N.M. Psychologists' Prescriptions a U.S. First
By Jackie Jadrnak
Journal Staff Writer
New Mexico is about to become the first state to allow psychologists to prescribe drugs to treat their clients' mental illnesses.
The rules to allow that authority, which supporters say will make mental health treatment more available around the state, take effect Jan. 7.
"I'm proud that we're able to be first in the country," said Mario Marquez, an Albuquerque psychologist and legislative chair for the New Mexico Psychological Association.
The fact that it has taken almost three years to put enabling legislation into practice, though, shows what a rough road it has been to get psychologists and physicians to agree to the ground rules.
And the turf wars aren't over. Expect a new battle in the Legislature this coming session to clarify exactly what medications psychologists will be able to prescribe.
Also, don't expect many psychologists to start handing out prescriptions Jan. 7. Before they can prescribe any, they must be certified by the state Board of Psychologist Examiners.
To be certified, an applicant must have a doctoral degree in psychology and be licensed to practice in the state. After that, applicants need 450 classroom hours of training in diagnosis and drug treatment of mental illnesses, along with 80 hours of practice in clinical assessment of patients. The final stage of training requires 400 hours of practice in seeing patients and prescribing medications for at least 100 of them.
About 40 New Mexico psychologists either have completed or are enrolled in that training, according to Elaine LeVine, director of the Southwestern Institute for the Advancement of Psychotherapy.
The Las Cruces program, which has a collaborative relationship with New Mexico State University, is the only such training program in the state, she said.
The psychologists enrolled there have been working with physicians under a family practice residency program, she said. "When you put an M.D. and a psychologist together on the front lines, resistance (to psychologists prescribing drugs) melts away," LeVine said.
Qualified psychologists can get a two-year conditional certification, during which they prescribe drugs under the supervision of a physician. Afterward, they can get a full certificate, but still must work in collaboration with a patient's primary health care provider.
Debate over drugs
Physicians and psychologists have squabbled, however, over what types of drugs are covered under the law.
The psychologists have contended they should have a full formulary, covering all medications called for under "best practice" for mental health treatment.
The physicians have countered that the law allows psychologists only to prescribe drugs approved by the Food and Drug Administration specifically for mental illnesses.
Under that interpretation, psychologists wouldn't be able to prescribe drugs often used for mental illnesses, but not specifically approved by the FDA for that use. Anti-seizure drugs, for example, often are used to treat certain mental illnesses.
Psychologists also wouldn't be able to prescribe drugs to counter the side effects of drugs prescribed for mental illnesses. For example, if the drug treating mental illness also caused high blood pressure, the psychologists wouldn't be able to prescribe a drug to lower the blood pressure.
"That's kind of like us practicing with one hand tied behind our back," said Marquez.
But Randy Marshall, director of the New Mexico Medical Society, argued such prescription privileges would go beyond the scope of the legislation.
Negotiations
Since both the state Medical Board, which oversees physicians, and the Psychologist Examiners had to approve the regulations, they were at an impasse. Art Jaramillo, head of the state Regulation and Licensing Department, stepped in to negotiate a compromise, apparently at the request of the governor.
According to the parties involved, the psychologists agreed to a set of regulations that could be interpreted to limit their prescription authority to drugs approved by the FDA for mental illnesses. In return, the governor is expected to back a bill in the next session to allow them the additional prescription authority they want.
Marshall said his group will fight that bill. "Before we allow them additional drugs, it's a good idea for psychologists to get a few years' experience in handling the drugs. We ought to give it at least two years," he said.
"We're the only state in the nation, other than Louisiana, allowing for this," Marshall said. "Let's let the dust settle."
Louisiana passed its law earlier this year and will go through a rule-making process in the coming months. Its faster implementation came because Louisiana's law did not require its medical board or any other group representing physicians to sign off on the rules, he said.
New Mexico has proceeded carefully because "everyone is well aware our efforts are being watched by the entire country," said Jenny Felmley, spokeswoman for the state's Medical Board. "If we get it wrong, we will do it in a highly public manner."
Copyright 2004 Albuquerque Journal
Commercial reprint permission.
Want to use this article? Click here for options!
(PRC# 3.4676.277849)
By Jackie Jadrnak
Journal Staff Writer
New Mexico is about to become the first state to allow psychologists to prescribe drugs to treat their clients' mental illnesses.
The rules to allow that authority, which supporters say will make mental health treatment more available around the state, take effect Jan. 7.
"I'm proud that we're able to be first in the country," said Mario Marquez, an Albuquerque psychologist and legislative chair for the New Mexico Psychological Association.
The fact that it has taken almost three years to put enabling legislation into practice, though, shows what a rough road it has been to get psychologists and physicians to agree to the ground rules.
And the turf wars aren't over. Expect a new battle in the Legislature this coming session to clarify exactly what medications psychologists will be able to prescribe.
Also, don't expect many psychologists to start handing out prescriptions Jan. 7. Before they can prescribe any, they must be certified by the state Board of Psychologist Examiners.
To be certified, an applicant must have a doctoral degree in psychology and be licensed to practice in the state. After that, applicants need 450 classroom hours of training in diagnosis and drug treatment of mental illnesses, along with 80 hours of practice in clinical assessment of patients. The final stage of training requires 400 hours of practice in seeing patients and prescribing medications for at least 100 of them.
About 40 New Mexico psychologists either have completed or are enrolled in that training, according to Elaine LeVine, director of the Southwestern Institute for the Advancement of Psychotherapy.
The Las Cruces program, which has a collaborative relationship with New Mexico State University, is the only such training program in the state, she said.
The psychologists enrolled there have been working with physicians under a family practice residency program, she said. "When you put an M.D. and a psychologist together on the front lines, resistance (to psychologists prescribing drugs) melts away," LeVine said.
Qualified psychologists can get a two-year conditional certification, during which they prescribe drugs under the supervision of a physician. Afterward, they can get a full certificate, but still must work in collaboration with a patient's primary health care provider.
Debate over drugs
Physicians and psychologists have squabbled, however, over what types of drugs are covered under the law.
The psychologists have contended they should have a full formulary, covering all medications called for under "best practice" for mental health treatment.
The physicians have countered that the law allows psychologists only to prescribe drugs approved by the Food and Drug Administration specifically for mental illnesses.
Under that interpretation, psychologists wouldn't be able to prescribe drugs often used for mental illnesses, but not specifically approved by the FDA for that use. Anti-seizure drugs, for example, often are used to treat certain mental illnesses.
Psychologists also wouldn't be able to prescribe drugs to counter the side effects of drugs prescribed for mental illnesses. For example, if the drug treating mental illness also caused high blood pressure, the psychologists wouldn't be able to prescribe a drug to lower the blood pressure.
"That's kind of like us practicing with one hand tied behind our back," said Marquez.
But Randy Marshall, director of the New Mexico Medical Society, argued such prescription privileges would go beyond the scope of the legislation.
Negotiations
Since both the state Medical Board, which oversees physicians, and the Psychologist Examiners had to approve the regulations, they were at an impasse. Art Jaramillo, head of the state Regulation and Licensing Department, stepped in to negotiate a compromise, apparently at the request of the governor.
According to the parties involved, the psychologists agreed to a set of regulations that could be interpreted to limit their prescription authority to drugs approved by the FDA for mental illnesses. In return, the governor is expected to back a bill in the next session to allow them the additional prescription authority they want.
Marshall said his group will fight that bill. "Before we allow them additional drugs, it's a good idea for psychologists to get a few years' experience in handling the drugs. We ought to give it at least two years," he said.
"We're the only state in the nation, other than Louisiana, allowing for this," Marshall said. "Let's let the dust settle."
Louisiana passed its law earlier this year and will go through a rule-making process in the coming months. Its faster implementation came because Louisiana's law did not require its medical board or any other group representing physicians to sign off on the rules, he said.
New Mexico has proceeded carefully because "everyone is well aware our efforts are being watched by the entire country," said Jenny Felmley, spokeswoman for the state's Medical Board. "If we get it wrong, we will do it in a highly public manner."
Copyright 2004 Albuquerque Journal
Commercial reprint permission.
Want to use this article? Click here for options!
(PRC# 3.4676.277849)
