GARDINER, Maine — Maine regulators suspended a mail-order pharmacy whose product killed two racehorses here earlier this year after finding it distributed thousands of doses of drugs to a veterinarian who dispensed them from a van to horses without prescriptions.
Pennsylvania-based and Maine-licensed Rapid Equine Pharmacy LLC was found to have been effectively “acting as a wholesale supplier of compounded prescription drugs” to a veterinarian and “knowingly or negligently facilitating the diversion” of drugs to horses without prescriptions.
The Maine Board of Pharmacy voted unanimously Thursday to suspend the pharmacy’s license for 30 days, citing public safety and finding the company didn’t have controls to prevent errors or drugs from being illegitimately distributed.
Assistant Maine Attorney General Andrew Black, who called the case “unprecedented,” said the board could consider stiffer penalties including a longer suspension, permanent revocation or a six-figure fine. The case may come up again next month unless an agreement is worked out.
“This is upsetting,” said Joseph Bruno, the president of the pharmacy board and the CEO of Augusta-based Community Pharmacies. “Two horses died needlessly from poor care, not only from the veterinarian but the pharmacy.”
In a statement, Rapid said it takes the board’s decision “very seriously” and has taken actions to correct the issues that led to it. The veterinarian is not named in the decision and could face discipline from another state board.
The U.S. Food and Drug Administration announced in July that Rapid had distributed a paste made of two medications — toltrazuril and pyrimethamine — meant to treat a parasite that attacks a horse’s central nervous system. But the proportions of the two medicines were reversed, resulting in a paste that contained 18 to 21 times the pyrimethamine.
Rapid created 84 batches and distributed six tubes of medication to the veterinarian for a horse named “Allie.” The veterinarian then distributed two of those tubes to two Standardbred horses in Maine — best known for their distinct gait in harness racing — on May 23.
High doses of pyrimethamine can result in seizures, fever and death in horses. Both Maine horses suffered “acute severe neurologic disease” between 12 to 20 hours after receiving the medication and were euthanized. A third horse in Ohio also died after the medication was used.
Another veterinarian who treated both Maine horses alerted Rapid of their deaths and later filed a complaint against Rapid with the board. The company recalled the batch after the notification.
Thomas Avery, an investigator for the Maine Office of Professional and Financial Regulation, learned about Rapid’s transactions with the prescribing veterinarian while investigating the complaint. He found Rapid’s record system did not comply with state law.
Upon further review, Avery discovered thousands of drug orders from the veterinarian made in the name of equine patients under that veterinarian’s Michigan address. They were shipped to the veterinarian at a Maine harness racing track.
At a Thursday meeting, Avery said the veterinarian admitted to sometimes distributing medication from Rapid out of a van to horses without prescriptions. Rapid was previously fined $3,000 by the board in 2015 for failing to notify the board of a change in the company’s pharmacist in a timely fashion.
Rachael Fiske, the state’s assistant veterinarian, said Rapid is commonly used by veterinarians in the region. She said compounded medication is often used in the equine world because it is cheaper than FDA-regulated products and is easier to administer because pharmacies can calibrate doses needed for an animals weight and metabolism.
Compounded medications are not regulated by the FDA and have resulted in deaths in horses before. A similar incident involving the same two drugs affected 10 horses in Kentucky and Florida in 2014. Four of them died or had to be euthanized, according to DVM360, a veterinary news website.