Naturopathic Physicians Can Prescribe a Much Broader List of Drugs

June 4, 2009 in Naturopathic Medicine, News and Views, Uncategorized

PORTLAND, Ore. (June 18, 2009)- On June 2, 2009 the Oregon house of representatives today “unanimously” passed Senate Bill 327, expanding the prescribing authority for the state’s approximately 850 licensed naturopathic physicians. In addition to the list of naturally-derived drugs that have long been on the naturopathic formulary, Senate Bill 327 will permit naturopathic doctors to prescribe common primary care pharmaceuticals that are synthetically derived. The passage of the bill is seen as a major win for Oregonians, who face a growing shortage of primary care physicians, particularly in the rural and underserved areas of the state.

Dr. David J. Schleich, president of National College of Natural Medicine in Portland, applauded the bill’s passage. “Oregon’s naturopathic physicians, educated and clinically trained as primary care physicians, will soon be in a position in which they can put their full scope of practice to use at a time when the demand for low-cost, preventive health care is highest.”

Schleich noted that health care experts currently project a crisis in patient health care access in the coming decade due to the declining numbers of primary care physicians and aging of baby boomers throughout the US.   ”We expect that this legislation will provide more opportunities for our naturopathic doctors to serve patients as primary care providers, especially where the need is most critical,” Schleich said.

The bill, signed into law today June 18th by Governor Kulongoski, allows naturopathic doctors (NDs) full primary care prescribing authority.  Although NDs are uniquely trained in the full range of synthetic and natural pharmaceuticals, before passage of this bill they were limited in their prescribing authority by a 1950s statute that stipulated that NDs could only prescribe naturally-derived substances, which precluded a few commonly used drugs, now considered “standard of care” in primary care settings.  The bill gives Oregon’s naturopathic physicians the nation’s broadest prescriptive authority, according to a news release from the Oregon Association of Naturopathic Physicians.

The new legislation enables the Oregon Board of Naturopathic Examiners (OBNE) through its Formulary Council to determine the full formulary of medications Oregon NDs can prescribe based on naturopathic principles, public need and evidence-based clinical reasoning. The Formulary Council presently consists of two pharmacists, a pharmacologist, a pharmacognosist, a medical doctor and two NDs.

Dr. Rick Marinelli, a naturopathic doctor and OBNE chair, explained, “The present formulary is very large. Although it includes all major drug therapy categories, some important, safe, low-cost synthetic drugs aren’t included. This limitation has forced naturopathic doctors to prescribe less efficacious medications to their patients or refer them to our medical counterparts, resulting in duplication of service and increased health care costs.”

Marinelli added that while the current naturopathic formulary is very comprehensive, the new law will allow the formulary to include common synthetic prescription drugs that NDs have been trained in, including diuretics and high blood pressure medications, among others.

NCNM’s Schleich said that that the medical school’s students are required to take 72 hours of pharmacological training as part of their doctoral degree. In addition to NCNM’s rigorous classroom training, students must also take 1500 hours of clinical training. Upon graduation, NDs are required to take 25 hours of annual continuing education courses-five of those required hours must be in pharmacology.

Schleich said, “NCNM is educating and training generations of physicians and practitioners to join forces with medical doctors, nurse practitioners and other health care professionals to help address the critical shortage in the health care workforce.”

Marinelli agreed that besides receiving the necessary education and training to practice medicine, licensed NDs also have strong oversight of the OBNE, which, he said, will successfully implement the change immediately as it becomes law. The law is slated to go into effect in January 2010.

Kevin Wilson, N.D. Chair of the Formulary Council for the Oregon Board of Naturopathic Examiners stated the value of ND’s having a broadened drug formulary well in his Oregonian letter to the editor.

“If a patient comes to us on medications, he may need to continue those medications until he’s able to regain his health through non-drug interventions.  For a naturopathic physician to assist a person in weaning safely off a prescription — if it’s even possible — the doctor must legally be able to prescribe that substance.

Many Oregonians use naturopathic doctors for their primary care, but the limitations in prescribing authority for naturopaths force some patients to schedule visits with a medical doctor just for a prescription, sometimes having to wait weeks or months to get an appointment.   SB 327 will bring better continuity of care and less expensive health care to Oregon by reducing the duplication of services that the current situation fosters.”

In another letter to the editor, Don Colburn wrote that “Medical doctors worry that naturopathic physicians lack the scientific training to prescribe medications” and that a naturopathic doctor prescribing drugs was ironic.  Coburn quoted one Oregon legislator who said that the concept was “a little bit of hypocrisy.”

An excellent response to this perspective was written in another letter to the editor by attorney Chris Reive, Vancouver, Washington in response to Colburn’s concerns.

“Nothing is further from the truth.  Standard training for a naturopathic medical degree covers biology, chemistry, biochemistry, anatomy, physiology, basic therapeutics and even pharmacology, just like the curriculum for medical doctors. In addition, naturopaths receive clinical instruction in naturopathic therapeutics, nutrition and patient counseling, and they are exposed to “traditional” medicines and treatments used in other cultures with success.  A recent study in Wisconsin found that the four-year naturopathic degree program requires a total of almost 1,000 more hours of in-class training than does one of its leading medical schools.

Naturopaths understand and value the therapeutic benefits of synthetic drugs and are trained to use them when appropriate. Modern medicine is now beginning to recognize and integrate the traditional with the modern. This benefits the patient, lowers total cost and improves the overall health of our population.”

ABOUT NCNM: Founded in 1956, NCNM is the oldest accredited naturopathic medical school in North America. A nonprofit college of natural medicine, NCNM offers four-year graduate medical degree programs in Naturopathic Medicine and Classical Chinese Medicine. Its teaching clinics offer free and low-cost medical care throughout the Portland metropolitan area and treat more than 40,000 patients per year. NCNM’s Helfgott Research Institute is a nonprofit research institute that conducts rigorous independent research to advance the science of natural medicine in order to improve clinical practice. Until July 2006, NCNM was known as the National College of Naturopathic Medicine.

ABOUT CNM: The Center for Natural Medicine (CNM) located in Portland Oregon founded in 1991 is one of the leading naturopathic healthcare facilities in the Northwest.  CNM also functions as a clinical education site for NCNM training 12 medical students and 1-2 residents each year.  The center offers a variety of health care services including primary care naturopathic medicine and diagnostic testing, chiropractic care, acupuncture, massage therapy, and a large natural product dispensary. It also has a diverse team of healthcare practitioners that includes board-certified naturopathic physicians and residents, a chiropractor, licensed acupuncturists, naturopathic medical students, a registered nurse, and licensed massage therapists working collaboratively to provide patients with well-researched and innovative treatments.

View SB 327 from the Oregon State Legislature Web Site