Naturopaths to receive authority to prescribe more drugs

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.

Naturopaths will be able to prescribe more prescription drugs starting in 2015. Creative Commons photo by jeffk via flickr

Naturopaths will be able to prescribe more prescription drugs starting in 2015. Creative Commons photo by jeffk via flickr

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.

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  • Paul Donovan

    Every physician I’ve known treats the whole person, and the cause, and not just symptoms. But I will agree there’s a big difference between the naturopaths’ “our medicine” and physicians’ medicine.

  • Naturopaths most certainly do not have the training or skill required to prescribe drugs. They don’t know the difference between a “natural antibiotic” and a “natural heavy metal poison”. 

    When the VT House Health Care committee held a hearing on this bill in April 2012, there was a representative of the medical society, myself and another Vermonter there to speak against it. The committee refused to let the third person speak. The representatives believed whatever the naturopaths, NDs, told them without every even asking for them to substantiate their claims while dismissing what Ms. Mongan, a lawyer for the medical society, and I said out of hand.

    I left with the distinct impression that the committee’s mind was already made up when the members walked in the door. While I realize the difficult time they had had with the hearings on vaccinations, I felt as if they just wanted to get rid of me so that they could cast their predetermined votes. I also spoke before a senate committee and another house committee on the same topic. Most of the members of those committees left me with the impression that they were at least interested in what I had to say and would take it under consideration.

    It was very apparent that Dr. Chen and the state regulatory officials were advocating for the naturopaths. What wasn’t and still isn’t clear is why. At the time there were 241 naturopaths, NDs, licensed in VT and virtually all those practicing here were still looking for patients. There was no evidence of their having much if any public support, certainly no where near enough to garner all the support they had from the administration and legislature. I’ve blogged about this if anyone is interested, and anyone who is interested in health care in VT most certainly should be.

  • Ben Maddox

    “The new regulations will require Naturopathic physicians to pass a pharmacology examination if they wish to prescribe drugs.” I am a person with a liberal arts degree and I was able to pass this online open book test a couple of years ago. This prompted Chris Winters and the OPR Naturopathic advisers to change test. Likely this was simply an effort to take the test out of the public’s eye. The new test will likely be as easy and protective of Naturopathic ignorance as the last. I took the test to show that Naturopathic education is really just a shell of appearances. It’s funny that Chen never bothered to look at what Naturopathic institutions actually teach or who teaches at them. The prevailing view in Naturopathic education is that modern medical science is totally corrupt and that Naturopathic thought is the only true alternative. Naturopathic learning institutions are essentially religious schools that seek to isolate their students from inquiry in favor of magical beliefs. Chen consulted a group of Naturopaths, know as the Council on Naturopathic Medical Education and they said that the education was equivalent. Way to dig dude. Naturopathic medical care is a reactionary closed loop placebo word game played with patients for profit. Prescribing real drugs is a great way to piggy back bogus treatments on modern medical science. As in, “It was the antibiotics AND the 25 B.S. supplements and energy alignments I sold you that got rid of that infection” Seriously, check the details on some of the treatments these guys are charging the state for. Chen needs to understand that when people “choose” fraud it’s not really a choice. Please Google Naturopath VT and check out some of the products and services these people are selling. These guys are supplement sales juggernauts. And common guys, how many times can you say “the whole person.”

  • Bob Orleck

    Quotes from the article:

    According to the VMS (Vermont Medical Society, “naturopaths have not received sufficient training to prescribe drugs as medical doctors do. But Health Commissioner Dr. Harry Chen disagrees.”

    “I think there won’t be a problem,” he said. “Every prescription a doctor writes gets reviewed by a pharmacist.”

    It is troubling how someone with the status of Dr. Harry Chen, Commissioner of the Vermont Department of Health would use specious justifications to promote such a questionable position allowing a new group of prescribers to be able to prescribe the entire panoply of drugs when they might not be trained or qualified to do so. If the medical society is correct then this clearly creates a danger to the public. Isn’t Dr. Chen supposed to be working to improve public health not to endanger it?

    I understand that before taking the position with the State of Vermont his specialty was emergency medicine. While no excuse for someone who heads such a department, he quite possibly he is not aware of what pharmacists do or not do in the course of their daily practice.

    I am a pharmacist and when I review a prescription it is in a vacuum of sorts. Most often we are not made aware of exactly what the MD is treating the patient for when he prescribes a particular medication. We can make assumptions by knowing what the medication is usually prescribed for and by doing due diligence with any information we are provided to try our best to insure that the patient is being properly treated. But in reality we really have no way to evaluate whether prescribers know what in fact they are doing and whether they have prescribed the right medication for the right illness. We as pharmacist get a limited look at things. We review orders for possible drug overdoses, potential side effects based on knowledge of the patient and drug interactions based on our knowledge of what other medications that patient is taking.

    So for the head of the Vermont Department of Health to base his opinion on a justification that a pharmacist’s review will protect the public when they review the prescription tells me he has either misspoken or is being very careless with the health of Vermonters.

    Could it be that because a large number of qualified physicians are leaving Vermont practice due to the deteriorating government created healthcare situation, that the pressure is on the administration to come up with some bodies that they will be able to claim are fully equipped to replace those leaving?

    Who knows but if the trustworthy Vermont Medical Society is concerned, so am I!

  • Naturopaths are different than Naturopathic Doctors in many states.
    Naturopathic Doctors receive the same number of hours of education in Pharmacology as Medical Doctors, we just don’t need to use the harsh chemicals as much because we have some many other options to use first.

    Naturopathic Doctors are also trained in the interaction between pharmaceuticals and herbs or food. How many times have you been to the MD and they have no idea what the mechanism of action is for the herb you are taking?

    Patients will still get the choice of which doctor they choose for their medicine but the public demands the opportunity to make the choice.

  • Richard Wasserman

    Hello, Dr. Fowl. I didn’t realize that you had a practice in Vermont.

    As a medical educator here in Vermont, I would appreciate seeing additional information to back-up the statement that “Naturopathic Doctors receive the same number of hours of education in Pharmacology as Medical Doctors.”

    Naturopathic doctors go through four years of school, but post-graduate training (three years is required of licensed MDs and DOs) is generally absent. I very much value my naturopathic colleagues’ knowledge of herbal remedies, but have serious doubts about the adequacy of their training in prescription medications.

    Thanks in advance for your thoughts.

    R. “Mort” Wasserman, MD, MPH
    Professor of Pediatrics
    University of Vermont College of Medicine

    • Paul Avery


      How many pharmacology courses do MD students take? When do MD graduates receive specific pharmacologic training in residency?

      You are being misleading, because the fact is that MD students take 1-2 courses on strict pharmacology, and receive little direct education on drug MOA in residency (a clinical training, not so much an academic one).

  • The subject labeled “pharmacology” that is taught in 4-year accredited naturopathic schools is alternative or naturopathic pharmacology. It is not evidence-based. It isn’t scientific.

    Four year accredited naturopathic schools do not give students educations equivalent to that of MDs or DOs.

    If you review my links, I think you will also conclude that NDs with degrees from accredited ND schools don’t even know anything about “natural” drugs including botanicals.

    I haven’t viewed this for awhile,, but I believe that towards the end you will hear what Dr. Chen told a legislative committee that was considering the bill that would grant NDs prescription privileges in VT.

  • Pat McGarry

    The “formulary” includes codeine, but not hydrocodone or oxycodone. If a naturopathic physician can prescribe codeine, then he has a DEA license from the federal government, and Vermont ought not prohibit him from prescribing related narcotics.

  • The DEA seems to permit many “midlevel practitioners”, and even animal shelters, to use specific controlled substances, but not all controlled substances. I assume that is based on the recommendations of each state and that the DEA trusts the states to know which particular substances each profession has the skill and training to use safely and effectively. I also assume that having the skill and training to use one doesn’t mean that someone has the skill and training to use others.

  • Chris Doyle

    Thank you for posting. I cannot believe that VT will let naturopaths prescribe drugs, it is totally crazy, what next? Let them do major surgery so they can realign our organs? The attempt to try and meld science based medicine with what is at best placebo medicine is dangerous, and letting naturopaths prescribe is not only dangerous but will fool people into thinking they are real doctors.

  • Harrison Fleming

    I just hope that they understand microbiology well enough to practice proper antibiotic stewardship. Also I hope that they do not use homeopathic principles when dosing antibiotics. A major concern in the medical world is the rise of antibiotic resistant microorganisms. Improper antibiotic stewardship such as using inadequate amounts of antibiotics or using improper combinations of antibiotics is allowing for the resistant strains of certain microbes to survive and replicate. This has led to some of the nightmare bugs such as Vancomycin Resistant Enterococcus (VRE), VRSA and MRSA (Staph aureus), Carbapenem Resistant Enterobacteriacea (CRE), Pseudomonas, Mycobacteria, and more! I understand that regardless of the precautions and care some resistances will develop. However, antibiotic usage is a bigger responsibility than we may perceive. I just hope that the N.D. that chooses to accept this responsibility will properly use the evidence based methods and clinical decision making that will not exacerbate this situation. Don’t be afraid to refer a patient to a M.D. or a D.O. if needed, we are all trying to work together here.

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