The debate within
the field of psychology regarding the right to prescribe
psychotropic medication has persisted for the past
two decades, with the American Psychological Association
(APA) officially considering the matter beginning
in 1989.1 Recent studies estimate
that over 44 percent of Americans are prescribed
at least one drug, and that 16.5 percent take at
least three.2 In response
to the growing debate, the APA established a task
force to evaluate the "desirability and feasibility
of psychopharmacology prescription privileges for
psychologists."3 The
task force proposed three levels of training in
psychopharmacology, including recommended focus
areas and curriculum requirements: (1) Level One
- basic education; (2) Level Two - collaborative
practice; and (3) Level Three - prescription privileges.4
The task force concluded that psychologists who
provided mental health services should at least
have access to level one training, and recognized
an evolving "subspecialty of psychology with
comprehensive knowledge and experience in psychopharmacology"
that has the potential to dramatically improve patient
care and treatment.5 In 1995,
the APA Council of Representatives formally announced
its objective to obtain prescription privileges,
and called for the drafting of model legislation
and training curriculum.6
The current APA model program for prescription privileges,
in addition to completing an accredited doctoral
program in professional psychology, requires a minimum
of 300 contact hours of didactic instruction and
supervised treatment of 100 patients, with no specified
minimum length of training time required.7
Despite what appears
to be only a slight majority of support from the
profession as a whole,8 the
APA has largely been successful in spreading its
initiative to the states. The cooperation and support
of the state legislatures is a necessary requirement
for the APA to achieve its goal, since the courts
have long recognized the authority and autonomy
of the states in regulating health care professionals.9
As of Spring 2002, after New Mexico became the first
state to pass legislation enabling psychologists
to obtain prescription privileges, state psychological
associations in thirty-one states had assembled
task forces to lobby their state legislatures to
enact similar legislation that would create a special
class within the licensed psychologists.10
Most recently, Louisiana became the second state
to enact a similar law on May 6, 2004, creating
a "medical psychologist" who may prescribe
certain medications with the consultation of a primary
care provider.11
The first part of
this note will compare and contrast the two state
statutes, New Mexico and Louisiana, which have enabled
psychologists to prescribe certain medications upon
completing specific requirements. In addition, the
states' basis and purpose for enacting these laws
will also be explored. The second part will discuss
the debate over the prescription privilege from
both sides, as it has evolved over the last twenty
years. The third part will discuss the legal implications
of a prescription privilege for psychologists, focusing
mainly on liability and governmental regulation. continued
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