Feature

New Mexico recently became the first state to implement a law allowing licensed psychologists with the appropriate training and certification to prescribe psychotropic medications. The regulations to activate the law were filed with the state's record center in December and took effect on Jan. 7. When the regulations were filed, psychology advocates said work remained in clarifying the scope of medications that qualified psychologists would be allowed to prescribe--the "formulary."

"This is an historic day in the sense that for the first time in the country's history, rules and regulations have been filed allowing appropriately trained psychologists to prescribe psychotropic medications," says E. Mario Marquez, PhD, the legislative chair of the New Mexico Psychological Association. "New Mexico prescribing psychologists are paving the way for the other states to provide a new means of offering quality mental health care."

The new regulations

The regulations were developed by a joint committee of physicians and psychologists. To receive a prescribing certificate in New Mexico, psychologists must complete at least 450 hours of coursework, an 80-hour practicum in clinical assessment and pathophysiology, and a 400-hour, 100-patient practicum under physician supervision. They also must pass a national certification examination, the Psychopharmacology Examination for Psychologists. The academic component includes psychopharmacology, neuroanatomy, neurophysiology, clinical pharmacology, pathophysiology, pharmacotherapeutics, pharmacoepidemiology and physical and lab assessments.

After completing these requirements, psychologists licensed to practice in New Mexico are eligible for a two-year conditional prescription certificate allowing them to prescribe under supervision of a physician. At the end of two years, if the supervisor approves and the psychologist's prescribing records pass an independent peer review, the psychologist can apply to prescribe independently. Only at that point will prescribing psychologists work independently, albeit in close collaboration with the patient's physician.

"There are more than 40 psychologists in New Mexico who already have completed the training or are currently enrolled in a training program," says Elaine LeVine, PhD, director of the Southwestern Institute for the Advancement of Psychotherapy/New Mexico State University Collaborative, a New Mexico psychopharmacology training program for psychologists. "These psychologists are very experienced practitioners who also completed seven years of doctoral training including two years of supervised practice in order to become licensed as psychologists before undertaking the extensive training in psychopharmacology."

The collaboration provisions of the regulations codify good clinical practice, says Russ Newman, PhD, JD, APA's executive director for professional practice. For example, the regulations call not only for psychologist-prescribers to initiate contact with patients' physicians when medication is warranted, but also for physicians to contact patients' psychologists when changes in patients' medical conditions might affect psychologists' treatment.

Psychology advocates say the prescriptive authority law represents an important step toward providing comprehensive mental health care to New Mexico residents, who face serious access-to-care challenges; seeing a psychiatrist can take up to five months and a lengthy commute.

Fine-tuning

At press time, psychology advocates of the legislation were working to clarify the statutory definition of formulary included in the regulations. Advocates planned to ask the New Mexico legislature to approve a revised definition of psychotropic medication that would allow psychologists to prescribe off-label drugs that are in common and proper use for mental health conditions when appropriate. This plan did not delay the regulations from taking effect on Jan. 7.

Proponents assert that the revision would clearly allow prescribing psychologists to follow usual and customary best practices by allowing them access to the full complement of medications necessary to manage mental disorders.

As currently written, the formulary only allows prescribing psychologists to prescribe those psychotropics specifically approved by the Food and Drug Administration for mental health disorders, thereby excluding any "off-label" uses that have become customary practice in the treatment of these disorders.

What's next

Psychology anticipates opposition in the upcoming legislative session as psychiatry reportedly has spent $100,000 on a lobbying campaign in New Mexico to undermine implementation of the law and to ultimately repeal it.

New Mexico was the first state to pass a prescribing law for psychologists in March 2002, following the passage of similar legislation by the U.S. territory of Guam in 1998. Louisiana passed similar legislation in 2004. At press time, the regulations to implement the Louisiana law had been published for review and comment and were the subject of a public hearing by the Louisiana State Board of Examiners of Psychologists.