Why can’t I buy ear medication for my dog over the counter?

Author: Dr Meredith Crowhurst (First published on LinkedIn in 2018)

A common complaint of many pet owners is why they can’t just get more medication over the counter. “My dog gets the same ear infection a couple of times a year and every time you give me the same ear drops. It is the same problem. Why do I have to pay for a consult and an ear swab when you will just give me the same ear drops again? Can’t you just sell me the ear drops over the counter?”

Veterinarians in Australia are bound by prescribing laws and regulations

Veterinarians in Australia are bound by law. They must follow the Drugs Poisons and Controlled Substances Act 1981 and the Drugs Poisons and Controlled Substances Regulations 2017. In any veterinary clinic, it is the veterinarians who solely carry the legal and ethical responsibilities when it comes to prescribing and supplying medications. Breaches of the relevant legislation, regulations, and guidelines constitutes professional misconduct. A veterinarian can be penalised and lose their registration to work as a veterinarian for breaching them.

What are the legal requirements for veterinarians dispensing medications?

What do the Act and Regulations require? Specifically, they require that:

1. The medication is provided for an animal under that veterinarian’s care.
2. The veterinarian has taken all reasonable steps to ensure that the animal needs that medication.
3. The medication is only supplied to the owner or carer of the animal.

Further guidelines are provided by the veterinary registration boards in each state (responsible for regulating the licenses of veterinarians) and by the Australian Veterinary Association (the peak body representing veterinarians within Australia).

What is meant by “under that veterinarian’s care”?

An animal is only considered to be under a veterinarian’s care if a genuine relationship has been established between the owner, the animal, and the veterinarian. Specifically, the owner or carer must have given responsibility for the health of their animal to that specific veterinarian. And this relationship must be a real relationship. This means there must be evidence that the veterinarian has had CONTACT WITH THE ANIMAL for diagnosis and treatment, so they can assume responsibility for diagnosis, treatment, and outcome.

(Note: Within a veterinary clinic, a veterinarian can assume responsibility for the health of other animals cared for by other veterinarians within the practice if they have unrestricted access to the health records.)

What is meant by “ensure that the animal needs the medication”?

The veterinarian is required to establish a clinical justification for the medication. IMMEDIATELY PRIOR to dispensing medication, the veterinarian must have seen the animal and conducted any relevant tests to ensure the animal needs the medication. The veterinarian needs to complete a record of the clinical examination, which includes any test results and a consideration of the diagnosis and appropriate therapies.

Veterinarians are also advised to ensure adequate follow-up in order to review treatments and determine that expected outcomes are achieved. The AVA guidelines advise that follow-up is important because “it completes the clinical history, ensures that the treatment regimen was appropriate, enhances the veterinarian’s experience and training, alerts the veterinarian to any unexpected outcomes or side-effects of the medication, (and) allows for monitoring of a client’s drug supplies and for the collection and correct disposal of any unused drugs.”

Veterinarians are also required to dispense only the quantity of drug required to treat the medical condition and to ensure that the medication supplied is only used for the specific purpose intended.

Why the legal requirements?

Veterinarians constantly receive verbal abuse for adhering to these requirements. Many of the public assume veterinarians won’t dispense medications over the counter because they are trying to make more money (from consults). But veterinarians are professionals and dispensing medications is a serious responsibility. If anything goes wrong, the animal suffers but veterinarians can also get in serious trouble.

The legislative requirements are in place to protect the animals, the public, and veterinarians. Any medication has the potential to cause harm and should only be given if required and if the benefits outweigh the risks. For example, medications can cause allergic reactions, undesired side-effects, toxicity, interactions with other medications, or (for antibiotics) resistance.

Thus, the veterinarian must have established that the animal needs the medication and that the benefits of administering the medication outweigh the risks. Veterinarians also need to ensure the medications won’t interact with other medications the animal might be on. And they need to make sure the owner understands the instructions and can administer the medication correctly. These factors can only be ensured if the veterinarian has seen the animal and owner immediately prior to prescribing the medication.

Unused drugs may also deteriorate or become out-of-date and owners may feel tempted to use them for other (undiagnosed) conditions. So, veterinarians must only supply an amount of medication specific for the current medical condition.

Ongoing medications for long-tem conditions

There are provisions for animals that have medical conditions that require ongoing medication. In this situation, if the veterinarian has established a genuine relationship with the animal and owner, has examined the animal and reached a diagnosis, and the animal’s condition is stable on a certain dose and type of medication, then the veterinarian may dispense ongoing medication over the counter. Prior to dispensing the medication, the veterinarian must review the patient’s file and assess the situation. For these patients, an established guideline is that veterinarians must see that animal every six months, sometimes more frequently for certain conditions, in order to ensure dispensing requirements are met. Examples of medical conditions that require ongoing medication include: thyroid disease, heart disease, and diabetes.

Getting medication from another clinic

Recently, a client rang up asking if they could get more medication over the counter that a specialist had initially dispensed. The specialist clinic had sent through their consult notes, which advised they wanted to see the patient again after one month. In this case, I was unable to dispense more medication.

A veterinarian is unable to dispense medication for a condition they have not seen even if the animal has been examined and diagnosed at another clinic. I could have supplied the medication if the veterinarian they had originally seen provided a script that gave approval to dispense more medication on their behalf. However, without a script, I would need to examine the patient myself to establish my own genuine relationship and to become up-to-date with its current health status. The guidelines do recommend referring the patient back to the original veterinarian, since they already have knowledge of the patient and its health status. But if the owners did not want to do this, a consultation with myself would be required before I could dispense more medication.

So why can’t I just get more ear medication over the counter?

So, back to the example provided at the beginning, where an owner is asking for ear medication over the counter. A veterinarian cannot dispense ear medication over the counter, even if an animal has been seen by the veterinarian not long ago for something else and has had many ear infections in the past.

Ear infections are very common but there are many causes. Often they are caused by allergies to things in the environment but they are also caused from swimming or bathing, by grass seeds, or merely by having droopy ears. Anything that creates a warm moist environment can cause an overgrowth of the normal bacteria or yeast that live in the ear. Even if the cause is the same, we treat every ear infection as a separate event. It might well be the same type of infection as last time but it also might not. Each time, we need to establish that there really is an infection, if it is a yeast or bacterial infection, what type of bacterial infection, if there is a grass seed or anything else that shouldn’t be in the ear, and if the ear drum is intact. To determine the answers, we usually need to look in the ear and also look at a sample of ear gunk down the microscope. I have been surprised many times when looking down the microscope, expecting one thing but finding another. We need to work out which ear drops to use, for how long, and if ear drops alone are enough. If we get it wrong, it can have bad consequences. This is not good for the animal. And your veterinarian, as dispenser, is ultimately responsible if something goes wrong.

Veterinarians are following the legal rules, regulations, and guidelines for you and your pets’ benefits

Instead of getting angry that you have to pay for a consultation before your veterinarian will dispense medication, be thankful that your veterinarian is acting professionally and following the rules. They are trying to establish a diagnosis and an actual need for medication. They are trying to determine the right medication and a treatment plan. This is instead of putting your pet at potential risk from chemical ingredients that your pet might not need and which could potentially cause harm.

***Please note: This article is focused on the requirements for standard household pets. There are more specific regulations regarding horses and other large animals, farm animals, animals used to produce food for human consumption, and herd situations.***

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Addendum: A list of the prescribing guidelines veterinarians must follow (taken from the Australian Veterinary Association):

­­­­­­­BEFORE – prescribing and dispensing a medications, the veterinarian must ensure that the following conditions are met:

1.      The person presenting the animal is a bona fide client.

2.      I have current knowledge of the management, health status and drug status of the animal and am satisfied there is a therapeutic or prophylactic need for the use and/or supply of this drug.

3.      I have followed the requirements of the drugs and poisons and control-of-use legislation in my state/territory in regard to: the ordering, purchase, storage, use and supply of this product (including any ‘off-label’ use), the use of appropriate containers, labelling requirements, including the provision of advice notes, recording requirements (including any guidelines from my professional registration body).

4.      I am confident the client understands my instructions regarding the use and storage of this drug, and is able to use it properly and safely.

5.      The amount I am prescribing/dispensing is reasonable for treatment of the condition for which I have documented the therapeutic need.

6.      If the drug is an antibiotic, I have considered the expected infectious agent, spectrum of activity of the drug and implications of antimicrobial resistance.

Published by

Meredith Crowhurst

Medical writer, veterinarian, former medical scientist

Published • 4yr ago on LinkedIn