Chiropractors' attitudes toward drug prescription rights: a narrative review

Abstract

BackgroundThe right to prescribe drugs remains a contentious issue within the chiropractic profession. Nevertheless, drug prescription by manual therapy providers is currently an important topic. Notably, physiotherapists in the United Kingdom were recently granted limited independent prescribing rights. Reports suggest that physiotherapists in Australia now want those same rights, and as such a review of chiropractors’ general attitudes toward drug prescription is needed.ObjectiveTo examine the literature concerning chiropractors’ attitudes toward drug prescription rights and to compare the opinions of chiropractors currently licensed to prescribe medication with those in the profession who are not.MethodsThis was a narrative review, consisting of a formal literature search and summary of included articles. Electronic databases searched included the Cumulative Index to Nursing and Allied Health Literature, PubMed, and the Index to Chiropractic Literature. Inclusion criteria consisted of prospective studies published in English in peer-reviewed journals. Studies were required to contain data on chiropractors’ opinions toward medication prescription rights.ResultsOf 33 articles identified, a total of seven surveys were included in the review. Of these, there was a general split in opinion among chiropractors regarding the right to prescribe drugs in chiropractic practice. Those supportive of prescribing rights favoured a limited number of over-the-counter and/or prescription-based medications such as analgesics, anti-inflammatories, and muscle relaxants. When questioned on full prescribing rights, however, chiropractors were generally opposed. In jurisdictions where chiropractors are currently licensed to prescribe from a limited formulary, such as in Switzerland, the majority perceived this right as an advantage for the profession. Moreover, continuing education in pharmacology was viewed as a necessary component of this privilege.ConclusionsBased on the literature to date there is a general split in chiropractors’ attitudes toward drug prescription rights. This split is most pronounced in countries where chiropractors are not licensed to prescribe medications. Notwithstanding, this is an important topic in chiropractic currently and warrants both further discussion and research to determine future directions and the implications of either pursuit or denial of prescription rights by chiropractors. Future surveys and/or qualitative studies of other chiropractors’ opinions toward gaining prescription privileges would be timely.

Attitudes toward drug prescription rights: a survey of Ontario chiropractors

“…Almost 70 % also felt that with limited prescriptive authority chiropractors could help counsel patients against overuse and over-reliance on these types of medications. This level of support for chiropractic prescribing rights is in contrast to that of previously published research which has shown that the profession has generally been divided on this topic [ 13 ]. A majority (55.2 %) of respondents from a recent survey of North American chiropractic students [ 19 ] were also not in favour of expanding the chiropractic scope of practice to include drug prescription.…”

“…All qualified participants in this study were contacted via e-mail messages, at one-week intervals, up to six times over the course of six weeks. The first e-mail was a pre-notification message containing an introduction to the survey and its purpose, as well as a link to a review article on the topic of prescribing rights in chiropractic [ 13 ]. The next four e-mail messages, which included up to three reminder notifications for non-responders, were distributed through SurveyMonkey® and included a cover letter, a link to the survey instrument, as well as opt-out instructions.…”

“…Some evidence suggests that this division in attitudes may be reflective of differences in philosophical orientation, with so-called ‘mixer’ chiropractors being in favour and ‘straight’ chiropractors being opposed [ 8 ]. However further research is needed in order to validate these findings, particularly within the current environment of the chiropractic profession [ 13 , 14 ]. Several of the aforementioned surveys [ 1 , 5 – 9 ] have also been limited by low response rates, leaving the generalizability of their findings open to question.…”

Chiropractic Identity in the United States: Wisdom, Courage, and Strength

“…If anything, their numbers are growing. According to a recent review, DCs are decidedly split on the issue of prescribing medications 21 . However, there does appear to be a trend in survey reports over time supporting some type of pharmaceutical use in practice.…”

Chiropractors¿ attitudes toward drug prescription rights: a narrative review

“…Finally, when compared to other research designs (e.g. systematic reviews), narrative reviews of the literature are more susceptible to bias [56].…”