Oregon legislature passes naturopathic formulary bill.

Oregon lawmakers in June passed Senate Bill 327, which expands the prescribing authority for the state's approximately 650 licensed naturopathic physicians. In addition to the list of naturally derived drugs that have long been on the naturopathic formulary, the bill will permit naturopathic doctors to prescribe common primary-care pharmaceuticals that are synthetically derived. The passage 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.

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Dr. David J. Schleich, president of National College of Natural Medicine (NCNM) 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 project a crisis in patient access to care in the coming decade due to the declining numbers of primary-care physicians. "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, which Governor Ted Kulongoski is expected to sign into law, allows naturopathic doctors (NDs) full primary-care prescribing authority. Although NDs are uniquely trained in the full range of synthetic and natural pharmaceuticals, they have been limited in their prescribing authority by a 1950s statute stipulating that they could only prescribe naturally derived substances--which precludes a few commonly used drugs that are considered "standard of care" in primary-care settings.

The bill enables the Oregon Board of Naturopathic Examiners (OBNE) through its Formulary Council to determine the full formulary of medications that Oregon NDs can prescribe based on naturopathic principles, public need, and evidence-based clinical reasoning. The Formulary Council 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 comprehensive, the new law will allow it 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 the doctoral degree program. 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 continuing-education courses annually, five of which 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.