen any benefit in the change and with regards to our monopoly, if thats what you want to refer to it as (I think this is dangerous) We are in a more precarious position now that we were then. Adequately trained lay people working within a veterinary owned practice were less of a threat than a highly trained nursing profession. It wouldn't take a big politcal shift for nurses to be giving vaccines in "vaccination clincs" only having to refer onto vets if they considered a problem.

I do think is dangerous though to start referring to our "monopoly" Any suggestion that we use the regulation to protect our income will lead to the industry being broken up. We do not operate in a monopoly situation, there is sufficient competition between vets that this is not the case.

Mark

Re: Informal ketamine register

Hannah Wynne Richards — Mon, 27 Sep 2010 11:10:17 GMT

Mark If you look at the evidence-Bob's petition on the cascade-you will find that I was the 1st to sign. I'm prepared to campaign against a frankly stupid law. I'm not however prepared to break the law, either the cascade, or allowing unqualified "nurses " to perform illegal acts, or any other law- I actually observe speed limits, and consider they should be rigidly enforced-even the speed-merchants amongst you would have to admit that that would cut the death toll,both human and animal on the roads

With regard to illegal drugs, you're obviously one of the "bleeding heart " do -badders who see addicts as victims. I see them as criminals, for they could not have become addicted without taking a deliberate decision to break the law when they 1st took an illlegal drug

I'm not sure what the answer is. Rigidly enforcing the law, with long prison sentences for any found in illegal possession, and all addicts, would have worked back in the 60s, when illegal drug use 1st started to increase-it would have frightened any potential criminals. There's so many now,the tax-payer couldn't afford to feed them all

With regard to allowing unqualified lay staff to perform procedures which should be confined to veterinary surgeons, VNs, or properly registered students (MRCVS or VN ), if you started a petition, I would start an opposing one

One of the things which most shocked the public about the Panorama programme was that lay staff were performing these procedures. Whether we like it or not, we will eventually get a new VSA. Medivet have shot the rest of the profession in the foot. It will be far harder for us to defend our monopoly, now the public are aware that some practices allow unqualfied people to exceed their legal responsibilities

We will end up going back to the bad old days, before 1948, when anyone could perform veterinary tasks-they were only breaking the law if they called themselves veterinary surgeons When I 1st qualified, I spoke to older veterinary surgeons who had qualified pre 1948 I only wish the rest of my generation had also done so-then those now in power would be more vigilant about defending our hard-won privilages

Wynne

Re: Informal ketamine register

Mark Holmes — Sat, 25 Sep 2010 13:43:07 GMT

The drug is cheap but unless you are going to dispense little boxes of diamorphine to the general population tbe supply chain will be expensive with regards to monitoring its use. I think the pilot studies has "drop in centres" so it could be observed to have been taken and therefore could not be traded. That said though, still cheap relative to the alternative. The politics is however the problem. Until people stop viewing drug abuse as a criminal issue and deal with it as a societal issue it will not be confronted effectively. Hence my original point, stop looking at the world in terms of what is and is not legal and look beyond such narrow boundries.

Re: Informal ketamine register

Bob Russell — Sat, 25 Sep 2010 11:21:11 GMT

Diamorphine is a cheap drug to buy so cost is not the issue but politics is!!!

Re: Informal ketamine register

Edward Jones — Sat, 25 Sep 2010 10:13:15 GMT

I was always under the impression that heroin cost 'pennies' to produce.

Re: Informal ketamine register

Michael Woodhouse — Fri, 24 Sep 2010 21:55:44 GMT

[quote user="Mark Holmes"]Oh and off topic I would go further on the methadone issue and have Heroin available on the NHS.[/quote]

[quote user="Mark Holmes"]Suplying heroin on the NHS would be costly but I expect less so than the costs of policing the crime associated with drug useage.[/quote]

You know Heroin is diamorphine? Many of you will have it in your practices. It is available on the NHS, but unsure if they use it for addiction.

Interesting fact of the day - 'Heroin' is a trademark of Bayer who initially marketed it as a over the counter recreational drug. Ask your rep next time they are in to see you.........

Re: Informal ketamine register

Mark Holmes — Fri, 24 Sep 2010 13:34:00 GMT

Wynne,

I do like and value and enjoy your posts but what seems to be a common thread is that all thought stops with what is or is not legal. My issue is not whether it is legal but whether it should be illegal. If the NHS can train staff on the job to perform simple and low risk proceedures then so should we. I have no issue with regulation or legislation as such but an issue with that regulation and legislation that is absolutely of no or little benefit. Take the ketamine register, I use alot of ketamine but in very low doses, I use it for analgesia, in infusions, in chronic arthritic patients, in all routine cat anaesthetics and occasionally in sedating very unpleasant dogs when D and T is insuffient. Recording the full details of every case vey much interupts the flow of proceedings and when that register will not be accurate by 50% due to the residual drugs in syringes etc of what benefit is it to anyone?

There is a huge difference between taking a blood sample and diagnosis and treatment of animals. I would include in that giving injections, that is administration of a drug not treatment of a condition which I would define as making the decision to use said drug.

There is endless beaurocracy, form fiddling (sorry filling) and legal meddling in our lives that it is stifling. I have spent time work abroad where things are more relaxed and it is a complete breath of fresh air.

Mark

Oh and off topic I would go further on the methadone issue and have Heroin available on the NHS. Addicts cannot sort their lives out and confront their problems when they face the daily pressure of feeding their addiction. The health issues of an opiate addiction are not so much associated with the drug, (unlike alcohol and nicotine) but the socio-economic effects of supplying that addiction. Once people have their lives back they are better placed to deal with their addiction successfully as proved by the pilot studies recently performed. Suplying heroin on the NHS would be costly but I expect less so than the costs of policing the crime associated with drug useage.

Re: Informal ketamine register

Bob Russell — Fri, 24 Sep 2010 12:50:56 GMT

Has there been criticism from the profession? If so who?

I have not seen any such comments but have not particularly looked. If there are people 'acting on behalf of us' we need to make sure we agree or disagree. This forum is a good starting point for such discussions.

Re: Informal ketamine register

Hannah Wynne Richards — Fri, 24 Sep 2010 11:59:53 GMT

Mark I'm annoyed that doctors (IMHO ) increase the addiction problem by providing addicts with methadone too easily, instead of forcing them to confront their problems, but where the VSA is concerned, I'm all in favour of it being enforced strictly where veterinary practices are concerned

I know that some will immediately jump at me, saying that this is inconsistent with my defending RSPCA Inspectors using euthatal, so I'll explain myself

Diagnosing or treating disease in animals is a privilege confined in law to qualified veterinary surgeons (with a few exemptions covered by the Act , or amendments to it ). Members of the public, who take their animals to a veterinary surgery and pay to have them treated rightly expect that their animals will recieve ALL their treatment from people legally allowed to perform that treatment . They were horrifed to discover that some practices allow unqualified lay staff to exceed their proper responsibilities. This revelation will (when it comes time for a new VSA ) make it much harder for us as a profession to defend our legal privileges, and we will go back to the bad old days before the 1948 Act

It is legally permissible for anyone to kill an animal, so long as it is done humanely. If the RSPCA ban on euthanasia is the result of misguided criticism from the veterinary profession, then we will have done animals no favours, especially as so few of us are capable of even getting to some of the animals they have to euthanase -sheep with broken legs stuck half way down cliffs are a regular call-out for the RSPCA in West Wales. The situation is even worse in some parts of the country, where veterinary surgeons have a weird disinclination to go out of the surgery The economic argument is that the overheads of running a veterinary practice are so high that very few practices won't lose money if they send a veterinary surgeon out to perform euthanasia at the same cost tothe RSPCA as sending one of their own Inspectors

Wynne

Re: Informal ketamine register

Noweia — Thu, 23 Sep 2010 21:34:45 GMT

[quote user="Michael Woodhouse"]

Is that both Ketaset and Vetalar?[/quote]

Ketaset, Narketan and all equivalents :(

Re: Informal ketamine register

Mark Holmes — Thu, 23 Sep 2010 17:45:57 GMT

[quote user="Sandy Edwards"]Am I right in thinking vet rules are tougher than human ? If so why [/quote]

Yes and I don't know, one of our nurses in a previous life was a phelbotomist, the training for which was two hours in the morning before being left to get on with it in the afternoon. In order to bleed animals unsupervised you need to have 3 years VN training and be an RVN..... madness! but I am indanger of reviving a previous (long) thread!

Re: Informal ketamine register

Hannah Wynne Richards — Thu, 23 Sep 2010 17:08:14 GMT

Because the doctors have more political clout

Wynne

Re: Informal ketamine register

Sandy Edwards — Thu, 23 Sep 2010 15:44:11 GMT

Oh dear VMD coming to see me Oct 11 th , so all too late for me except i have kept a log of odd horse castrate , cat doses are on our op sheets, all kept. Doing the keyholder bit , good idea.

I am very suspicious of euro -directives , they may not be on our statute books, and could possibly be challenged in court, especially the powers of a VMD inspector to enter premises , I suspect it may be on very fluffy legal grounding , like if I say no !! Its tempting me . Apart from the annoyance of a veterinary degree being inspected by a science degree from a jumped up polytechnic.

I remember the days when we made our own drugs ...sigh.

Am I right in thinking vet rules are tougher than human ? If so why ?

Re: Informal ketamine register

Michael Woodhouse — Mon, 20 Sep 2010 21:58:20 GMT

[quote user="Laura Henderson"]

Speaking of Ketamine - has anyone else a problem with supply? We've just been told we won't be able to get it in for a month :S

[/quote]

No, but we do keep a bit in stock for the odd horse GA - more than enough to satisfy a years worth of smallies.

Is that both Ketaset and Vetalar?

Re: Informal ketamine register

Noweia — Mon, 20 Sep 2010 21:16:29 GMT

Speaking of Ketamine - has anyone else a problem with supply? We've just been told we won't be able to get it in for a month :S

Re: Informal ketamine register

bob lehner — Mon, 20 Sep 2010 15:23:54 GMT

Dunno mate - poss worth speaking to NVS/Centaur computer bods ?

Re: Informal ketamine register

Bob Russell — Mon, 20 Sep 2010 15:18:19 GMT

[quote user="bob lehner"]

The BVA 'Good Practice Guide on Veterinary Medicines' says (Page 5) that you can use a computerised record for Controlled Drugs - but ' Safeguards must be incorporated into the software to ensure that the author of each entry is identifiable, entries cannot be altered at a later date, and a log of all data entered is kept and can be recalled for audit purposes'. 'Access control systems should be in place to minimise the risk of unauthorised or unecessary access to the data in the computerised Register'.

Personally I've never come across anyone using a computerised CD record - you would need to speak to a computer geek to see if those criteria can be met.

[/quote]

Commercial CD software is available but is aimed mainly at Pharmacies and tends to be hideously expensive. For most practices a book is easier. Do any of the PMS's do this? May be worth getting them to have a look as it should only be a case of linking CD purchases with usage and sales. Perhaps when you set up an item there should be a little CD? box.

Re: Informal ketamine register

bob lehner — Mon, 20 Sep 2010 15:07:17 GMT

Personally I've never come across anyone using a computerised CD record - you would need to speak to a computer geek to see if those criteria can be met.

Re: Informal ketamine register

Laurence Webb — Sun, 19 Sep 2010 18:02:11 GMT

I asked the PSS inspector if it was possible to use our practice management software as a record. He didn't rule it out but said that it would only be valid if we could ensure that only a MRCVS was able to add ketamine use to a client's records and adjust quantities in the stock file as otherwise it was open to abuse by other members of staff. Even then he wasn't certain.

If it were valid then that would be a really practical way of doing it!

Re: Informal ketamine register

Bob Russell — Sat, 18 Sep 2010 18:05:43 GMT

I was hoping someone out there had a really practical way of keeping the register - seems we are doing what we can even if it is a pretty pointless exercise!

Re: Informal ketamine register

Laurence Webb — Sat, 18 Sep 2010 16:06:16 GMT

Well given that an article in our local rag said that you could buy ketamine on the street for £15 per gram (mind you I don't know how much that has been cut with baking power etc) it's more expensive to buy ketamine from NVS. It must be easier to make it than nick it as most vets keep it under lock and key. I can see how the odd bottle could be 'lost' in a large animal practice if records aren't kept well, but in a small animal practice the quantities used are relatively small so I'm sure it would be noticed.

Re: Informal ketamine register

Bob Russell — Sat, 18 Sep 2010 11:19:20 GMT

We treat ketamine with a lot of 'respect' because of the possibility of misuse. It is always locked up - there are three members of staff (including me) with access. I just cannot see how our recording is going to balance the books accurately at the end of the month. I am hopeful that we will keep the authorities 'happy' with our system but it is still a major fudge.

I would love to know how many people get offered a bottle of Ketaset on the street corner.

Re: Informal ketamine register

Laurence Webb — Sat, 18 Sep 2010 11:02:11 GMT

[quote user="Martin Atkinson"]

Ketamine is kept in the DD cabinet anyway and as I'm the only one with a key because there's also a gun in there

[/quote]

You could set up your own underworld gang - drugs and guns already. Have you got a Hummer with blacked out windows too?