Australian coroner calls for greater restriction of veterinary drug

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An Australian coroner’s recommendation following an inquest into two suicides that access to the veterinary drug pentobarbitone be “upscheduled” is opposed by the country’s lead veterinary body.

South Australian Deputy Coroner Anthony Schapel made the recommendation after investigating the self-inflicted deaths of a 25-year-old female veterinary science student and a 30-year-old female veterinarian, who died in 2014 and 2015 respectively.

Pentobarbitone is used for the anaesthetising and euthanasia of animals. In its liquid form it is known commercially as Lethabarb. The drug can come in tablet form, but these are no longer readily available or used, the coroner noted.

Liquid pentobarbitone is listed as a “Schedule 4” substance under the Commonwealth Poisons Standard, which means that it must be stored in an area where the public did not have access.

“Pentobarbitone is listed as a Schedule 8 drug, but only in tablet form. If a drug is scheduled under Schedule 8 it is required to be stored in a locked container or safe at all times unless in use,” Schapel said.

The deaths of the pair were linked to the drug.

Schapel noted that there had been several suicides committed in Australia by the ingestion of Lethabarb.

“It has been said that the incidence of suicide within the veterinary profession and industry, in general, is greater than within the general community.”

Suicide by the ingestion of pentobarbitone was the subject of a coronial inquest conducted in Queensland in 2016 and 2017, which involved a dog groomer.

Following that inquest, Schapel noted, the coroner recommended that injectable pentobarbitone be adjusted to a Schedule 8 drug, but that recommendation that was not implemented by the TGA (Therapeutic Goods Administration).

“There is therefore a powerful argument that the deceased’s death in that case would have been prevented if the substance had been a Schedule 8 substance, at least as far as that method of suicide is concerned.”

He made the observation that the same consideration would apply to the veterinary student who must have sourced the pentobarbitone from a container that was not locked as it would have been if it had been a Schedule 8 substance,  Schapel said.

But the Australian Veterinary Association (AVA) has disputed claims that upscheduling the drug would make any substantial impact on the high suicide rates in the profession, asserting that the primary focus should be on addressing the risk factors which lead to suicide.

“Deputy Coroner Schapel is not seeing the forest for the trees. The issue here isn’t accessibility to this drug or any other substance that could be used to commit suicide, the issue here is mental health and addressing the actual risk factors which lead to suicide,” AVA president Dr Julia Crawford said.

“There are a large number of drugs in any veterinary practice that could be used to lethal effect; restricting one drug will not make any meaningful change.”

The AVA supported regulation requiring the drug to be stored in a locked cupboard, safe or receptacle, but does not support upscheduling the drug to a Schedule 8 poison.

Following the Queensland case, the manufacturer of Lethabarb had also opposed upscheduling of the drug to Schedule 8 for several reasons, including that new vaults would be needed to be constructed to hold the drug, and the additional regulation would place more stress on staff in veterinary clinics because they will be required to account in some detail for a drug that is used repeatedly.

It also said that “staff other than veterinary surgeons and veterinary nurses working at veterinary clinics would ‘simply find an alternative method of suicide’.

The AVA’s arguments opposing the upscheduling also noted the need for veterinarians to buy new and larger drug safes; it also said there were “many lethal means available in veterinary practices quite apart from pentobarbitone”, and “rescheduling would not prevent suicide”. It also said the potential hazard of misuse by staff other than veterinarians and veterinary nurses was not widespread.

While acknowledging that a holistic solution must involve increased education and support around mental health, the Queensland Coroner said “a holistic approach also necessitates the introduction of measures for when increased education and support does not work”.

“The administrative and financial burden of such a change is relatively minor when weighed against the benefit of saving human lives,” and “the argument that only a small number of human lives will be saved by this measure fails to recognize the value of human life”.

“The product is clearly marked as a euthanasia drug. Its sole purpose is to kill. Such a drug that is so clearly dangerous and where its potential for misuse is obvious should not be allowed to be stored in an unlocked cupboard with its usage unrecorded,” the Queensland Coroner’s report said.

In his conclusion, Deputy Coroner Schapel said “the depriving of this method of suicide might well save the lives of those who would be disinclined to use other less attractive methods”.

The AVA’s Dr  Crawford said the association had always recommended that veterinary practices should limit access to any potentially dangerous substances by non-veterinary staff, “but those most at risk – veterinarians – will still need access to these drugs on a regular basis. Animal welfare could be adversely affected if tighter restrictions delay timely euthanasia of animals in an emergency”.

“The primary source of vet suicide is adverse psychosocial working conditions, and claiming otherwise distracts from the important work we are doing in mental health.”

The AVA identified long working hours, high workloads, poor work-life balance, the attitude of clients and stress about performing euthanasia as prime reasons leading to veterinarian suicide.

“It is not just a suicide issue, many in the veterinary profession suffer from high levels of anxiety, depression, stress and burnout, and high personal expectations due to these risk factors,” Crawford said.

The AVA said it had resources and programmes that aim to address some of these risk factors and to assist with responding when veterinarians or their staff are identified as being at risk or in a crisis situation.

It introduced a graduate mentoring program in 2015 that pairs newly graduating veterinarians with an experienced colleague in another practice. All mentors are given training, including some mental health training to assist with recognising problems in their mentees and how to refer if needed.

In 2016 the AVA rolled out Mental Health First Aid Training to assist practice staff in identifying employees who may be experiencing mental health issues and help them know how to respond and offer assistance and appropriate referral. The goal is to eventually have a Mental Health First Aid Officer in every veterinary workplace in Australia.

Alongside this, there is an AVA counselling line, an AVA HR Advisory service, seminars and lectures around resilience, wellness and mental health issues, individual collegial support where a specific need is identified and many other related programs.

“We love our profession and care deeply for the animals we look after, but we must focus our efforts on improving the working conditions for vets, veterinary nurses and veterinary students. This isn’t an issue that can be solved overnight but we are making good progress,” Crawford said.

Coroner’s report

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