Naturopathic Medicine - storage and dispensing of drugs and supplements 1 Denise Catherine Rigato & Ezadkiel Villarico Marbella Naturopathic Medicine - storage and dispensing of drugs and supplements 2 Denise Catherine Rigato & Ezadkiel Villarico Marbella Table of Contents About Naturopathic Medicine 3

Manual therapy 3

Hydrotherapy 3

Herbalists 3

Acupuncture therapy 3

Aromatherapy 3

Nutrition 3

Code of Conduct 4 Storage and Dispensing of Drugs and Supplements 5

Labeling 5

Security 5

Record Keeping 6

Mark-Up 6

Packaging 7

Disposal of Medicines 7

Dispensing Medicines 8

Recalled Medicines 8

Conclusion 8 Naturopathic Medicine - storage and dispensing of drugs and supplements 3 Denise Catherine Rigato & Ezadkiel Villarico Marbella About Naturopathic Medicine Naturopathic medicine, also known as naturopathy, is the practice of naturally healing one’s illnesses and/or injuries through a number of different ways.1 The most popular of these different methods in- clude manual therapy, hydrotherapy, herbalists, acupuncture, aromatherapy, and nutrition.

Manual therapy The treatment of physical ailments through ‘hands- on’ exercises including joint mobilization, joint ma- nipulation, and soft tissue mobilization.2 Hydrotherapy Uses water to sooth away pain and injury. Hydro- therapy can be practiced in different forms including hot and cold pack, steam baths, general baths with hot or cold water, and wet and dry bandages.3 Herbalists The use of medicinal herbs from around the world. Herbalists treat conditions by dispensing and pre- scribing herbal medication. 4 Acupuncture therapy Is a technique of inserting filiform needles (thread like needles) into one’s body, also known as “acupuncture points” with the goal of freeing sick- ness and restoring well-being.5 Aromatherapy The use of fragrant plant materials known as essen- tial oils to affect a person’s mood or health.6 Nutrition Nutrition is the mindful act of nourishing the body by eating nutritious foods filled with vitamins on a regular basis and exercising regularly.7

Naturopathic practice began before 1900, however, went into decline around the 1930’s after the dis- covery of penicillin and other antibiotics. It was difficult to say that Naturopathy ever existed before the 1950’s because it was rarely practiced and there were no legitimate schools implementing its tech- niques, but by 1956 the first modern naturopathic school offering medicinal training through science and naturopathic regulations was established.8

1 Wikipedia. “Naturopathic medicine.” http://en.wikipedia.org/wiki/Naturopathy (accessed Sept. 17, 2007). 2 Wikipedia. “Manual therapy.” http://en.wikipedia.org/wiki/Manual_therapy (accessed Sept. 17, 2007). 3 Wikipedia. “Hydrotherapy.” http://en.wikipedia.org/wiki/Hydrotherapy (accessed Sept. 17, 2007). 4 Wikipedia. “Herbalist.” http://en.wikipedia.org/wiki/Herbalist (accessed Sept. 17, 2007). 5 Wikipedia. “Acupuncture.” http://en.wikipedia.org/wiki/Acupuncture (accessed Sept. 17, 2007). 6 Wikipedia. “Aromatherapy.” http://en.wikipedia.org/wiki/Aromatherapy (accessed Sept. 17, 2007). 7 Dictionary.com. “nutrition” http://dictionary.reference.com/browse/nutrition (accessed Sept. 17, 2007). 8 Wikipedia. “Naturopathic medicine.” http://en.wikipedia.org/wiki/Naturopathy#History_of_naturopathic_medicine (accessed Sept. 17, 2007). Naturopathic Medicine - storage and dispensing of drugs and supplements 4 Denise Catherine Rigato & Ezadkiel Villarico Marbella Code of Conduct Naturopathic doctors choose not to treat their patients with surgeries or synthetic drugs. They prefer treatments that allow for natural remedies. There are six philosophical principals that naturopathic practitioners are taught to identify themselves with9:

1. The Healing Power of Nature – This is the self practice of healing through natu- ral means. It is the naturopath’s role and responsibility to prevent illnesses in them- selves and their patients by listening to the internal and external elements.

2. Identify and Treat the Causes – Doctors must identify the cause of the illness before a full recovery can occur. This must be done first because symptoms of the illness play a role in the healing process.

3. First Do No Harm – Physicians follow three steps to not harm their patients:

A. Use products that have minimal side effects.

B. Avoid ignoring symptoms because symptoms affect the healing process.

C. Practice The Healing Power of Nature principal.

4. Doctor as Teacher – Doctors should teach their patients about naturopathy so they develop a respect for it, thereby developing a self-practicing routine involving naturopathic medicine.

5. Treat the Whole Person – Since health and disease come in a package: spirit, emotion, genetics, environment; doctors develop remedies that pertain to all these needs.

6. Prevention – The primary goal of doctors is to prevent future ailments in patients by assessing their risk factors.

9 Wikipedia. “Naturopathic medicine.” http://en.wikipedia.org/wiki/Naturopathy#Naturopathic_Principles (accessed Sept. 17, 2007). Naturopathic Medicine - storage and dispensing of drugs and supplements 5 Denise Catherine Rigato & Ezadkiel Villarico Marbella

Storage and Dispensing of Drugs and Supplements Labeling

All medicines dispensed in a ND’s office must have the following information on a label fixed to the medicine or on a piece of paper attached to the medicine10:

๏ Dispensing ND’s name or clinic name with telephone number

๏ Patient’s name

๏ Name of medicine/device

๏ Date medicine/device was dispensed

๏ Expiry date for medicines

๏ Strength, proportion, weight, volume for medicines

๏ Directions for use

๏ Cautions/warnings for use

The labeling information must be recorded and added into the system. It has to dynamically update inventory and patient information. Reports would have to be produced from this data depending on the stakeholder ie. insurance, other NDs, Patients....

Security

The dispensing ND must keep all medicines in a locked cabinet/room where access is controlled to avoid contamination.10

This requires the ND to keep an inventory of all medicines coming out and going into the secured cabinet/room.

The ability to monitor key information on medicines, such as where they are dispensed and how much has to be on a system. This information might be important for stakeholders whoever they may be.

10 Board of Directors of Drugless Therapy – Naturopathy. “Policy Dispensing of Medicines and Devices.” http://www.boardofnaturopathicmedicine.on.ca/pdf/Dispensing_Policy_rev_Oct_2005.pdf (accessed Sept. 9, 2007). Naturopathic Medicine - storage and dispensing of drugs and supplements 6 Denise Catherine Rigato & Ezadkiel Villarico Marbella Record Keeping

The dispensing ND must include the following information into the patient’s medical record10:

๏ Name/strength of medicines

๏ Dosage and frequency of use

๏ Dispensing date

๏ Number of repeats

๏ For devices: frequency and duration of use

The ND must keep an up-to-date record of all the patients he/she has treated.

On a system, the ND has to be able to type in a patient’s name, resulting in a chart of medicines pre- scribed, recommended dosage, date, etc. to appear on screen. This sort of database has to allow the ND to make changes to a patient’s record when a prescription/treatment has changed or when a new prescription/treatment needs to be recorded.

Mark-Up

If the ND is dispensing medicines supplied from a wholesaler the mark up value should not exceed 90% of the wholesaler’s price per unit.10

The dispensing ND needs to take note of how much they purchased a particular medicine or com- pound for from the manufacturer to ensure the proper mark-up value was added to the price.

A system has to allow the ND to type in the cost at which he/she bought a product for and the mark-up percentage desired, resulting in an automatic calculation of the final cost. This final cost calculation has to stop the user if the mark-up percentage desired is greater than 90% of the wholesaler’s price per unit and calculations must also include current tax rates. Naturopathic Medicine - storage and dispensing of drugs and supplements 7 Denise Catherine Rigato & Ezadkiel Villarico Marbella Packaging

Medicines must be stored in a PVC-free (Poly Vi- nyl Chloride – a heard plastic used for pipes) and food grade (one that does not transfer toxic sub- stances into the food its holding) container. Food grade containers protect contents from outside contaminations such as moisture and oxygen and prevent damage during shipping and handling.11

The ND should keep track of how many PVC-free and food grade containers there are at the clinic so he/she is able to dispense a medicine when appropriate and so he/she knows when to order more.

A system that keeps a record on the total of remaining/added/subtracted containers must be used. These containers are vital in dispensing medicine.

Disposal of Medicines Disposal of Tools

Tools, such as needles and trays, used by acupuncturists for example need to be disposed of immedi- ately after use.12 Other tools, such as speculums and tubing, used by hydro therapists for example also need to be one-use only and disposed of immediately after use.13

The ND needs to keep track of the number of supplies and tools there are at the clinic so he/she is always prepared to perform a treatment on a patient. Therefore, reducing the number of supplies every time one is used will signify to the ND when it is time to order more.

A system for this type of inventory has to be designed in a same manner as for the labels on the pack- aging. The ND should be able to reduce the number of supplies remaining from the system.

11 WaltonFeed. Food Grade Packaging. “A.1 What Is Food Grade Packaging?” http://waltonfeed.com/grain/faqs/iva1.html (accessed Sept. 9, 2007) 12 Board of Directors of Drugless Therapy – Naturopathy. “Guidelines and Standards for the Clinical Practice of Acupuncture.” http://boardofnaturopathicmedicine.on.ca/pdf/accupuncture.pdf (accessed Sept. 17, 2007). 13 Board of Directors of Drugless Therapy – Naturopathy. “Guidelines and Standards for the Clinical Practice of Colon Hydrotherapy.” http://boardofnaturopathicmedicine.on.ca/pdf/Colon_Hydrotherapy.pdf (accessed Sept. 17, 2007). Naturopathic Medicine - storage and dispensing of drugs and supplements 8 Denise Catherine Rigato & Ezadkiel Villarico Marbella Dispensing Medicines Expired Medicines

Expired Medicines shall not be made available for patients under any circumstances. Expired medi- cines must be disposed of immediately and inventory must be updated.14

The dispensing ND needs to check the dates on the medicines daily to ensure there are no expired products in storage.

The ND has to be notified if expired products are in the inventory. The ND has be to able to remove expired products from inventory on the system.

Non-Expired Medicines

Medicines shall only be made available if the expiry date is at least one month after the patient is to be done taking the medication.14 For example, In January a patient is prescribed a medicine which is to last three months. The medicine must not expire until atleast April, one month after the patient will fin- ish his/her treatment.

The ND needs to ensure he/she is not giving any patients medicines that may be harmful due to close expiry dates.

Recalled Medicines

If a medicine dispensed by a ND produces serious side effects to a patient, the ND must fill out an Ad- verse Reaction Report, which is an assessment of the benefit-risk profile of a product, and bring to their local health unit.

If the medicine is deemed unsafe for public consumption it has to be removed from all inventory and a public notice will be issued.

Conclusion

We conclude that a labeling, patient record and inventory system is needed. Proper labeling must be done for all inbound and outbound inventory. Patients records and inventory must reflect these changes. The system must comply with current regulation and laws for mark-up, packaging, disposal and dispensing. Recalled Medicines must be removed from inventory and disposed of in a safe man- ner. Reports will be issued specific to each stakeholder(still yet to be determined).

14 Board of Directors of Drugless Therapy – Naturopathy. “Policy In-Office Preparation and Compounding of Na- turopathic Medicines. “ http://www.boardofnaturopathicmedicine.on.ca/pdf/Compounding_of_Medicines_2005.pdf (accessed Sept. 9, 2007).