Metacam Dispensing Rule Change in the UK

[SiobhanRoisin]

Good Afternoon,

I am interested in getting the views of fellow rabbit owners in the UK regarding the apparent changes in the dispensing laws for metacam.

I have had my current rabbits for over seven years now, and to date they have been healthy, bonded, cage free, and overly spoiled. I take them to the vet for their yearly checkups and vaccines, and there have been no issues noted with their care or general health. I treat them like cats, they have free run of the apartment which is covered in their hay, spend a fortune on herbs for them, and they sleep on the bed with me. They live the best life I can give them.

When they were younger there were issues with stasis, and I lost one of my first rabbits to this quite dramatically. I think the fear of stasis hits all rabbit owners quite close to the heart. To deal with this, over the last five years or so, I have developed an effective system, as the vet has always provided me with a little bit of extra metacam to have on hand at home. Like most rabbit owners I can see almost immediately when something is off with them and I find that if I monitor the situation and give them a dose of metacam in the early stages I have been able to nip most problems in the bud before they need to go to the vet. This has, I believe, saved a huge amount of distress for my rabbits over the years, and even their lives. Waiting until the vet is open in the morning hours, or there is a free appointment, the stress of the visit when they are unwell, it all has a huge negative impact on the sensitive rabbit system and can allow a small problem to rapidly become a major problem. Further to this, I have never given the rabbits excessive amounts of metacam - I have only ever given one dose for each specific stasis concern - if that does not resolve the issue or the rabbit appears to get worse I would immediately take them to the vet. The stasis concerns over the last five years or so have also dramatically decreased there is usually only one or two bumps in the year at most.

Today I called my vet as I am running low on metacam. The vet has told me, however, that they are no longer able to provide extra metacam for me to have at home. I am supposed to bring the rabbits in every time there is a slight issue now. As an experienced rabbit owner this is extremely distressing - as noted above, having a dose of painkiller at home to immediately provide can stop a stasis problem from developing, save the rabbit stress, and ultimately I believe, their life. I belive this change in dispencing will have a huge negative impact on rabbit welfare for experienced owners and will ultimately cost rabbit lives. I am going to meet my vet on Monday to discuss this - but am curious if other rabbit owners in the UK have experienced similar issues recently, and what your opinions on the matter are.

The only option I could see being practical is if the vet allowed for an online assessment of the rabbit - a video call to show the rabbit - and this enabled them to dispense the metacam without the rabbit needing to make a stressful trip when they are already unwell. However, this would still mean a delay in treatment as you would need to wait for opening hours, availability, and travel time to collect - all of which can be crucial time in providing effective rabbit care.

Thank you for any feedback anyone can provide.

All the best

Siobhán

 

[Shimmer]

The vet is really only giving the advice that they ought to be giving, I'm afraid. Metacam is a POM (prescription only medicine) and is only allowed to be dispensed to a specific named animal at a specific dose, for an animal that has been examined by a vet. I don't think there's been any change there, just that you happened to have some at home with some prior approval to use as directed. Even places like rescues and kennels are subject to getting the same approval for an animal that needs eg pain relief. It should not be given without the specific approval of the vet.

You may be able to develop a good relationship with a vet over time and for an animal with a consistent medical need for a particular medication, but even then, the vet is required to frequently see that animal to examine it.

 

[SiobhanRoisin]

The vet is really only giving the advice that they ought to be giving, I'm afraid. Metacam is a POM (prescription only medicine) and is only allowed to be dispensed to a specific named animal at a specific dose, for an animal that has been examined by a vet. I don't think there's been any change there, just that you happened to have some at home with some prior approval to use as directed. Even places like rescues and kennels are subject to getting the same approval for an animal that needs eg pain relief. It should not be given without the specific approval of the vet.

You may be able to develop a good relationship with a vet over time and for an animal with a consistent medical need for a particular medication, but even then, the vet is required to frequently see that animal to examine it.

The guidelines were updated in September 2023. I'm reading them just now.

They make sense from a broad perspective. However, while metacam is a POM- it isn't an anitfungal, antibiotic, antiviral, or antiparasitic - which is what a lot of the logical concern seems to be focused on - i.e., resistance, etc.

There are specific passages that state that the vet does have discretion - and in exceptional circumstances - there can be modifications based on the need of care and possible outcomes. The speed at which you can provide relief to a rabbit will drastically affect their outcome, distress levels, and overall welfare. Once again, the specific needs of rabbits are overlooked - they are so different to cats and dogs - the idea that a vet does not offer a small amount of a necessary backup anti-inflammatory to experienced owners when the outcomes of not having it may be fatal is just not okay.

 

[Liz47]

Hello and welcome to the forum I work in a vets and whilst I'm currently on maternity leave I go in for keeping in touch days and learned about the updated dispensing guidelines, as you say it's all POM-V medications and the regulations state the vet must have physically examined the animal and a note be put on their records in writing to state they can have 'insert medication name here' dispensed on repeat. The guidelines then state medication reviews have to take place at least every 6 months (so again physically examination) but preferably every 3. With the exception of parasite treatment than can be 12 months. Although I do agree it's helpful to have something like metacam in it just can't be done whilst following the regulations. Unless it's dispensed for a specific rabbit and their long-term illness, ie arthritis, with appropriate medical reviews

 

[InspectorMorse]

Hello and welcome to the forum I work in a vets and whilst I'm currently on maternity leave I go in for keeping in touch days and learned about the updated dispensing guidelines, as you say it's all POM-V medications and the regulations state the vet must have physically examined the animal and a note be put on their records in writing to state they can have 'insert medication name here' dispensed on repeat. The guidelines then state medication reviews have to take place at least every 6 months (so again physically examination) but preferably every 3. With the exception of parasite treatment than can be 12 months. Although I do agree it's helpful to have something like metacam in it just can't be done whilst following the regulations. Unless it's dispensed for a specific rabbit and their long-term illness, ie arthritis, with appropriate medical reviews

This is exactly what my Vet said.

 

[SiobhanRoisin]

Hello and welcome to the forum I work in a vets and whilst I'm currently on maternity leave I go in for keeping in touch days and learned about the updated dispensing guidelines, as you say it's all POM-V medications and the regulations state the vet must have physically examined the animal and a note be put on their records in writing to state they can have 'insert medication name here' dispensed on repeat. The guidelines then state medication reviews have to take place at least every 6 months (so again physically examination) but preferably every 3. With the exception of parasite treatment than can be 12 months. Although I do agree it's helpful to have something like metacam in it just can't be done whilst following the regulations. Unless it's dispensed for a specific rabbit and their long-term illness, ie arthritis, with appropriate medical reviews

Hi - thanks for the welcome and the feedback!

I can understand that a vet needs to examine an animal and the medication should not be given out willy nilly. If my rabbits had to be brought in every six months when healthy to have this reviewed that would be fine. The issue I have is that if a rabbit has to be brought in when suffering from stasis this is not just 'not helpful' but life-threatening to the rabbit. In recent years - if my rabbit starts to get that look - the telltale signs we all know of stasis - I can rapidly give them a dose of metacam and more often than not the problem resolves itself within one to three hours. If this option is taken away from me as a rabbit owner - this means that when those telltale signs occur - I have to contact the vet and wait for an appointment - which could be almost 24 hours in some cases, transport the rabbit which is extremely stressful, take them to the vet's office which as a large prey animal is traumatic as they are not used to being around dogs and cats and the vets office in my experience does not provide adequate waiting spaces for rabbits that are quiet and protected. The added time and stress of this whole process could very well lead to a death when it comes to rabbits. I do not see how the regulations are fit for purpose if they are endangering an animal. There is no need to give excessive amounts of metacam, but the idea that I cannot have one or two doses in advance for a condition that is extremely likely to occur and well document in rabbits to me indicates that something is wrong with this system.

Speaking as someone at a vets - if they saw the rabbit for nail trimming and vaccine every six months - would that then warrant them providing a backup dose if required of metacam to have at home?

Thanks again for your feedback

All the best

Siobhán

 

[Shimmer]

I think you would have to ask your vet that question. It is up to them at the end of the day.

I understand your concerns - many of us have been in the same situation. The argument would be that only a vet can make a diagnosis and issue POM-Vs if they think it's appropriate. We, as owners, are not trained or legally qualified to make the diagnosis, etc. and we may miss something subtle but important.

 

[SiobhanRoisin]

I think you would have to ask your vet that question. It is up to them at the end of the day.

I understand your concerns - many of us have been in the same situation. The argument would be that only a vet can make a diagnosis and issue POM-Vs if they think it's appropriate. We, as owners, are not trained or legally qualified to make the diagnosis, etc. and we may miss something subtle but important.

Thanks - I will - I have an appointment on Monday.

I think as owners though we also offer an important perspective that may be overlooked by bodies creating guidelines that apply to all species.
Many of us also have scientific/medical/veterinary backgrounds.

I think it's important that we speak up and advocate for the care of our rabbits - to help limit unnecessary distress.

 

[KarenM]

Speaking as someone at a vets - if they saw the rabbit for nail trimming and vaccine every six months - would that then warrant them providing a backup dose if required of metacam to have at home?

I'd say the main issue there is that it's then left up to the owner to decide if and when to give metacam. It's not so much about them not having seen the animal recently, but the idea of how appropriate it is for the owner to be deciding exactly when meds should be given.

Slightly different scenario but our dog is on long term pain relief for spinal conditions.... she has daily meds but, if we ever feel like her pain isn't being managed, we still need to speak to the vet each and every time we want to up the dose, even though we have the meds to hand. Sometimes the vet will suggest a temporary increase/additional meds & other times they increase the dose long term.

You seem to be very in tune with your rabbits and their needs so I appreciate your frustration though. I'd agree about having a conversation with your vet. Some of the issues you've mentioned (things like having to wait until the vet is open, waiting 24 hrs for an appointment) could probably be solved in other ways... eg. using the out of hours service, same day appointments so aren't really an argument for having meds to hand at home.

 

[SiobhanRoisin]

I'd say the main issue there is that it's then left up to the owner to decide if and when to give metacam. It's not so much about them not having seen the animal recently, but the idea of how appropriate it is for the owner to be deciding exactly when meds should be given.

Slightly different scenario but our dog is on long term pain relief for spinal conditions.... she has daily meds but, if we ever feel like her pain isn't being managed, we still need to speak to the vet each and every time we want to up the dose, even though we have the meds to hand. Sometimes the vet will suggest a temporary increase/additional meds & other times they increase the dose long term.

You seem to be very in tune with your rabbits and their needs so I appreciate your frustration though. I'd agree about having a conversation with your vet. Some of the issues you've mentioned (things like having to wait until the vet is open, waiting 24 hrs for an appointment) could probably be solved in other ways... eg. using the out of hours service, same day appointments so aren't really an argument for having meds to hand at home.

It is not just frustration because I am in tune with my rabbits. It is what appears to be poor regulations that do not consider the specific needs of rabbits and will put them in life threatening situations.

Yes, pain killers should not be given out ad lib, I completely agree. I could understand that a vet would not provide an entire bottle of metacam to have at home. However, there should be provisions made to enable an owner to have one or two doses for each pet at home to save their life and avoid a life threatening situation. Stasis is acknowledged as a common issue that every rabbit owner deals with. It can appear rapidly without an obvious reason in many cases to the healthiest of bunnies and requires constant awareness - and rapid treatment. Not providing such treatment creates massive distress for the owner and rabbit and negatively impacts on the animals welfare.

There should be clauses in the regulations to recognize this and to state that for rabbits after a vet has spoken with the owner - and at their discretion- the provision of pain relief can be made in advance to avoid negative outcomes. Furthermore, this can could come with the guideline- as I have always applied it - that if after one dose of pain relief and several hours, the situation has not improved, then the rabbit is taken immediately to the vet. However - I must say that giving my rabbits care at home leads them to recover extremely quickly when compared to when they are taken to the vets, as the combined distress can mean that it takes days for them to recover instead of hours.

If need be I have and will take my rabbits to the 24 hour vet. However, for many owners the idea of paying the extremely high 24 vet fees for a case of stasis that could have been rapidly solved at home with one treatment of painkiller seems quite ridiculous. Why add this additional stress to the animal, the owner, and the vet? It just does not seem like a logical or practical strategy.

Furthermore, it could take 24 hours, in some cases - if the vets are overboooked during the week and do not have availability, if you do not live in a big city with easy access to locations during the evening and night hours. The practicalities of these situtations need to be considered from the perspectives of all owners and the added distress that will be put upon the animal.

Once again - the idea that one or two doses of pain killer - not an antibiotic or such - can no longer be provided to owners that vets deem responsible after meeting - seems to be working against the welfare of the animal and is an extremely concerning change.

 

[InspectorMorse]

It is not just frustration because I am in tune with my rabbits. It is what appears to be poor regulations that do not consider the specific needs of rabbits and will put them in life threatening situations.

Yes, pain killers should not be given out ad lib, I completely agree. I could understand that a vet would not provide an entire bottle of metacam to have at home. However, there should be provisions made to enable an owner to have one or two doses for each pet at home to save their life and avoid a life threatening situation. Stasis is acknowledged as a common issue that every rabbit owner deals with. It can appear rapidly without an obvious reason in many cases to the healthiest of bunnies and requires constant awareness - and rapid treatment. Not providing such treatment creates massive distress for the owner and rabbit and negatively impacts on the animals welfare.

There should be clauses in the regulations to recognize this and to state that for rabbits after a vet has spoken with the owner - and at their discretion- the provision of pain relief can be made in advance to avoid negative outcomes. Furthermore, this can could come with the guideline- as I have always applied it - that if after one dose of pain relief and several hours, the situation has not improved, then the rabbit is taken immediately to the vet. However - I must say that giving my rabbits care at home leads them to recover extremely quickly when compared to when they are taken to the vets, as the combined distress can mean that it takes days for them to recover instead of hours.

If need be I have and will take my rabbits to the 24 hour vet. However, for many owners the idea of paying the extremely high 24 vet fees for a case of stasis that could have been rapidly solved at home with one treatment of painkiller seems quite ridiculous. Why add this additional stress to the animal, the owner, and the vet? It just does not seem like a logical or practical strategy.

Furthermore, it could take 24 hours, in some cases - if the vets are overboooked during the week and do not have availability, if you do not live in a big city with easy access to locations during the evening and night hours. The practicalities of these situtations need to be considered from the perspectives of all owners and the added distress that will be put upon the animal.

Once again - the idea that one or two doses of pain killer - not an antibiotic or such - can no longer be provided to owners that vets deem responsible after meeting - seems to be working against the welfare of the animal and is an extremely concerning change.

My understanding is that this should not be the case. The Vet can use their professional discretion and sign off a supply of analgesia for a competent care giver to use in an emergency situation. This would obviously mean that there is a well established Vet/client working relationship based on mutual trust.The Vet being able to trust that the client is experienced enough to know when just giving a dose of analgesia is not enough, that the client is capable of identifying a case where-by the prompt use of prokinetics and fluids is just as important as analgesia. I have several contacts in the Rabbit Rescue/Rabbit Sanctuary world and none have encountered any problems relating to the recent changes in prescribing guidelines. Myself included

 

[SiobhanRoisin]

My understanding is that this should not be the case. The Vet can use their professional discretion and sign off a supply of analgesia for a competent care giver to use in an emergency situation. This would obviously mean that there is a well established Vet/client working relationship based on mutual trust.The Vet being able to trust that the client is experienced enough to know when just giving a dose of analgesia is not enough, that the client is capable of identifying a case where-by the prompt use of prokinetics and fluids is just as important as analgesia. I have several contacts in the Rabbit Rescue/Rabbit Sanctuary world and none have encountered any problems relating to the recent changes in prescribing guidelines. Myself included

Oh - that sounds like how I would have assumed the system would work! This gives me hope!

I have only been to my vets once a year for quite a while now (touch wood), as the rabbits have only needed vaccines and I have been able to manage any stasis blips at home. I normally top up my metacam when I go for the vaccine but I forgot this year. I called the vets and the receptionist just told me that I would no longer be allowed any metacam - it was so stark and concerning. I asked the vet to call me, but then decided to just make an appointment for Monday - face to face is better and I am hoping that if they see the health records of my bunnies and how good looking they are, that they will allow me a few doses.

There has to be room for the vet to make a call at their own discretion. I am concerned that as they don't see me a lot though, that I may not have developed a 'good relationship' with them- I see a different vet every time I go in it seems.

 

[KarenM]

It is not just frustration because I am in tune with my rabbits. It is what appears to be poor regulations that do not consider the specific needs of rabbits and will put them in life threatening situations.

I understood it was the regulations that you were referring to; I think you misinterpreted what I was saying.

I didn't realise you hadn't spoken to the vet already so (no offence to vet receptionists) you may have been given the official policy ie. no meds without seeing the vet, because a receptionist wouldn't be authorised to make that sort of call on the vet's behalf. The vet themselves might well be willing to allow you a dose or two to have at home.

As for the guidelines themselves, I think they've been left quite general/non specific for good reason because it would be impossible to cover every possible scenario. Like you say, there are exceptions included within the guidelines and so vets are able to use their discretion where appropriate &, quite possibly, your situation would be one of them.

Hopefully you'll get some good feedback from them on Monday.