Seeing the signs, managing addiction in veterinary practice

The opioid epidemic reaches across industries and backgrounds. And the veterinary profession is not immune. Dr. Matt Moskosky, co-owner of Fredericksburg Equine in Fredericksburg, Texas, has personal experience with addiction and how it can impact one's life and career.

Dr. Moskosky spoke about his story Dec. 2, 2018, at the American Association of Equine Practitioners' convention in San Francisco.

"I've been struggling with addiction since I was 12 years old," he said in an interview with JAVMA News. "I played football and had a 4.0 GPA. I was the all-American kid, but I was living this double life."

Recovery and relapse

When Dr. Moskosky graduated from Texas A&M University College of Veterinary Medicine & Biomedical Sciences in 2009, he had chronic pain from years of football injuries, and he was an opioid addict.

"I went on to work at a mixed animal practice, and my addiction blossomed from there," he said. "It wasn't long before my addiction came to light, and I was ultimately terminated."

Dr. Moskosky went into treatment. When he was out, he started working at Dick's Sporting Goods and going to meetings for recovering addicts. Eventually, after approval from the Texas State Board of Veterinary Medical Examiners, he decided to dip his toe back into the veterinary world.

"I rigged out my (Ford) F-150 with an old Astoria veterinary box (and) solar panel and started a mobile veterinary practice," he said. "As time went on, more money flowed in, and I got busier and busier. Work became an idol and my top priority, and my recovery took a back seat. My phone would ring, and my blood pressure would shoot up. I was burning myself out. ... I relapsed. I had an order (from the Texas State Board of Medical Examiners) in place, and I was being monitored, but I used a medication that didn't show up on the drug screens."

In February 2015, nearly two years later, the drug Dr. Moskosky was using showed up when he was randomly selected for a different drug screening.

"I had breached my board order, and I thought I would never be able to practice again," he said. "But, by the grace of God and the Texas state board, they allowed me one last chance. However, only under strict guidelines. Among other things, I would no longer be able to be the Lone Ranger practitioner anymore. And with that, I watched the practice I'd worked so hard to build dissolve."

Safeguarding against theft

James Arnold, chief of the liaison section at the Drug Enforcement Agency's Diversion Control Division, spoke at the AAEP convention about how veterinary practices can assist the DEA in combating the opioid epidemic and described best policies for recognizing and handling addiction within a practice.

Arnold said veterinary offices across the nation are experiencing internal theft issues and having clients come in with their animals to try to obtain controlled substances.

"Addiction is an equal-opportunity employer," he said in an interview with JAVMA News. "It doesn't matter what the profession is. … It is an issue for everybody."

Arnold suggests six areas where veterinarians can improve security to better protect themselves, their practices, and their patients:

• Keep controlled substances locked up.
• Have a working alarm system, possibly with cameras.
• Take inventory, and keep good dispensing records.
• Implement standard procedures to deal with clients who come in demanding controlled substances.
• Consider installing a panic button.
• Report theft and losses to the local police and the DEA.

When Dr. Moskosky first got clean, he had someone else handle administrating controlled substances to his patients. Now, it isn't about access, it's about desire, he said.

"Of course, there are medications (at the practice) that I could get high off," he said. "But the same is true at the dollar store or the liquor store down the street. For me, access is not the issue."

One of the many elements aiding in Dr. Moskosky's sobriety is accountability.

"We have a lot of roadblocks and safeguards in place. ... We do not keep a lot of controlled substances (at the practice). We only keep what we need," Moskosky said. "We also have an open line of communication. My partner and employees know that I am in recovery, and so that adds to the accountability."

Dr. Moskosky hopes his story will make a difference to someone who may need help.

"Veterinarians are not removed from this problem," Dr. Moskosky said. "Those with substance-abuse disorders should not be ashamed and should know that they are far from alone. It is important for the veterinary community to know that addiction truly is a disease and that these are sick people that need help, and they can recover. ... People should not be ashamed, and they should know that there is help (out there), and they can recover and continue to be competent, ethical, compassionate, and capable veterinarians if given the opportunity."

Related JAVMA content:

What veterinarians need to know about the opioid epidemic (Oct. 15, 2018)

Putting drug testing into practice (Sept. 15, 2015)