In this episode of the Cone of Shame Veterinary Podcast, host Dr. Andy Roark discusses the post-euthanasia risks associated with pentobarbital injection. Dr. Warren Hess, the first author on a notable paper in JAVMA on the subject offers valuable insight as their conversation dives into the environmental and legal implications veterinarians may face after performing euthanasia using pentobarbital. Dr. Hess emphasizes the importance of understanding the drug’s impact beyond the act of euthanasia, addressing issues such as liability, rendering, and potential impacts on food and feed. The conversation explores the need for better education among veterinarians and clients, and the importance of documentation to protect practitioners. Dr. Hess also mentions ongoing efforts by the AVMA to provide resources and education on this critical topic for veterinary professionals.
Article Referenced: https://avmajournals.avma.org/view/journals/javma/261/11/javma.23.03.0161.xml
AVMA Axon: https://axon.avma.org/
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ABOUT OUR GUEST
Dr. Hess is an associate director in the American Veterinary Medical Association’s (AVMA) Division of Animal and Public Health and as AVMA’s Disaster Coordinator. He provides technical and scientific expertise to the Committee on Environmental Issues (CEI) , the Aquatic Veterinary Medicine Committee (AqVMC), the Council on Veterinary Service (CoVS), and the Committee on Disaster and Emergency Issues (CDEI).
Dr. Hess graduated from Colorado State University in 1989. He worked in small animal practice with an emphasis on birds and other exotic animals until 2004 when he began working for the Utah Department of Agriculture and Food (UDAF) where he served as a field veterinarian, assistant state veterinarian and 18 months as acting state veterinarian. He began working at the AVMA in 2016.
Dr. Hess became involved early in his career with organized veterinary medicine and was elected president of the Utah Veterinary Medical Association (UVMA) in 2000. Dr. Hess has led several state and national organizations including serving as president of the National Alliance of Animal and Agricultural Emergency Programs (NASAAEP). Dr. Hess was voted Veterinarian of the Year in 2014 by the UVMA. He was the recipient of the NASAAEP Service Award in 2017 and the American Veterinary Medical Foundation (AVMF) Paws Up Award in 2018. He is married to his high school sweetheart (Lori), and together they have 5 children and 14 grandchildren.
Dr. Hess has enjoyed the companionship of horses, dogs, various birds, and marine fish. He enjoys fishing, rowing/kayaking, and motorcycles and has completed a motorcycle trip from his home state of Utah to Alaska and back with his 87-year-old father in tow.
Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here today with Dr. Warren Hess. He’s the first author on an interesting paper that I saw in JAVMA. It was about pentobarbital and what happens after the injection. And I’ll, be honest, it was something I was not really aware of. I genuinely don’t really think about what happens after we perform euthanasia. And it turns out there’s a number of things we need to at least have some eyes on. There’s some liability for veterinarians. There are there are some environmental impacts.
There are impacts around rendering and feed and food. And it’s just, it was something I had not really considered in a long time. And so it was a really good refresh. So anyway, this is a short conversation where we get right into it and just talk about what do veterinarians need to know?
What do they need to remember? What should we be talking to pet owners and animal owners about before we do euthanasias using pentobarbital? So anyway, that’s what it is. Let’s get into this episode.
Kelsey Beth Carpenter: (singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark
Dr. Andy Roark: Welcome to the podcast, Dr. Warren Hess. How are you?
Dr. Warren Hess: I’m great, Andy. Thanks for having me.
Dr. Andy Roark: I am very excited that you are here. For those who don’t know you, you are a veterinarian. You are also the American Veterinary Medical Association’s Disaster Coordinator, which I think is the best title you could possibly have. You are also an associate director in the AVMA’s Division of Animal and Public Health.
And I just became aware of some of your work quite recently. I was actually reading through the JAVMA issue that came out earlier this year. And you were the first author on a paper called Survey of Veterinarians Who Use Pentobarbital for Euthanasia Suggests Knowledge Gaps Regarding Animal Disposal.
It was actually an interesting survey that you did about what veterinarians know and don’t know, about what happens with animal disposal after we use pentobarbital. And it was funny because I looked at this and I thought I would check every “no, I am unaware box” on the whole survey. And so I actually found this survey quite interesting.
One, in what veterinarians know and don’t know, but also in the like, why would we do this survey? What are we supposed to know? What is important to know about animal disposal when we use pentobarbital and drugs like that? So let me just start at a really high level and just say, when I looked at this article at first, I was like, I had no idea that there was anything I need to be concerned about in this regard.
Why should we be aware? What should we know?
Dr. Warren Hess: Andy, you’re similar to most of us, I think, especially if we come from a small animal background, which, I do. We go through vet school, we’re taught pentobarbital is one of the choice agents for euthanasia and we’re taught how to use it but we’re not really taught much more than that.
And what we’re learning about pentobarbital is, it doesn’t break down very well after it’s injected into the body for, euthanasia purposes. And that can create quite a bit of a problem, the scope of the problem is multifactorial.
Dr. Andy Roark: Okay.
Dr. Warren Hess: It ranges from issues with traces of pentobarbital ending up food and feed through a variety of processes. It impacts renders and it also impacts scavenger animals that might get access to a carcass or animal remains.
And it also impacts the environment, when pentobarbital leeches out of animal remains into the ground it can reach waterways. It can impact microbial life in, the surrounding area, and it can get into waterways and impact aquatic life as well.
Dr. Andy Roark: What motivated you to start to do this survey and look at this? Do you get the impression that it is an increasing problem? Is it something that has just been around and you feel like it’s lingering without getting any attention or unawareness? But what made you decide that this was the thing that you were gonna look into?
Dr. Warren Hess: Back in 2018, there were a couple of incidents where pentobarbital was detected in pet food.
And that started a discussion between AVMA and the FDA about why was that happening and what could we do to bring better awareness to, not just veterinarians, but other industry professionals out there as well.
Dr. Andy Roark: How does that happen? how do we end up with pentobarbital in pet food?
Dr. Warren Hess: The FDA would probably be the best one that answer that accurately but my understanding is that there were two different scenarios. One where there was enough pentobarbital in some meat products that were used for pet food that it actually impacted the animals that were consuming it.
Dr. Andy Roark: Okay.
Dr. Warren Hess: The other scenario was and I don’t even recall what organization it was, but after that event happened where animals where their health was impacted. An organization just grabbed some pet food off the shelf and ran had a lab run pentobarbital levels and detected it in those products even though it wasn’t causing clinical signs in animals. So that, brings up the issue that, probably rendering products were involved and the more sensitive our tests become, the easier it is to just pick up minute amounts of pentobarbital. And, any amount of pentobarbital in a food or feed product is what FDA considers an adulteration, and would be cause for a recall.
Dr. Andy Roark: Are there guidelines or precautions that veterinarians should be taking when they use pentobarbital that you think that veterinarians don’t know or they’re not aware of?
Dr. Warren Hess: The first thing I would say is that veterinarians should understand that their responsibility about the drug, pentobarbital, that they use doesn’t end when they inject it. Their responsibility continues for any impacts that occur from that animal after it leaves their clinic or after they leave the farm or anything like that. That would be the first thing to be aware of. There have been veterinarians that have been prosecuted for the impacts that pentobarbital had on protected species of animals that ended up having access to those animal remains and being impacted by it.
Dr. Andy Roark: There were veterinarians that were prosecuted because, I’m guessing you’re saying are we talking about endangered species or protected species scavenged something? What does that look like?
Dr. Warren Hess: Yes. They euthanize a horse, for example, and leave it with the owner to take care of. And the owner doesn’t take care of it, just leaves it out in the field. And eagles or something like that come along and feed on it and either die or are severely impacted from the pentobarbital that they’re getting from the meat that they’re eating.
Dr. Andy Roark: I’m looking at my career and I’m going, “where did I mess this up?” And so the first thing I say, do I have concerns if I’m using cremation service, something like that?
So your standard small animal veterinary and, we’ve got pets, we’ve got, we’re going to, we do our injection, we send the pet off to be cremated. Is there anything that I should be thinking about that? Is, should I give that a second thought or is that an acceptable disposal that does, is not gonna have any problems?
Dr. Warren Hess: As far as we know, cremation is probably one of the best ways to dispose of animal remains that have been euthanized with pentobarbital. There really hasn’t been a lot of study. Along that line, but the temperatures that the cremation services reach to cremate animals should degrade the pentobarbital.
Dr. Andy Roark: Hey guys, is your clinic slowing down? Are you having more open appointments than you had in the past? Are you wondering a little bit about what you need to do to get clients to, one, come into the building, and then, two, listen to your doctors and your staff when they get there? Well, you, my friend, might need to head over to the Uncharted conference in April.
That’s right! It’s in Greenville, South Carolina. It is April 18th through the 20th. This is the granddaddy of the Uncharted Veterinary Conferences. This is the one that we started with. This is our marketing and strategy conference back to our roots. I love this stuff! The theme of this conference is ‘Standing Out In A Sea Of Noise’
It is all about strategic communication. It is about getting heard. This is going to be a lot about your brand identity is understanding the modern consumer who is getting more price conscious because things are getting more expensive. We are going to need to up our marketing game, our communication game, our client bonding game, our trust building game, we’re going to have to turn the volume over on that stuff.
Guys, we didn’t have to do that for the last couple of years. People have been coming in, the pandemic was a surge in business. A lot of us are trying to keep our head above water. It’s not going to be that way going forward. It’s time to re-engage with our clients in a motivating, educating way to get them coming back into the building.
Guys, Uncharted is not a bunch of lectures. You are not going to come here and sit in lectures. You are going to work on your business at this conference. You are going to be surrounded by butt-kicking, positive people who love vet medicine, who love pet owners, and who want to create a great experience and make a wonderful place for, pets to get the care that they need.
They want to have a positive workplace. They want to have a place where people smile when they come to work and they’re working on making that happen. And so if that sounds like you, or if you want to be surrounded by those people, you got to come to the April conference. Also, this is the last time for a while that the April Uncharted conference is going to be in Greenville, South Carolina.
This is our birthplace. It’s our home base. It’s our nest, this is kind of a big deal for me. At least I, you know, I, I have loved this conference in Greenville. I still love it in Greenville. I think Greenville will always be our home, but guys, we’re spreading our wings. We are going to be moving out and doing new things and going to new places.
And it is going to be amazing. But if you want the original Uncharted experience, if you are like, man, I’ve heard so many people talk about Uncharted in downtown Greenville and how the conference just fits into that community and how amazing it is, this is your chance. You want to be here. Also, if you have been an Uncharted member, if you’ve come to our conferences before, if you loved it, you always thought there’d be a chance to come back to the old Westin Poinsett and downtown Greenville you should grab a spot.
I think that there will probably be a chance in the future, but it won’t be for a while. I think there’s going to be a lot of people coming back because they want to do it one more time at the Westin before we move on and check out some new places and do some new stuff.
So I do expect this event will sell out. Guys, go ahead, head over to UnchartedVet.com and grab your registration spot right now. I’ll put a link down in the show notes. Again, you do not want to miss it. This is an investment in yourself and in your practice and your future. It is an investment in skills that you will have and use again and again, and it’s an investment in connections.
You are the average of the people you spend time with and you’re about to be surrounded and spend time with some really amazing people. Anyway, let’s get back into this episode.
Do you think that veterinarians need to not allow pet owners to take the body of pets’ home? Or do you think that we should not allow, say farms to dispose of bodies without some sort of supervision or some sort of a waiver or, what does that look like? Are we going to not yield access back to pet owners after they have this drug in the body?
Or are we going to legally protect ourselves? What does that look like in your mind?
Dr. Warren Hess: AVMA hasn’t come out with a position on that. My personal opinion is that I hope we don’t get to the point where people are afraid to send animals home, or leave animals at a farm, but hopefully better education, better awareness by the veterinarians, better education to the clients, and maybe some forethought about how things are going to happen rather than an afterthought of, “now that we’ve euthanized this animal, what are we going to do?” Because you want, you hopefully want with forethought, you can plan ahead and, let people know what really needs to happen if the animal’s not going to go for, stay with the veterinarian under their control and that probably will solve a lot of problems. Certainly, the number one message that’s out there that not all veterinarians apparently are aware of is that pentobarbital should not be utilized in animals that are going to go for intended for food or feed products. So that means either directly to a to be processed for meat or to go to a renderer and have rendering products. It’s a big issue right now in the rendering industry and a lot of people that deal with cattle and horses know that there’s been a major shift in the rendering industry over the past five or six years. And it’s much more difficult to a lot of renders will not even pick up horses anymore.
So that’s really limiting the options for horse carcass disposal, and some renderers won’t even pick up cattle anymore off of farms. The only products that they will pick up are from slaughterhouses. They’ll pick up unused product from slaughterhouses. And that’s all they’ll do because it costs tens of thousands of dollars to do a cleanup in a rendering facility once pentobarbital has been detected.
And most renderers are now, because of this issue, most of them are routinely scanning doing spot tests for pentobarbital residues in their products.
Dr. Andy Roark: Do you think there’s fallout for veterinarians if you’re called out to the farm and you’re going to put cattle down or something and they go, oh, no, we’re not rendering this and then they change their mind or you’re like, is there anything that we need to do to protect ourselves is this going to come back on me when I go and I do a euthanasia and I, this is not what I thought was going to happen and maybe the story that I get is not accurate or the intentions change after I leave, do I need to cover myself in this significant way
Dr. Warren Hess: I’m not a lawyer, right? But my, my suggestion would be to document. Document your discussion, what you talked about with the owner. Make sure it’s in the record and that way you’ve probably protected yourself as best you can.
Dr. Andy Roark: if, I have a just a, dog or a cat come in and they come in for a euthanasia appointment or I go and I do a house call and I’ve had plenty of clients who say, I have a spot in the yard where I’m going to bury, Capsy and that’s, it’s her spot. I, do you have concerns about that other than maybe to talk about?
I don’t know, proper burying techniques where we’re not going to have problems with scavengers, things like that. I don’t mean to be morbid, but, those are the ones that I have done. I’ve a hundred percent used pentobarbital to put pets to sleep and the owner said, you know what? I, want to, bury, I want to bury her out by the, by the tree.
Yeah. Do, does that, does my approach to that need to change? Do I need to be having a different conversation?
Dr. Warren Hess: I, think there needs to be, there should be a conversation now that stresses the importance of the drug that was used the ramifications on if, if that carcass is accessed and also just be paying attention to what the regulations are in their location obviously a lot of these regulations are local they fluctuate from city to city, so it’s really difficult for veterinarians to know what those regulations are going to be, but if there’s shallow water tables that, leaching of that pentobarbital can certainly impact It’s not going to be treated by water treatment plants, and it’s not and it can, if it’s not going to a water plant, but going directly to a stream or something like that, it can impact the aquatic life there.
Dr. Andy Roark: If there are veterinarians out there who are just sitting and processing this and they would say, I’d like to think a little bit more about this, what resources do the AVMA have? What, would you recommend for people who wanted to learn a little bit more and, maybe start to process but what exactly they’re going to say or how this might affect the way that they practice. Where would you send them?
Dr. Warren Hess: AVMA is in the process of developing some resources, Andy, I wish I wish I could point you to an exact spot right now, but what I would say is be looking for information on AVMA’s website concerning this in the coming six months. And also, our digital education platform, which is called Axon we’ll be developing a, a webinar for veterinarians and, further education about this, expanding on what we’ve discussed today, pointing them to local resources. If you have specific questions about handling pentobarbital in larger animals certainly check with your state veterinarian, they might be a great first point of contact to understand if there’s any developing legislation in the state around this or anything like that.
Dr. Andy Roark: Good. All right, that sounds good. Dr. Warren Hess, thanks so much for being here today. I really appreciate your time. Guys, thanks for tuning in. I will put a link to the original JAVMA article in the show notes. I’ll also link up to Axon the educational portal for AVMA and hopefully you guys will be aware when they release new information there.
Dr. Warren Hess: Thanks, Andy.
Dr. Andy Roark: Hey, thanks a lot. Thanks everybody. Talk to you later.
And that’s it guys that’s what I got for you. Thanks for being here. Thanks to Dr. Warren Hess. I hope you guys learned something from this. I hope you got something to think about I’ve been thinking about a little bit since the interview and just going, you know How would I say this and when pet owners want to take their pets home to bury them at home? What’s my communication strategy going to be? So I’ve been rolling it around. It’s definitely been a good conversation for thought provoking purposes Anyway guys, thanks for being here. Take care of yourselves everybody. I’ll talk to you later.