Naturopaths' prescribing rights expanded

Naturopathic doctors are among a group of medical professionals pushing for expanded prescribing rights — and they're recently seeing success.

After extensive lobbying efforts, naturopaths across Canada are getting governmental green lights for greater prescribing rights.

Need an antibiotic for that nasty lung infection? Your naturopath may soon be able to prescribe it.

That's because naturopathic doctors are among a group of medical professionals that are pushing for expanded prescribing rights — and they're recently seeing success.

Ontario just became the second province in Canada to get the green light for increased prescribing rights for naturopaths. British Columbia granted its naturopaths the right to prescribe a greater number of medications — as well as high-dose vitamins, amino acids, hormones, botanicals and herbs — in April 2009.

The announcement follows the granting of more powers to other health professionals, such as midwives and registered nurses.

On Oct. 20, the province's standing committee on social policy voted to amend Ontario's Naturopathy Act through Bill 179, allowing naturopaths in the province to prescribe, dispense compound or sell a drug listed in the regulations.

The bill is expected to be approved by the end of the year.

Drugs still require regulatory approval

The news is being welcomed by naturopaths across the country. "We see it as a very positive step," Shawn O'Reilly, executive director of the Canadian Association of Naturopathic Doctors in Toronto, told CBC News. "It will allow access to naturopathic doctors to prescribe drugs and supplements formerly off limits."

Though naturopathic doctors will still be restricted in the types of drugs they can prescribe, O'Reilly says they will be able to provide patients with medication they would otherwise have had to seek at walk-in clinics and emergency rooms. She says this decision will decrease ER wait times, and clear the way for speedier treatment for the acutely ill.

While the amendment increases the number of medications naturopaths can prescribe, it is far from being a carte blanche. Many drugs will still be off limits to NDs, such as psychotropic medications, including lithium, which affects the mind and emotions, and chemotherapy drugs. In B.C., these drugs currently can only be prescribed by physicians, said Christoph Kind, president of the British Columbia Naturopathic Association in Vancouver.

He says the list is still under review by the province's regulator, though he foresees acute-care drugs, such as antibiotics, to be included under the new prescribing rules.

Ontario's naturopaths have less prescribing freedom

In Ontario, the list could be more restrictive, according to Angela Moore, executive director of the Board of Directors of Drugless Therapy-Naturopathy in Toronto. She says the amendment to Ontario's Naturopathy Act essentially paves the way for the regulation of NDs under the Regulated Health Professions Act; currently NDs are regulated under the Drugless Practitioners Act.

Health professionals such as midwives, dentists, optometrists and chiropractors fall under the RHPA.

Moore says that over the years, the government has restricted or "scheduled" certain medications and supplements that were formerly prescribed by naturopaths. One example is Vitamin D. "We can't prescribe more than 1,000 international units," said Jill Shainhouse-Kerr, a Toronto-based naturopath. Another example is Quercetin, an antioxidant used to treat allergies and asthma: it's now off limits as well.

The new amendment essentially reinstates many of these products and opens the door to more prescribing rights when the transition to regulation under the RHPA is complete. This process could take between 18 months and three years, said Moore. 

In the meantime, a soon-to-be established transitional council will make decisions on which drugs and supplements can be prescribed and what training Ontario naturopaths will need to undertake in order to prescribe these drugs. This list will eventually have to be approved by Ontario's health ministry.

MDs call for more pharmacological education

Naturopaths are excited to have their prescribing rights expanded. "It recognizes the validity of naturopathic physicians as primary care providers," says Kind.

But MDs aren't so enthralled with the idea. Many feel that the granting of more rights to NDs puts them on equal footing with MDs. On its website, the B.C. Medical Association states that greater prescribing rights are "of concern to many physicians because naturopaths are not trained to the same rigorous standards as medical doctors. Naturopaths are, by design, trained to use 'alternative' treatments."  

Naturopathic training All licensed naturopathic physicians complete a minimum of three years university level pre-medical training, then four years at an accredited naturopathic medical college. There are two such colleges in Canada, and four in the United States. Students of naturopathy study such subjects as biochemistry, microbiology, physiology, botanical medicine and pathology. As well, they study pharmacology, such as the side effects and correct uses of medication in different drug classes.

But Kind says such a reaction is expected. "There's always been [a] push back," he says. "With continued conversation and education, things will eventually be understood."

The Ontario College of Physicians and Surgeons cautions that if prescribing rights are granted to naturopaths, education needs to be part of the equation. "Each health profession's college is best suited to determine the appropriate standards for its members, provided that public safety is protected," said Kathryn Clarke, senior communications co-ordinator for the College of Physicians and Surgeons of Ontario.

"Stringent educational requirements must be put in place to ensure that all health professionals have the necessary knowledge, skill and judgment to effectively and safely prescribe the drugs designated in their respective regulations," she said.

In the meantime, naturopathic doctors are hoping governments' recent decisions around prescribing powers are a first step in acknowledging the education level and training of naturopaths. And they're hoping more provinces will move in a similar direction. Currently, Nova Scotia and Alberta are looking at changing their legislation.

But they're also realistic about the way naturopathy is viewed. "There's a general lack of awareness that NDs are primary care providers," said Jill Shainhouse-Kerr, a Toronto-based naturopathic doctor. "The government needs to come and see what we do."

"If we had a wider scope of practice, it would lessen the burden on our congested medical system."