How Hong Kong's On-Track Pharmacies Work

Last week Frank Stronach, chairman and founder of The Stronach Group, proposed introducing an on-track pharmacy as part of a 10-point plan to control medication use and abuse at his six racetracksSanta Anita Park, Gulfstream Park, Pimlico Race Course, Laurel Park, Golden Gate Fields, and Portland Meadows. If implemented, racetrack veterinarians would be prohibited from bringing medications onto Stronach's racetrack properties and would be required to obtain any medication needed to treat their clients' horses through the on-track pharmacy. Detailed records about what the horses are receiving would be kept and subject to periodic review. Tracking medication use in this matter is routine at The Hong Kong Jockey Club. The Blood-Horse editorial director Eric Mitchell contacted the HKJC recently about how the on-track pharmacy system works and got answers from Dr. Christopher M. Riggs, HKJC's head of veterinary clinical services.

BloodHorse.com: Does The Hong Kong Jockey Club operate a pharmacy at each racetrack?
Dr. Christopher Riggs: "The HKJC ensures provision of veterinary care to all horses in Hong Kong through the Department of Veterinary Clinical Services. Vets within the DVCS, who are all employees of the HKJC, provide sole care for all horses in Hong Kong. The DVCS operates from an equine hospital at the Sha Tin racing complex, where all racehorses are stabled. There is a tightly controlled, secure pharmacy within the equine hospital, which is subject to strict operating protocols, based on safe, secure principles. Adherence to these protocols is regularly and independently monitored by the club's audit department. Only drugs and supplements supplied by the DVCS pharmacy can be used on HKJC horses. There are small, satellite vet clinics at the Happy Valley Racecourse (which is only functional at race meetings), in quarantine, at the 'Olympic Stables' (a stable unit at Sha Tin that is physically separated from the main stable complex), and at the stables where retired racehorses are retrained for equestrian use. Each of these clinics maintains small drug stores that are subunits of the main pharmacy and are subject to the same control measures."

BH: How does a veterinarian access the medications he needs? Does he simply fill out a prescription?
CR: "Medications can only be dispensed from the pharmacy after approval by a DVCS vet. Routine medications (e.g., continuation of a course of antibiotics, trainer request items), are dispensed directly to the stable in a sealed container (Secure Stable pharmacy box) each morning after vet approval. The vet will break the seal to gain access to the medications when they attend the stable. Vets also carry a fixed inventory of stock with them (in their own vet medicine box) for ad hoc treatments. A check of the stock in each individual vet medicine box is performed at the end of each day and stock movement is reconciled against prescriptions entered into the DVCS information system (The Veterinary Management Information System--VMIS). Any discrepancies are immediately followed-up. Either way, all stock that leaves the pharmacy must be recorded in the VMIS as prescribed to a certain horse."

BH: How is the medication dispensed? Does a vet only buy a 10cc dose or can the vet buy a vial of a medication?
CR: "All vets work for the HKJC and so they are not involved in any financial transactions. All stock movements are recorded in the VMIS and are charged directly to the owner of the relevant horse's account. Stock is routinely dispensed in the smallest relevant unit. For example, all injectable drugs are pre-drawn in syringes at the time they are dispensed from the pharmacy (and supplied either in the Secure Stable pharmacy box or in the vet's own medicine box)."

BH: How are medication records on individual horses recorded and archived? How often?
CR: "On the VMIS in real-time. In addition, all trainers are responsible for maintaining a Trainer Medication Book. This must record all prohibited regulated substances administered to each and every horse. Each prescription must be countersigned by the DVCS vet who prescribed (and administered) the drug. Horses are subject to random 'Horse in Training' sampling. If this reveals presence of an unauthorized prohibited substance the finding is then reconciled against entries in the Trainers Medication Book. If there are any discrepancies (i.e., presence of unaccounted for drugs) this is vigorously investigated by an independent veterinary department (the Department of Veterinary Regulation)."

BH: If a horse colics and requires immediate medical attention, does the racetrack veterinarian have at his/her immediate disposal the drugs needed to deal with an emergency?
CR: "Yes, in their ad hoc medicine box. Also, DVCS vets have full access to the pharmacy if required. As employees of the HKJC, all vets are subject to pre-employment security checks and are bound by the HKJC's code of conduct. The DVCS operates to the highest standards of integrity. However, all entry in and out of the pharmacy is also recorded and there is extensive closed-circuit TV coverage."

BH: Are horses allowed to ship in for any Hong Kong race and if so, how does the HKJC handle drug testing? Does it require the trainer to supply medical records?
CR: "There are five race meetings annually that are open to international horses. All trainers with horses that are entered must provide detailed drug administration histories. Blood and urine samples are collected from each horse under security conditions immediately after it arrives in Hong Kong. If these reveal the presence of prohibited substances that prevent the horse from being able to compete then the owner will have to refund all travel subsidies provided by the Club and the trainer may be liable for a fine.

"A urine (or blood) sample is collected from each and every horse on the morning of racing and screened for presence of prohibited substances pre-race. All first- and second-placed horses and favorites that finish third or lower are automatically blood and urine sampled immediately post-race as well as any other horse as directed by the racing stewards. In addition, horses that did not provide urine pre-race are sampled post-race."

BH: What medications are available at the pharmacy and when is it open?
CR: "All medications that have a legitimate, clinical indication are provided by the pharmacy. It is staffed by pharmacy staff six days a week."

BH: Are private vets allowed on the backside of Hong Kong racetracks?
CR: "No. Although an owner or trainer is free to ask for a second opinion from an external vet but that vet would have to be registered to practice in Hong Kong and would need to work in close association with the DVCS."

BH: Are the vet trucks searched for any unauthorized or non-prescribed drugs? How often are these searches conducted?
CR: "This is not applicable as all vets are employed by the HKJC and all facilities are owned by the HKJC. Extensive closed-circuit TV networks throughout the stables and random drug testing on horses in training guard against unauthorized treatment by other people."

BH: What happens if a vet is found with an unauthorized substance? What about a trainer?
CR: "If the vet was found to be acting against the Rules of Racing he would most likely be fired. A trainer would be breaking the Rules of Racing and likely to face serious penalties."

BH: Does the HK conduct out-of-competition testing?
CR: "Yes. Out-of-competition testing is referred to as 'Horse in training' testing in Hong Kong, as mentioned above. No horses are every really 'out-of-competition' in Hong Kong, unless retired. During the most recent 2012/2013 racing season, the club conducted over 1,200 out-of-competition tests in addition to approximately 14,000 race-day tests."

BH: Are trainers allowed to give any therapeutic medications themselves?
CR: "No. They would be breaking the Rules of Racing (and likely to face severe penalties) and may be breaking the law in Hong Kong."

BH: Is furosemide (Salix) allowed during training? Are any other medications allowed during training?
CR: "No, routine treatment with furosemide is never permitted in training. A range of medications is permitted, based on clinical indication. However, strict withdrawal periods are advised (and closely adhered to) to ensure that horses are free of prohibited substances when they race."

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