Oregon Legislature Passes Naturopathic Formulary Bill

Law will expand patient access to primary care physicians

Marilynn Considine

PORTLAND, Ore. (June 2, 2009)—Oregon lawmakers today passed Senate Bill 327, expanding 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, Senate Bill 327 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.

Dr. David J. Schleich, president of National College of Natural Medicine 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 currently project a crisis in patient health care access 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 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, before passage of this bill they were limited in their prescribing authority by a 1950s statute that stipulated that NDs could only prescribe naturally-derived substances, which precluded a few commonly used drugs, now 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 Oregon NDs can prescribe based on naturopathic principles, public need and evidence-based clinical reasoning. The Formulary Council presently 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 very comprehensive, the new law will allow the formulary 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 their doctoral degree. 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 annual continuing education courses—five of those required hours 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.

ABOUT NCNM: Founded in 1956, NCNM is the oldest accredited naturopathic medical school in North America. A nonprofit college of natural medicine, NCNM offers four-year graduate medical degree programs in Naturopathic Medicine and Classical Chinese Medicine. Its teaching clinics offer free and low-cost medical care throughout the Portland metropolitan area and treat more than 40,000 patients per year. NCNM’s Helfgott Research Institute is a nonprofit research institute that conducts rigorous independent research to advance the science of natural medicine in order to improve clinical practice. Until July 2006, NCNM was known as the National College of Naturopathic Medicine.