Perspectives

Psychology professor's study finds lethal drug access could be cause of higher suicide rates among veterinarians

Dr. Tracy Witte

A new study by Auburn University psychology associate professor Tracy Witte and researchers with the Centers for Disease Control, published in the Journal of the American Veterinary Medical Association, indicates higher suicide rates among veterinarians, when compared to the general population, might be attributable to pentobarbital access, a drug used for the humane euthanasia of animals.

Witte’s study builds upon previous studies, such as a 2018 study from the Centers for Disease Control, which show suicide rates among those in the veterinary profession were significantly higher than for the general U.S. population. She hopes the results of her study will lead to improved administrative controls for pentobarbital access, raise awareness of the issue and ultimately decrease the number of suicides.

“Although we have known about the elevated risk for suicide among veterinarians for decades, there was little clarity regarding why they were at elevated risk,” Witte said. “Clearly, suicide is a multifaceted problem that arises from a complex combination of risk factors. That said, elucidating the role of pentobarbital provides a clear intervention target that can be used to prevent suicide now, even if we don’t yet understand exactly why a particular individual might become suicidal.”    

Her study reviewed death records for 202 veterinary professionals whose manner of death was characterized as suicide or undetermined intent from 2003 to 2014. Of the 73 veterinarians who died by suicide, 25 percent used pentobarbital. In 72 percent of the veterinarians who died from pentobarbital poisoning, the death-related injury occurred at home.

“We also found that veterinarians were less likely than the other veterinary occupational groups in our sample to have a history of non-fatal suicide attempts. This suggests that veterinarians are more likely to die by suicide on their first attempt, presumably due to knowledge about and access to a highly lethal method like pentobarbital.”

Witte said her study was the most comprehensive investigation of suicide among U.S. veterinarians to date and the first to examine deaths by suicide among veterinary technicians or technologists and veterinary assistants or laboratory animal caretakers.

“Veterinarians and veterinary technicians or technologists had significantly higher rates of death by suicide, compared with findings for the general population, whereas veterinary assistants or laboratory animal caretakers did not,” she said.

The study also revealed that the most notable difference between veterinarians and the other veterinary occupational groups was that veterinarians were significantly more likely to have used pentobarbital as a suicide method. The high likelihood of suicide by self-poisoning among veterinarians is in contrast to the general population, where among males, firearms are the most common suicide method, and among females, self-poisoning is slightly more common than firearms as a suicide method. 

“It has been assumed that veterinarians have a higher suicide risk because of their access to certain lethal drugs such as pentobarbital, but this study was the first to find evidence supporting that possibility,” Witte explained, adding that when death records were removed for those who used pentobarbital poisoning as a suicide method, male and female veterinarians no longer indicated a difference in suicide rates compared with the general population.  

“This provided compelling evidence that access to pentobarbital might explain the high risk of suicide among veterinarians, and this has critical implications for prevention efforts,” she said. “Specifically, restricting access to lethal methods for persons at risk of suicide is among the strategies with the best available evidence for suicide prevention.” 

The CDC National Institute for Occupational Safety and Health describes a hierarchy of controls for limiting exposure to occupational hazards. In regard to pentobarbital in veterinary settings, the institute says it is not feasible or desirable to use elimination controls, which involve physically removing the hazard; substitution controls, which involve replacing the hazard; or engineering controls, which involve isolating people from the hazard. 

“This means that administrative controls, which involve changing the way people work, is the most viable option for limiting pentobarbital access in veterinary clinics,” Witte said. 

Witte’s study suggests a minor change in the way veterinarians access pentobarbital, such as requiring a second person’s signature when accessing the drug, could have a preventative effect for suicide among veterinarians, while still allowing access for clinical purposes.

“Increased administrative controls could also make it more difficult for a veterinarian to take pentobarbital out of the clinic to be used outside of the workplace, where most of the pentobarbital-related suicides in our sample occurred,” she said. “Auburn’s College of Veterinary Medicine is a model for safe controls of pentobarbital and students are learning the importance of controlling access to this drug before they go into practice as veterinarians.” 

Moving forward, Witte said the next step in this line of research would be investigating the feasibility and acceptability of increasing administrative controls for pentobarbital in veterinary clinics. 

“We need buy-in among key stakeholders in the veterinary community to work toward changes and stronger controls of pentobarbital,” Witte said. “Any changes would need to be done in consultation with that community.” 

The United States Department of Justice’s Drug Enforcement Administration classifies pentobarbital as a schedule II substance, and drugs classified as such are required to be in a locked cabinet or other secure storage. 

“The problem is that many veterinarians are solo practitioners or work in a small practice,” Witte said. “As such, they have easy access to the substance for themselves, and they would be able to remove the substance from the lockbox without needing anyone else to know about it.”

Witte hopes that her study could lead to stronger restrictions on pentobarbital access, which could ultimately help reduce suicides.

“People often assume that if someone is suicidal and is prevented from accessing a particular suicide method, he or she will simply choose another method,” she said. “However, the research is not consistent with this idea. Moreover, if a person is blocked from accessing a highly lethal suicide method, like pentobarbital, he or she is less likely to have a fatal outcome even if method substitution occurs, if the substituted method is less lethal.”   

“Suicides are tragic and cause tremendous grief,” said Dan Givens, associate dean for academic affairs in the College of Veterinary Medicine. “In the veterinary profession, which is characterized by compassionate care for pets and livestock, this grief is both deeply personal and an openly acknowledged concern. This study is a valuable contribution to our understanding of the direct causes of suicide in our profession. Applying this new information toward the development of additional concrete measures to prevent suicide is critically important, yet the resulting measures must not excessively hinder or delay the compassionate medical care that that our society demands for its animals.”

Despite the findings of her research, Witte said it’s important to note that although suicide rates are elevated among veterinarians, suicide is still a rare outcome in the profession. 

“There are great efforts within the profession and field of veterinary medicine to increase awareness about mental health issues, including suicide,” she said. “We have many reasons to be optimistic that we will see improvements in suicide rates in the coming years.” 
 

Written by Miranda Nobles | Communications Editor | Auburn University Office of Communication and Marketing 

Last Updated: August 21, 2019