Statement: Authorisation of Oral Equid Sedatives for Use by Clients

purpose this document sets standards for the authorisation of oral equid sedatives (which are restricted veterinary medicines) for an existing client for use on their own equids these are requirements that we expect all veterinarians to follow it aims to ensure the safe and effective use of sedatives while maintaining high standards of animal welfare and professional conduct background this statement is prepared to help veterinarians deal with specific issues in practice sedatives are restricted veterinary medicines (rvms) that require careful oversight due to their significant effects and potential risks the use of sedatives must be managed to prevent misuse and ensure the safety of animals, veterinary professionals, and the public for example, sedatives are commonly authorised to enable procedures to be performed on horses e g clipping, farriery less commonly, they may be authorised with careful oversight for use in certain circumstances for ridden exercise or transport situations policy statement veterinary authorisation requirement the use of sedatives is restricted to instances where a veterinary authorisation has been issued authorisation for client use on their own equids sedatives may be authorised for clients to use on their own equids or specific equids they are the authorised agent for, provided that proper precautions are taken these measures ensure that sedatives are administered by individuals with the appropriate training and competence, under the guidance of a veterinarian prohibition under veterinary operating instructions the use of sedatives under a veterinary operating instruction (voi) is strictly prohibited vois are intended for situations where no veterinary discretion, oversight, or guidance is needed when the restricted veterinary medicine (rvm) is used given the nature of sedatives, their use requires ongoing veterinary oversight and cannot be adequately managed under a voi nb an exception to this standard is the authorisation of sedatives using a voi under the mpi accredited groom scheme for the transportation of horses by air risks associated with sedatives sedatives pose several risks, including undesired level of sedation and associated complications of sedatives sedatives can cause profound sedation incorrect dosing or administration can lead to severe complications, including respiratory depression and cardiovascular effects health and safety while effective for calming and analgesia, using sedatives carries risks of unpredictable behaviour due to the effect of the drug on the nervous system and individual animal characteristics to mitigate these risks, proper dosing, observation, and competence are crucial potential for misuse due to their potent effects, there is a risk of misuse or abuse if not properly controlled examples of misuse are administering to animals that may or may not be specified on the authorisation, to enable painful procedures to be performed without appropriate pain relief percutaneous absorption sedatives carry human health and safety risks given their potential for percutaneous absorption proper handling and administration techniques must be followed to mitigate these risks commonly used sedatives and associated risks detomidine hydrochloride uses detomidine hydrochloride is used for sedation and restraint in horses, e g for procedures such as clipping or for the farrier when necessary risks to animals potential side effects include bradycardia, sweating, and respiratory distress some horses, though apparently deeply sedated, may still respond to external stimuli it potentiates the effect of other sedatives and anaesthetics risks to people detomidine hydrochloride can cause skin and eye irritation, and systemic effects if absorbed through the skin or mucous membranes because detomidine hydrochloride is administered sublingually, there is a material risk of accidental contact with the handler’s hands lips, mouth, or eyes during administration systemic absorption via these routes can cause dose dependent sedation, respiratory depression, bradycardia, and hypotension in humans pregnant women should exercise particular caution detomidine has been associated with uterine contractions and decreased fetal blood pressure following accidental exposure; ideally, pregnant women should not handle the product handling precautions are necessary to avoid accidental exposure, including wearing appropriate chemical resistant/impervious gloves and washing hands after administration acepromazine paste uses acepromazine is available as a paste for oral administration and is used as a tranquilizer for horses before certain procedures or when there are risks to horse or human health without it veterinarians may also authorise it for other therapeutic uses, e g in some cases of exertional rhabdomyolysis (n b it does not provide analgesia) risks to animals potential side effects include hypotension, bradycardia, and in rare cases, excitement or aggression use of acepromazine in breeding stallions carries a risk of irreversible penile prolapse or paraphimosis, which may lead to permanent reproductive impairment or require surgical intervention it is known to be used to facilitate exercise programmes (e g in racehorses), and it is important to be aware that this may carry risks to the rider and horse risks to people acepromazine paste can cause hypotension and central nervous system depression if absorbed through the skin in cases of ingestion, acepromazine can cause serious adverse effects in humans, including respiratory depression, seizures, coma, and has been associated with at least one reported death acepromazine has also been identified internationally as a drug of abuse and associated with drug facilitated assault, which reinforces the importance of careful supply controls and storage requirements proper handling and protective equipment are necessary to avoid exposure these oral sedatives are important for managing the sedation and restraint of horses but must be handled with care to avoid risks to both animals and people proper training, protective equipment, and adherence to safety protocols are crucial when administering these medicines considerations for veterinarians when authorising the use of sedatives, veterinarians must consider the following accidental human administration dormosedan geland acepromazine paste can be absorbed through the skin and mucous membranes such as lips and eyes (outlined above) in the event of accidental exposure, the affected area should be washed immediately with large amounts of fresh water and medical advice sought if symptoms develop competence of the people administering the product ensure that any person administering sedatives is adequately trained and competent to do so this includes understanding the correct dosage, administration techniques, and potential side effects level of supervision required determine the appropriate level of supervision needed when sedatives are administered this may vary depending on the competence of the client and the specific circumstances of the case the level of supervision required should be in accordance with the guidelines set out in the vet council document on veterinary supervision this would include the veterinarian using their judgement to decide the level of supervision required on a case by case basis competence of the people performing the procedure ensure that any individual performing any procedure on a sedated equid is adequately trained and competent to do so this includes understanding the risks and welfare aspects associated with the procedure farriers working on sedated horses are a typical example where the veterinarian may appropriately authorise sedation without being present, given the established nature of this practice where sedation is sought to facilitate dental work by a third party lay equine dentist, the veterinarian should approach the authorisation decision by satisfying themselves that there is good reason why they do not need to be present to supervise the procedure, rather than treating attendance as the exception relevant factors include the specific procedure to be performed, the qualifications and demonstrated competence of the dentist, whether the procedure is likely to involve pain or tissue damage, and the welfare implications for the animal if the procedure is not adequately managed veterinarians must decline to authorise sedation where they are not satisfied that the animal’s welfare will be appropriately protected during and after the procedure for further guidance on authorising rvms for use by non veterinarian staff, see the vet council guidance on authorising restricted veterinary medicines for dispensing and use by non veterinarian staff informed consent by the owner obtain informed consent from the animal’s owner before authorising the supply of sedatives for client use the owner should be made aware of the potential risks and benefits, including the human health and safety risks associated with handling these products further information on informed consent can be found on the hub here assurance from the owner regarding use ensure that the owner understands that the use of the sedative is limited to the people and animals specified on the authorisation this must include that the owner ensures that any person working on the animal is aware that it has been sedated because monitoring of use once the product has been dispensed is inherently difficult, the veterinarian should obtain and record an explicit declaration from the owner confirming their understanding of and commitment to the permitted use this declaration should be recorded in the veterinarian’s clinical records and may be obtained in writing or, where recorded, verbally a declaration does not transfer the veterinarian’s professional responsibility, but it demonstrates that the necessary information and expectations have been communicated and acknowledged documentation ensure appropriate documentation of the training and competence assessments of clients the authorisation of the rvm, specifying the person authorised to administer the rvm, and the specified animals it can be administered to the client’s informed consent including understanding risks associated with the administration the owner’s declaration confirming their understanding of permitted use, and any related conditions communicated by the veterinarian (e g the intended purpose, specified animals, and any restriction on use in connection with particular procedures) the owner’s declaration that they will inform any person working on the sedated animal and communicate the risks health and safety considerations under the health and safety at work act 2015, veterinarians, veterinary clinics, businesses, and clients must have clear measures in place to assess and manage the risks associated with the authorisation and use of rvms, including sedatives as duty holders under section 45 of the act, veterinarians must ensure, so far as is reasonably practicable, the health and safety of workers and that other persons are not put at risk by their work further considerations when deciding whether to authorise a client to hold and administer sedatives, veterinarians must comply with sections 1 7 of the veterinary medicines section of the code and the acvm notice requirements for authorising veterinarians the expectations for appropriate stewardship of veterinary medicines are significant, and veterinarians should consider the following the character of the client are they sufficiently competent, reliable, and trustworthy? the qualification, or training and experience, of the person being given the responsibility of having the sedatives in their custody are they sufficiently competent? what level of supervision or oversight is appropriate for this type of medicine? what recommendations will you make regarding the safe storage of and access to the product? how should it be dispensed and labelled (e g appropriate warnings, etc )? how much should be supplied? how is use monitored? this is difficult, though observing the patient’s condition and the frequency of repeats may provide some insight into the appropriate use of the product adverse events if an adverse event occurs related to the use of sedatives, the following procedures should be followed immediate veterinary contact clients must have immediate access to contact information for the authorising veterinarian or an emergency veterinary service this ensures that any adverse reactions or complications can be promptly addressed emergency instructions the authorising veterinarian must provide clear, written emergency instructions to the client these instructions should include steps to take in case of an overdose, adverse reaction, or other emergency situations first aid measures clients should be informed of basic first aid measures to manage potential adverse reactions until veterinary assistance is available this may include measures to support respiratory and cardiovascular function documentation any adverse events associated with the use of sedatives must be documented by the client and reported to the authorising veterinarian as soon as possible this documentation should include details of the incident, actions taken, and the outcome deciding to decline a request to authorise an rvm section 4 of the client relationships part of the code of professional conduct states that veterinarians are not obliged to provide a requested treatment, provided that animal welfare and professional standards are met with these aspects in mind, the responsibility sits with the veterinarian to make a reasonable judgement ultimately, the veterinarian must take all these factors into account to decide whether it is reasonable to authorise an rvm in this situation this means that veterinarians must consider the welfare of the animal, the appropriateness of the treatment, and their professional standards before making a decision if the requested treatment does not align with these considerations, the veterinarian has the right to refuse the treatment this ensures that all actions taken are in the best interest of the animal and adhere to the highest professional standards conclusion vet council is committed to supporting veterinarians while ensuring the safe and responsible use of veterinary medicines by restricting the use of sedatives to instances where a veterinary authorisation is issued and prohibiting their use under a voi, we aim to uphold the highest standards of veterinary practice and animal welfare for further information, please refer to the acvm notice requirements for authorising veterinarians and the veterinary operating instructions guidelines https //www mpi govt nz/dmsdocument/20054/direct https //www mpi govt nz/dmsdocument/20054/direct https //www mpi govt nz/dmsdocument/20057/direct https //www mpi govt nz/dmsdocument/20057/direct code of professional conduct docid\ h lauut6krscm2qcooknt veterinary supervision docid\ ahlbispk lyjchtc wash https //hub vetcouncil org nz/veterinary medicines#uvp0z transparency statement on ai assisted drafting this technical advice has been prepared with the assistance of artificial intelligence (ai) tools to support the drafting and refinement of content the use of ai does not replace expert judgment or council oversight it serves as a tool to support the production of high quality, reliable guidance for the veterinary profession