The AAEP has established guidelines for veterinarians involved in treating non-racing performance horses which compete in a wide range of athletic activities and may need different treatment than those involved in racing. Since a majority of AAEP members work with non-racing performance horses during years of training and competition these members should be aware of the guidelines.
The AAEP recognizes that veterinarians need to be responsive to various discipline demands, which influence the ways in which they practice. However, irrespective of the influence current competition business/economic models may have on treatment protocols, the AAEP believes that appropriate treatment of performance horses requires accurate diagnostics and the development of evidence-based therapeutic regimens.
Non-specific treatment including multiple joint injections, without specific indication, is an example of under diagnosis and over treatment. Some horses are simply unable to perform effectively in today’s intensive scheduling of competitions and may require periods of decreased activity as part of appropriate medical management. Ignoring the individual’s needs while responding to the demands of the particular competition may lead to excessive treatment and failure to consider the best interests of the horse.
Veterinarians are trained to evaluate and manage performance-limiting problems, and when actively involved in the care of a horse, can provide expertise effective in preventing injuries resulting from training or competition and can help prolong a horse’s career. The judicious use of therapeutic techniques and medications is at the core of successful veterinary intervention.
The current use of medications to manage competition horses is often permissive and excessive.1-8 This environment is propagated by owners, trainers and veterinarians who fail to appreciate the potential harm to the horse inherent in the excessive or frivolous use of multiple medications and supplements in the quest for competitive success.
Failure on the part of the primary care veterinarian to evaluate the supplement and medication menu of each individual horse can lead to inadvertent overdoses and antagonistic effects between compounds. The administration of medications, implementation of treatment techniques and the recommendation of nutritional supplementation should be based on thorough examination, the subsequent development of a differential diagnosis and a thorough understanding of the athletic and scheduling demands of the particular discipline in which the horse participates.
The mission of the AAEP is to improve the health and welfare of the horse, to further the professional development of its members and to provide resources and leadership for the benefit of the equine industry. The AAEP recommends these “Clinical Guidelines for the Treatment of Non-Racing Performance Horses” to enable its members and the equine industry to provide appropriate care of the horses involved. While veterinary practices may vary depending upon the type of competition, basic tenets concerning diagnosis, treatment and safe and ethical use of medications must be employed.
Treatment of equine athletes must be directed toward normalizing their performance and avoiding performance enhancement by illegal or unethical means. While veterinarians are required to follow the regulations governing the discipline in which their patients are competing, participation in the establishment of these rules and regulations can be the most effective way to ensure that they are reasonable, uniform and give due consideration to the health and welfare of the horse.
Definitions
For the purposes of this document the following definitions apply:
complementary and alternative therapies: Acupuncture and chiropractic therapy, also called integrative therapies, which may be used alone or in conjunction with other medical therapies deemed in general to be more traditional or conventional.
desensitization procedure: The placement of a local anesthetic or other chemical agent adjacent to a nerve or within a synovial structure for the purpose of desensitizing a portion of the body, such as a joint, muscle, limb or tail.
extra label (off label) drug use: Use of a drug which is not approved for the horse or for a particular disease, but which has FDA approval for use in another species or for a different disease or route of administration. Off-label use does not apply in cases in which the product label prohibits a certain use or AAEP medication guidelines prohibit a certain practice for ethical reasons. Off -label use does not apply to illegally compounded products or to medical devices. All the criteria for therapeutic medications apply to off-label use.
extracorporeal shockwave therapy (ESWT): The application of acoustical shocks to bone or soft tissue to reduce inflammation, reduce pain and promote healing.
intra-articular (IA) injection: An injection intended to deposit medication into a joint space, such as the carpus, tarsus or fetlock.
intramuscular (IM) injection: An injection intended to deposit medication in the muscle.
intrathecal (IT) injection: An injection intended to deposit medication into a tendon sheath.
intravenous (IV) injection: An injection intended to deposit medication into the circulatory system by way of a vein.
medication: substances administered to horses for the purpose of preventing, treating or alleviating the clinical signs of disease or injury. non-steroidal anti-inflammatory drug (NSAID): A drug which inhibits cyclooxygenase enzymes which are needed for the production of prostanoids and leukotrienes and which results in analgesic/anti-inflammatory effects.
performance-enhancing treatments: Medication intended to create a level of performance that is beyond the capability of the horse in its natural state.
prohibited medications: Those agents that can affect a horse’s disposition, performance or appearance. These substances should not be administered internally or externally to a horse prior to or during an event except in a medical emergency under proper veterinary care and within competition regulations.
- Any stimulant, depressant, tranquilizer or sedative that could affect the performance of a horse. Stimulants and depressants are defined as substances that stimulate or depress the cardiovascular, respiratory or central nervous system.
- prohibited medications: Those agents that can affect a horse’s disposition, performance or appearance. These substances should not be administered internally or externally to a horse prior to or during an event except in a medical emergency under proper veterinary care and within competition regulations.
- Any stimulant, depressant, tranquilizer or sedative that could affect the performance of a horse. Stimulants and depressants are defined as substances that stimulate or depress the cardiovascular, respiratory or central nervous system.
- Any substance that might interfere with or mask the detection of a prohibited drug or medication.
- Any non-steroidal anti-inflammatory drug (NSAID) other than those allowed by the governing discipline.
- Any metabolite and/or analog of any of the above described forbidden drugs or substances.
soring (hypersensitization): The term used to define an intentional increase in sensitivity to a portion of the body.
subcutaneous (SQ) injection: An injection intended to deposit medication beneath the skin.
therapeutic medication: A drug or pharmaceutical used to control or cure a disease or disease process.
therapeutic procedure: a veterinary activity intended to treat disease or injury.
veterinarian-client-patient relationship: The veterinarian-client-patient relationship (VCPR) is the basis for interaction among veterinarians, their clients and their patients.9 A VCPR exists when all of the following conditions have been met:
- The veterinarian has assumed responsibility for making clinical judgments regarding the health of the horse(s) and the need for medical treatment, and the client has agreed to follow the veterinarian’s instructions.
- The veterinarian has sufficient knowledge of the horse(s) to initiate at least a general or preliminary diagnosis of the medical condition of the horse(s). This means that the veterinarian has recently seen and is personally acquainted with the keeping and care of the horse(s) by virtue of an examination of the horse(s), or by medically appropriate and timely visits to the premises where the horse(s) are kept.
- The veterinarian is readily available, or has arranged for emergency coverage, for follow-up evaluation in the event of adverse reactions or the failure of the treatment regimen.
Medication and Treatment Guidelines
- All therapeutic treatments for performance horses should be based upon a specific diagnosis and administered in the context of a valid and transparent owner-trainer-veterinarian relationship.
- All therapeutic treatments for performance horses should be based upon a specific diagnosis and administered in the context of a valid veterinarian-patient relationship.
- All therapeutic medications should be administered to performance horses by or under the direction of a licensed veterinarian.
- All therapeutic procedures should be performed with a sufficient interval provided to allow evaluation of the response to treatment prior to competition.
- All treatments should be scheduled and administered with an underlying recognition that the health and safety of the horse are the ultimate objectives. Maintenance therapy is an inappropriate medical concept. Systemic and or intra-articular medication administered on a periodic basis must be based on a prior diagnosis with periodic monitoring of the diagnosed condition to determine the appropriate frequency of administration.
- Non-therapeutic or non-prescribed medications or substances should not be administered to performance horses by anyone. The use of some non-therapeutic substances prior to competition is considered unethical, i.e., as in the use of substances intended to produce a calming effect. Some of these substances may carry a risk of injury or illness for the horse.
- Veterinarians should not perform surgical procedures or injections of any foreign substance or drug that could affect a horse’s performance or alter its natural conformation or appearance, except for those treatments or procedures, which have the sole purpose of protecting the health of the horse or are therapeutic.
- Understanding of regulations in specific competitions is imperative. Any medication administered prior to the day of competition should be done so in accordance with the rules of the competition and should not affect performance, behavior, normal movement or inhibit the physiologic response which protects the horse from injury.
- No medication should be administered to a horse within 12 hours prior to competition.
- Only one (1) Non-Steroidal Anti-inflammatory Drug (NSAID) should be permitted in plasma or urine samples collected for testing purposes.
The AAEP recognizes that the judicious use of intra-articular medications with a valid veterinarian-patient relationship is appropriate treatment and can benefit a horse’s health and well being. The AAEP defines this relationship to be a clinical or lameness examination with appropriate diagnostic tests prior to initiation of a therapeutic plan. Clinicians treating performance horses in the competitive environment are encouraged to develop treatment regimens, particularly with reference to the use of IA corticosteroids, which allow adequate evaluation of the horse’s response to treatment prior to competition.
Please see Clinical Guidelines for Veterinarians Treating Horses Used in Non-racing Competitions at http:www.aaep.org