Naturopaths will soon be able to prescribe a wider range of pharmaceutical drugs.
Beginning in 2015, naturopaths will be free to prescribe drugs within their “scope of practice.” But as the state Office of Professional Regulation is finishing the exact wording of the new rules, the Vermont Medical Society (VMS) has expressed concern that naturopaths don’t have adequate training to prescribe drugs.
Dr. Harry Chen, the commissioner of the Vermont Department of Health, disagrees with the society, which represents traditional doctors.
“Naturopaths are health professionals,” Chen said. “They go through at least four years of health training after college, and they have been licensed in Vermont for 15 years. They provide the health care that many Vermonters choose.”
Naturopaths typically rely on traditional medicine and self-healing in conjunction with modern techniques.
Currently naturopaths are limited to prescribing drugs as determined by a formulary compiled in 2009.  With the passing of Act 116 in 2012, all physicians in Vermont were given the right to prescribe drugs within their “scope of practice.”
The current formulary allows naturopathic physicians to prescribe a wide range of drugs, but the new regulation will dramatically increase that authority, said Bernie Noe, a licensed naturopathic physician at Green Mountain Natural Health in Montpelier.
During a hearing before the Legislative Committee on Administrative Rules last week, Sen. Diane Snelling, R-Chittenden, asked why naturopaths, who treat patients holistically, need to prescribe medications.
Chen said licensed naturopaths are primary care physicians in Vermont, and they need the tools to provide care for patients.
“I think there won’t be a problem,” he said. “Every prescription a doctor writes gets reviewed by a pharmacist. I’m in support of the regulation and I think they (the Office of Professional Regulation) are carefully considering this to ensure safety.”
The medical society wrote a letter to the Office of Professional Regulation raising questions about the phrase “scope of practice.”
Other health practitioners, such as optometrists and nurses, are already authorized to prescribe drugs within their “scope of practice.” In the letter, the Vermont Medical Society said these professions are more clearly defined and their scope of practice is restricted. Naturopaths treat the entire body and a broad range of diseases, from cancer to diabetes.
“VMS is concerned that under these proposed rules, OPR would have no guidance to rely on other than the naturopath’s own characterization of his or her scope of practice,” VMS said in the letter written by Paul Harrington, executive vice president, and Madeleine Mongan, deputy executive vice president.
The same issue applies to medical specialties, Chen said. Emergency physicians, for example, can prescribe cancer medications even though he or she may have little knowledge of those pharmaceuticals, he said.
Sixteen states in the U.S. have licensed naturopaths and more than half of them have the right to prescribe drugs regulated by a formulary. If the Legislative Committee on Administrative Rules passes the new regulations, Vermont will be the first state in the country to give naturopaths the unlimited right to prescribe drugs, according to the VMS.
Noe of Green Mountain Natural Health said the issue has been controversial among naturopaths. Some welcome the change as they say their work as primary care physicians has been handicapped by current regulations.
Noe describes situations in which patients come to him as a primary physician with symptoms that need to be treated with prescription drugs. “If they have asthma, they need an inhaler, or if a patient has an infection, they need antibiotics,” he said.
Currently, naturopaths are authorized to prescribe a limited number of antibiotics, and if patients are resistant to an antibiotic they must be referred to a medical doctor, Noe said.
“It’s a waste of resources,” he said. “Our medicine focuses on treating the whole person, the cause of the disease and not symptoms. So, it’s outside our core practice, but as practicing primary care physicians there are times when we do need to prescribe drugs.“
The new regulations will require naturopathic physicians to pass a pharmacology examination if they wish to prescribe drugs. The first 100 drugs prescribed will also undergo review, according to the Office of Professional Regulations.
LCAR did not reach a decision last week and has given the Office of Professional Regulation until Sept. 19 to meet with the Vermont Medical Society to work out details.