Says Only Oral Intake is Within Scope

On August 22, 2012 the Missouri Chiropractic Board Issued a Memo on Injectables asserting that nutritional products are defined as legend drugs once they are administered via injection.

In their Memo the Board stated they had been receiving inquiries regarding the injectable and intravenous delivery of dietary nutritional supplements to chiropractic patients and that the Missouri Board of Pharmacy was prompted to examine the sale and distribution of injectable nutrition in Missouri. The Chiropractic Board consulted with the Missouri Board of Pharmacy to clarify the issue and then issued the Memo “in order to assist Missouri chiropractors in evaluating the contemplated utilization of injectable nutrients within a licensee’s practice.”

The Memo states in part:

• Scope of practice does not include the authority to prescribe any drug or medicine
• The State Board is not authorized to approve a type of treatment not within the scope of practice
• The practice of chiropractic in Missouri shall not include the use of operative surgery,obstetrics, osteopathy, podiatry, nor the administration or prescribing of any drug or medicine nor the practice of medicine.
• Legend drug is defined in Missouri as any drug or biological product that is subject to Section 503(b) of the Federal Food, Drug and Cosmetic Act or is dispensed via prescription
• No legend drug can be sold to, or purchased and administered by, any health professional(s) that do not have statutory authority to prescribe legend drugs.
• The US Food and Drug Administration, (FDA), has informed the chiropractic board that nutritional supplements, in essence, become legend drugs when they are manufactured, packaged, and sold for administration via the route of injection or IV.
• In order to be a dietary supplement rather than a legend drug the supplement must be one that is intended for ingestion in tablet, capsule, powder, softgel, gelcap, or liquid form.

The Memo closes by stating that a:

“Missouri licensed chiropractor considering the utilization of injectable nutrition, needs to first consult with their own legal counsel to discuss the legality and implications of such practice by examining the scope of practice for chiropractors, the laws relating to legend drugs, and corresponding regulations promulgated by the Missouri Board of Pharmacy and Federal Food and Drug Administration.”   

In related news, two other states recently went on the radar screen regarding injectables: Colorado and Arizona.

In Colorado, the Board is proposing the following:
 
All chiropractors that choose to administer homeopathic and botanical medicines, vitamins,
and minerals. phytonutrients, antioxidants, enzymes and glandular extracts by means of
injectable procedures shall be certified by the board. Applications for certification in
lnjectables shall be made in a manner approved by the Board. Certification in lnjectables by
the State Board of Chiropractic Examiners may be obtained by complying with the following:

1. Successfully complete a minimum of a combined total of 24 hours of theoretical study
and supervised clinical instruction obtained from a college of chiropractic approved
by the Council on Chiropractic Education (CCE) or the equivalent hours of study and
clinical supervision obtained from an instructor recognized by the postgraduate
facility of a chiropractic institution or approved by CCE to teach this course and

2. Passing a nationally recognized Injectable certification examination recognized by a
CCE accredited chiropractic college.

In Arizona, the Arizona Association of Chiropractic (AAC) has submitted a formal proposal asking for an expansion of the scope of practice to allow chiropractors to take a few hundred hours of extra classes and receive a certificate to be an Advanced Practice DC. The proposal uses New Mexico’s Advanced Practice certification as an example that other states are moving in this direction. Chiropractors who get the Advanced Certificaiton would then be allowed to prescribe homeopathic medications, orthomolecular therapy and natural substances orally or by injection and IV.

Chiropractors are urged to remember that injectable nutrients are a very slippery slope.  In Oklahoma, they are doing IV EDTA chelation and prolotherapy under the banner of injectable nutrients.