PRESCRIPTION RIGHTS: The Timex Topic:
It Took A Licking But Kept On Ticking

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:     Frankp@chiro.org

FROM:   Chiropractic & Manual Therapies 2016 (Aug 24)

Peter C. Emary, Taco A. W. Houweling,
Martin Wangler, Stephen J. Burnie,
Katherine J. Hood and W. Mark Erwin

201C Preston Parkway,
Cambridge, ON
N3H 5E8 Canada.

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The last I heard, all the significant National and International Associations, who comprise the Chiropractic Summit had all agreed (back in 2013) that chiropractic should maintain Drug-Free. However, I am also a member of a FaceBook group (Evidence-Informed Chiropractic Medicine) and the topic keeps popping up. Our Blog has posted on medical resistance to chiropractic's use of manipulation under anesthesia (MUA), and that one STILL has me scratching my head. After all, the DC isn't knocking anyone out, a medical anesthesiologist does that, so this inter-professional service benefits both our professions, as well (in theory) the Patient. We have also posted on the “expanded practice” movement in general, and we don't need to revisit that here. So, I have collected all our Blog postings on the prescription rights and “expanded practice” movements into one nice neat package in the new Prescription Rights and Expanded Practice Debate page. The upper Background Materials section contains all our Blog postings, and the lower Recent Additions section contains this and earlier thoughtful articles on the expanded-practice and prescription rights movement, The last section is titled Drug Evidence and it includes articles discussing the evidence base for various drugs for spinal pain. I have no interest in rehashing all those conversations. I hope that if this is a hot topic for you, that you will read all these materials, and then let them percolate. It's called informed decision. You have to get informed before you set your Profession on a different course. I hope you will take the time to absorb these materials.

A Commentary on the Implications of Medication Prescription Rights
for the Chiropractic Profession

Chiropractic & Manual Therapies 2016 (Aug 24)

There is a growing desire within (a tiny segment of the) chiropractic profession to expand the scope of practice to include limited medication prescription rights for the treatment of spine-related and other musculoskeletal conditions. Such prescribing rights have been successfully incorporated into a number of chiropractic jurisdictions worldwide. If limited to a musculoskeletal scope, medication prescription rights have the potential to change the present role of chiropractors within the healthcare system by paving the way for practitioners to become comprehensive specialists in the conservative management of spine / musculoskeletal disorders.

However, if the chiropractic profession wishes to lobby to expand the scope of practice to include limited prescriptive authority, several issues must first be addressed. These would include changes to chiropractic education and legislation, as well as consideration of how such privileges could impact the chiropractic profession on a more theoretical basis. In this commentary, we examine the arguments in favour of and against limited medication prescription rights for chiropractors and discuss the implications of such privileges for the profession.

KEYWORDS:   Attitudes; Behaviour; Chiropractic; Drug prescriptions; Evidence-based practice; Knowledge

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From the FULL TEXT Article:

Background

Despite a growing number of surveys demonstrating a positive attitude among chiropractors and patients towards the limited use of medication within chiropractic practice, chiropractors remain unable to prescribe medication in most parts of the world [1–8]   (2007 and 2011 Ontario Chiropractic Association member surveys: B. Haig; personal communication, 3 November 2014).   In many countries, chiropractors also lack direct access to musculoskeletal (MSK) diagnostic imaging and laboratory testing – limitations that have real implications for the clinician in accurately diagnosing and managing their patient. Meanwhile, allied health care professions such as optometry, chiropody, and naturopathy have been steadily expanding their respective scopes’ of practice and gaining limited medication prescription rights relevant to their areas of training and expertise. [9–11]   Most notable for chiropractors is that physiotherapists are also interested in and have been granted prescriptive authority in some countries. [12, 13]   Moreover, there are increasing examples of physiotherapists with advanced training in medication prescription and diagnostic testing who now manage patients with MSK disorders at the primary care level. [14–16]

Currently within the chiropractic profession, three jurisdictions have incorporated the prescription of limited medications into their scope of practice.   These include Switzerland [1],   New Mexico (USA) [17], and most recently, Liechtenstein   (C. Mikus; personal communication, 7 November 2015).   In Switzerland and Liechtenstein, the formularies are limited to analgesics, anti-inflammatories, and muscle relaxants.   Swiss chiropractors have had these privileges since 1995 [1], and surveys have shown judicious use of this authority in clinical practice. [1, 4, 18, 19]   Along with these privileges, chiropractors in Switzerland share primary care status with general physicians in managing patients with spine-related and other MSK complaints. [18, 19]   As such, limited prescriptive authority has generally been regarded by Swiss chiropractors as an advantage for the profession in that country. [1, 4]

In New Mexico, USA, the chiropractic formulary also contains MSK medications; however, various hormones and other injectable substances for treating non-MSK disorders have been included. [17]   Attempts have been made by New Mexico chiropractors to further expand this formulary to include additional prescription drugs and injectable medicines for non-MSK conditions. [20]   The motivation behind this push for broader prescriptive authority appears to be that some chiropractors in New Mexico [5] and elsewhere in the United States [21] wish to become ‘primary care physicians.’   There is evidence to suggest, however, that the medical and chiropractic professions would largely oppose such an initiative [6, 8, 11, 20, 22–24], while a collaborative role for chiropractors as ‘primary MSK/ spine care providers’ with limited prescriptive authority would be favoured. [11, 18, 25–30]

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