Friday, August 13, 2010

Prescribing Authority for Naturopathic Doctors

Many Ontarians see their Naturopathic Doctor (ND) as their primary health care provider or "family doctor", as family members of all ages receive effective, safe, natural health care for myriad acute and chronic health concerns from colds and flus to weight management, allergies to arthritis, travel health preparation to pediatric well-child visits. Like medical doctors (family doctors or "GPs"), NDs are trained to function as primary health care providers, utilizing the full range of conventional laboratory diagnostics (e.g. blood work, urinalysis), physical examination, medical interviewing and the latest published research to inform their practice. NDs are also trained to recognize when it is appropriate to refer patients to different types or levels of health care, including medical emergencies.
Prescribing Authority Awarded to Naturopathic Doctors
In November 2009) the Ontario government (all three political parties) gave final approval to Bill 179, including the amendment to the new Naturopathy Act that gives Ontario NDs the right to "prescribe" medicines. More specifically, this legislation secures the controlled act of "prescribing, dispensing, compounding or selling a drug designated in the regulations" for NDs in Ontario. Prescribing authority is slated to come into effect for Naturopathic Doctors in 2012. Why is it so important? For years we have lamented the state of "crisis" that our OHIP-funded health care system is in, and never seems to get out of. Legislators have recognized that Naturopathic Doctors offer tangible solutions to some of the critical issues facing our health care system, by providing cost-effective, low-risk treatment and wellness-promoting education to patients that not only minimizes side effects (a hidden cost of conventional medical care) but also equips patients with the education they need to address the root causes of disease, and prevent and reverse chronic and acute illness. This means that naturopathic health care saves OHIP uncountable dollars both in the short and long term by helping patients get well. Recognizing this fact, the approved amendment to Bill 179 affords NDs the legal ability to work within the full scope of their training, which includes prescribing higher-risk natural substances as well as basic first-line pharmaceutical drugs, where appropriate.
Why is Prescribing Authority for Ontario NDs Important to Patient Care?
Prescribing authority for NDs was recommended by the Health Professions Regulatory Advisory Council (HPRAC) (Critical Links report 2009, click here) in recognition of the need to preserve the scope of practice of NDs to compound, dispense and prescribe medicines that are within their training but to which access is becoming increasingly restricted due to federal regulations including the Food and Drugs Act and Regulations and the Natural Health Products Regulations. HPRAC also recognizes that NDs have the capability to take on a larger role in primary care with access to basic primary care pharmaceuticals.
Prescribing Authority for NDs Means Better Health Care for Ontarians
Important functions protected by the approved legislative amendment include:
  • Ensuring accessibility to restricted natural substances when prescribed by a Naturopathic Doctor, e.g. ephedra for asthma, L-carnitine for vascular health, L-tryptophan for sleep, folic acid in doses greater than 1 mg, etc. Currently, most if not all restricted natural substances (especially the herbal/botanical ones) are simply unavailable to the public, as only medical doctors (MDs) would be allowed to "prescribe" them, but they are not typically included in an MD's training.
  • Providing prescribing authority for basic primary care pharmaceuticals (e.g. anti-bacterials, anti-fungals) used in common medical practice where necessary. This means, for example, that a patient undergoing naturopathic treatment for a persistent respiratory tract infection who requires the addition of a common antibiotic won't need to be referred to a second clinician (e.g. MD or NP) simply for the prescription (the ND would be able to provide it if needed).
  • In-office use and administration of emergency or "crash-cart" medicines where indicated (e.g. diphenhydramine, salbutamol, epinephrine, oxygen).
  • Clear authority to compound and dispense restricted natural or traditional substances that are or will become restricted via implementation of federal legal provisions including the Natural Health Products Regulations.
A Healthier Ontario with Naturopathic Medicine
NDs are primary care providers who can support a turn-around in many of the critical health care issues facing Ontarians and the OHIP system today. An essential part of optimizing the contribution of of NDs to the health of Ontarians is to ensure secure, legislated access to naturopathic medicine according to the full scope of their training. Prescribing authority for NDs means better health care for Ontarians.
For more information and legislative updates concerning the naturopathic profession, please consult the Advocacy section of the Ontario Association of Naturopathic Doctors (OAND) web site ( and my page on Regulation.

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