We have succeeded! After 3 years of planning and working on the Chiropractic Advanced Practice Registry we have successfully passed our bill into law! As Dr. Perlstein and Dr. Jones have previously said and all who went to the round house for the Senate Public Affairs committee experienced, our bill and profession were highly regarded by the legislature, medical profession and acupuncture profession. I would like to think that this is the beginning of a new era for the chiropractic profession in NM, an era of cooperation, collaboration and better integration into healthcare.

But now that our bill has passed, what does it do for us, and where do we go from here? The bill places our profession in the Pharmacy Act and Drug, Device and Cosmetic Act. Placement in these acts is necessary to be able to do IM injections or IV treatments with even sterile H2O, as H2O is regulated as a drug when injected. This placement also protects our ability to prescribe nutrition. If, as our late friend and colleague, Dr. Dubin has predicted, the FDA, following the example of Codex and the World Trade Organization, restricts availability of natural substances, including vitamins, minerals and herbs to prescription only items, we will still have access to these things through prescription.

The bill also names a list of natural substances that we will be able to prescribe. However, this list could include many things and so a “formulary” will be developed by our NMBCE with approval of the medical board and pharmacy board, which will list all the substances that we may prescribe by any route of administration. Those substances listed in our legislation include: “A certified advanced practice chiropractic physician may prescribe, administer and dispense herbal medicines, homeopathic medicines, vitamins, minerals, enzymes, glandular products, naturally derived substances, protomorphogens, live cell products, gerovital, amino acids, dietary supplements, foods for special dietary use, bioidentical hormones, sterile water, sterile saline, sarapin or its generic, caffeine, procaine, oxygen, epinephrine and vapocoolants”. Although there are presently other states in which DCs can administer by injection, no other state has DCs included in the pharmacy acts. Inclusion in the pharmacy acts clarifies that we have the knowledge to responsibly prescribe named substances to our patients.

Doctors not obtaining advanced practice certification will be able to continue prescribing vitamins, minerals, herbs, amino acids and other substances as they had previously. However, those doctors who pursue advanced practice certification will be able to administer some of the same substances, if appropriate, by injection or IV infusions. Advanced practice certified DCs will also be able to prescribe bioidentical hormones as determined by our formulary. Additionally, advanced practice DCs will be able to perform trigger point injections and other procedures shown to be effective for myofascial pain syndromes and fibromyalgia using procaine and sarapin.

For those desiring to obtain advanced practice certification, there are clear steps to take. We have a 90-hour course that will include training in pharmacology and toxicology, so we may better understand the drugs Americans are taking, recognition of adverse reactions and compatibility with other drugs and natural substances. It will include pharmaconosy, the study of drugs derived from natural substances. This includes the study of vitamins, minerals, amino acids, herbs, accessory nutrients, etc. We will also study administration of those items we may prescribe. Routes of administration of course are oral, topical and rectal, which we may already do, but new to us here are intravenous (IV) and intramuscular (IM) administration. Doctors completing the certification will be prepared to do: IM injections (B12, homeopathic, magnesium, trigger point, etc.), Neural therapy injections, Intravenous procedures (Meyer’s cocktail, H2O2, chelation, ascorbates, amino acids, minerals, etc.), emergency procedures and laboratory testing and diagnosis.

In addition to completing the 90-hour course, doctors must apply for credentialing with ACPCC and also testing by ACPCC. When these steps are completed the doctor may receive Advanced Practice Certified (AP-C) status and may begin practice of those newly learned advanced skills.

After 2012 the requirement for advanced practice certification, for those not already certified, will be a “graduate degree in a chiropractic clinical practice specialty.” We are working with the chiropractic colleges right now to develop a program in primary care. This could include clinical rotations in primary care settings here in NM as a requirement.

There is competition going on in the health care world to see which profession will be the Primer Provider of alternative health care. In competition are the Naturopaths, Acupuncturists and Chiropractors, but also Doctors of Physical Therapy, alternative minded CNPs, Osteopaths and MDs. I believe that this bill puts us in the lead for our state. We as a profession have extensive broad based training in healthcare and have the respect of other professions that has been slowly and painfully earned. Our bill places us in a new relationship with the medical profession in that it requires collaboration between us regarding education and prescription for advanced practice. Although some may have concern over this, I believe that it will increase our status in the health care world and open previously closed doors to our participation in health care delivery and politics.

This is the first time a bill has succeeded in any state of the USA that so advances our professional scope of practice. We will hope that our actions can serve as a template to other states that desire to make this advance in our great profession.