As of July 1st, 2015, naturopathic medicine will now be regulated under the Regulated Health Professions Act (RHPA) which is the umbrella legislation that governs all regulated health professions in Ontario.
The History
Naturopathic medicine has been regulated under the Drugless Practitioner's Act since 1925. The scope of practice for Ontario naturopathic doctors has steadily increased since 1925 and includes gynecological exams, rectal exams, naturopathic manipulation, acupuncture, intravenous therapy, taking blood samples and communicating a naturopathic diagnosis. The Drugless Practitioner's Act was an antiquated Act that did not provide the same degree of regulatory structure as other regulated health professions and restricted the scope of practice. In order for naturopathic doctors to have the level of regulation commensurate with other regulated health professions in Ontario the profession had to move under the RHPA.In 2007 the Naturopathy Act was passed and the decision to move naturopathic doctors under the RHPA was confirmed. At the time that the Naturopathy Act was passed, naturopathic doctors were informed that they would maintain their current scope of practice.
Current Status
Proclamation has taken a number of years. But, we are pleased to announce that naturopathic doctors in Ontario have, for the most part, maintained their full scope of practice. Click here for the link to the College of Naturopaths of Ontario (CONO) to access the list of the controlled acts.One of the positive things that will happen under the RHPA is that the College of Naturopaths of Ontario (CONO) will be able to ensure that anyone who uses the title naturopath or naturopathic doctor has received the training that they require. The terms naturopath, naturopathic doctor, ND and others are now officially protected titles.
There are some changes in the way that naturopathic doctors will have to practice. Some of these changes, we hope will be short term. The changes include:
Laboratory Testing
- Taking of blood samples: Although naturopathic doctors have been authorized the act of taking blood samples according to the Laboratory and Specimen Collection Centre Licensing Act, they are currently not allowed to take blood samples that have to be sent to a lab for analysis as an inspection program has not yet been developed and approved and the access for standard medical blood testing has not been written into the Controlled Act. The Controlled Act, currently, only allows for point-of-care blood samples for seven laboratory tests that are assessed in-office. For standard medical blood test naturopathic doctors will, for the time being, have to provide patients with a requisition form and have patients visit an Ontario laboratory facility for the blood draw. Results will still be sent directly to their naturopathic doctor. Although the blood will be drawn at an Ontario laboratory facility, the blood work will not be covered by OHIP.
- Range of laboratory tests: Prior to proclamation, naturopathic doctors were able to order any laboratory test. During the consultative process a list has been created which defines what laboratory tests naturopathic doctors are able to order. Generally speaking, the list is fairly comprehensive and includes 194 laboratory tests, but there are some common laboratory tests or test panels that did not make it to the approved list. Click here for the list of approved laboratory tests, or talk to your naturopathic doctor directly. The OAND and the naturopathic profession will continue to work with the CONO and the MOHLTC to seek inclusion of the remaining laboratory tests that are required.
- Handling of external laboratory tests: Thankfully, naturopathic doctors maintained access to a number of external laboratory tests, but similar to blood testing, the handling of external laboratory testing, such as saliva testing, urine testing for environmental toxins, urinary organic acid testing, will be handled differently than it is now. The process is not completely worked out, but it most likely will involve your naturopathic doctor providing patients with a collection test kit and having them return the kit to an Ontario laboratory facility for shipment to the external lab. Your naturopathic doctor will be able to clarify the new process and any change to fees when they provide you with the test kit.
Prescription Rights and Intravenous Therapy (IVIT)
Prior to proclamation only those naturopathic doctors that were IVIT certified were able to prescribe a select list of drugs and substances as part of their IVIT treatment. The following is the update on prescription rights and IVIT therapy.- List of IVIT substances: Most of the substances that naturopathic doctors have been using for intravenous therapy (IVIT) are included on the prescribed list, yet there are a few that have been removed at this time. The OAND and naturopathic profession will continue to work with CONO and the MOHLTC to add back the substances that have been omitted.
- IVIT treatments: Under the new regulations that requirements for IVIT practitioners are much stricter and ensure optimal patient care. Any naturopathic doctor that meets the new standards and that passes the prescribing course will be able to continue to offer patients IVIT treatments.
- Prescription rights for non-IVIT naturopathic doctors: The controlled act of prescribing primarily relates to substances that are used in IVIT treatments, but under the new RHPA regulations there are a few substances that non-IVIT naturopathic doctors will have the ability to prescribe once they successfully complete a prescribing course. The substances that have been added include bio-identical hormones estrogen and progesterone and thyroid hormone, as well as the ability to prescribe high doses of Vitamin D, Vitamin A, Vitamin K and Folic acid.
Next Steps
There are a lot of positives about the move to the RHPA, but there will be some challenges during the transitional period. Generally speaking, patients that are working with naturopathic doctors will primarily experience changes with respect to the handling and access to laboratory testing.
If you have any questions about these regulatory changes, I encourage you to visit the CONO website at: www.collegeofnaturopaths.on.ca/, the website of the Ontario Association of Naturopathic Doctors at www.oand.org or talk directly to your naturopathic doctor.
This is an exciting time for the naturopathic profession. These regulatory changes will ensure greater patient safety, increased clarification as to the scope of naturopathic doctors and will increase the opportunity for intra-professional collaboration and support.
It is a great time to work with a naturopathic doctor to optimize your health.
