OPINION NO. 93-21
PHARMACY, BOARD OF; HOMEOPATHIC MEDICAL EXAMINERS, BOARD OF;
DRUGS; CONTROLLED SUBSTANCES:
Amendment of NRS 0.040 in 1985 allowed homeopathic physicians
to be considered to be "physicians," but exclusively
homeopathic practitioners may only possess, prescribe, dispense
or administer those dangerous drugs and controlled substances
in such manner and quantity as allowed by NRS 630A.040.
Carson City, September 20, 1993
Mr. Keith W. Macdonald, Executive Secretary
Nevada State Board of Pharmacy
1201 Terminal Way, Suite 212
Reno, Nevada 89502
Dear Mr. Macdonald:
You have asked whether the amendment to NRS 0.040
made by the 1985 Legislature changes the letter opinion issued
on January 7, 1985, such that an exclusively homeopathic physician
may not prescribe, possess, dispense, and administer controlled
substances and dangerous drugs. The brief answer to your question
is that an exclusively homeopathic physician may prescribe a
limited group of dangerous drugs (those that are "sarcodes")
to patients and may possess and administer a limited group of
dangerous drugs and controlled substances, all in compliance
with the statutory criteria provided in NRS 630A.040.
Did the amendment to NRS 0.040 enacted by the
1985 Legislature affect the letter opinion issued January 7,
1985, such that homeopathic physicians who are not also licensed
as allopathic or osteopathic physicians may obtain a controlled
substance registration or may prescribe, possess, or administer
controlled substances and dangerous drugs?
Prior to the 1985 legislative session, NRS 0.040
provided as follows:
1. Except as otherwise provided in subsection
2, as used in Nevada Revised Statutes, "physician"
means a person who engages in the practice of medicine, including
2. The terms "physician," "osteopathic physician,"
"homeopathic physician" and "chiropractic physician"
are used in chapters 630, 630A, 633, and 634 of NRS in the limited
senses prescribed by those chapters respectively.
The 1985 Legislature left NRS 0.040(2) unchanged,
but amended NRS 0.040(1) so that it now
Except as otherwise provided in subsection 2,
"physician" means a person who engages in the practice
of medicine, including osteopathy and homeopathy. [Emphasis
This office rendered a letter opinion on January
7, 1985, regarding whether a homeopathic practitioner was a
"physician" under NRS 0.040(1). The letter opinion
was rendered prior to the amendment to NRS 0.040(1) and, in
fact, precipitated the amendment. In the letter opinion, this
office drew two conclusions: (1) that a homeopathic physician
was not a "physician" for the purposes of NRS chapters
453, 454, and 639; and (2) that a homeopathic physician who
was also licensed in Nevada as an allopathic or osteopathic
physician could write prescriptions for controlled substances
and dangerous drugs, provided that the homeopathic physician
did so only for legitimate allopathic or osteopathic treatment
and not for homeopathic purposes.
The amendment of NRS 0.040(1) had the far-reaching
effect of bringing homeopathic practitioners within the coverage
of all the sections throughout the NRS in which reference is
made to "physicians." The amendment of NRS 0.040(1)
also changed the analysis of the January 7, 1985, letter opinion
in the limited way that the question presented at that time,
namely whether a homeopathic physician was a "physician"
under NRS 0.040, must now be answered affirmatively. The amended
and present version of NRS 0.040(1) clearly indicates that homeopathic
physicians are "physicians" as that term may be used
throughout the NRS. The inquiry does not end here, though.
Subsection (2) of NRS 0.040 refers inquiries regarding
each of the specific practitioner groups
in subsection (1) to each's specific practice act. As such,
the answer to the specific question addressed in this opinion
regarding the prescribing, possessing, and administering powers
of exclusively homeopathic practitioners must be made by reference
to various portions of the pharmacy laws and NRS chapter 630A,
the practice act for homeopathic practitioners.
NRS 453.226(1) provides the general definition
of those persons who must be registered with
the board of pharmacy to distribute or dispense controlled substances:
Every practitioner or other person who manufactures,
distributes or dispenses any controlled substance within this
state or who proposes to engage in the manufacture, distribution
or dispensing of any controlled substance within this state
shall obtain biennially a registration issued by the board in
accordance with its regulations. [Emphasis added.]
A "practitioner" may administer controlled
substances pursuant to NRS 453.375(1). A "practitioner,"
as defined in NRS 453.126, includes a "physician."
Any person who manufactures, distributes or dispenses a controlled
substance without prior registration may be punished by imprisonment
of one to six years, may be fined not more than $2,000. NRS
453.232. Similarly, NRS 454.213(1) allows a "practitioner"
to possess and administer dangerous drugs, and NRS 454.215(3)
allows a "practitioner" to dispense dangerous drugs.
NRS 454.00958(1) defines a "practitioner" to include
a "physician." Any person who furnishes dangerous
drugs without the valid prescription of a practitioner may be
imprisoned for one to six years, may be fined not more than
$5,000, or both. NRS 454.221(1).
NRS 630A.040 specifically defines the pharmacopoeia
of medicines available for use by homeopathic physicians as
"Homeopathic medicine" or "homeopathy"
means a system of medicine employing substances of animal, vegetable,
chemical or mineral origin, including nosodes and sarcodes,
1. Given in micro-dosage, except that sarcodes may be given
2. Prepared according to homeopathic pharmacology by which the
formulation of homeopathic preparations is accomplished by the
methods of Hahnemannian dilution and succussion, magnetically
energized geometric patterns, applicable in potencies above
30X as defined in the official Homeopathic Pharmacopoeia of
the United States, or Korsakoffian; and
3. Prescribed by homeopathic physicians according to the medicines
and dosages in the homeopathic Pharmacopoeia of the United States,
in accordance with the principle that a substance which produces
symptoms in a healthy person can eliminate those symptoms in
an ill person, resulting in the elimination and prevention of
illness utilizing classical methodology and noninvasive electrodiagnosis.
NRS 630A.090(4) clearly distinguishes homeopathic
medicine from allopathic medicine and prohibits homeopathic
physicians from practicing allopathic medicine: "This chapter
does not authorize a homeopathic physician to practice medicine,
including allopathic medicine, except as provided in NRS 630A.040."
Additionally, pursuant to NRS 630A.230(2)(c), all homeopathic
physicians must be licensed as allopathic or osteopathic physicians
"in any state or country, the District of Columbia or a
territory or possession of the United States." Thus homeopathic
practitioners can be licensed exclusively as homeopathic physicians
under NRS chapter 630A or can have dual licenses as homeopathic
physicians and allopathic or osteopathic physicians.
In contrast to the narrow statutory scope of the
practice of homeopathy, the definition of "practice of
medicine" in NRS 630.020 is as follows:
1. To diagnose, treat, correct, prevent or prescribe
for any human disease, ailment, injury,
infirmity, deformity or other condition, physical or mental,
by any means or instrumentality.
2. To apply principles or techniques of medical science in the
diagnosis or the prevention of any such conditions.
3. To offer, undertake, attempt to do or hold oneself out as
able to do any of the acts described in subsections 1 and 2.
4. To use in connection with a person's name the words or letters
"M.D.," or any other title, word, letter or other
designation intended to imply or designate him as a practitioner
of medicine in any of its branches, except in the manner authorized
by NRS 630A.220. [Emphasis added.]
The definition of "osteopathic medicine"
is found in NRS 633.081 and provides:
"Osteopathic medicine" or "osteopathy"
means the school of medicine which:
1. Utilizes full methods of diagnosis and treatment in physical
and mental health and disease, including the prescribing and
administering of drugs and biologicals of all kinds, operative
surgery, obstetrics, radiological and other electromagnetic
2. Places emphasis on the interrelationship of the musculoskeletal
system to all other body
systems. [Emphasis added.]
The legislative intent from the above definitions is clear:
homeopathy is a limited practice whereas allopathy and osteopathy
are general. Allopaths may use "any means or instrumentality"
their practices. Osteopaths may use "full methods of diagnosis
and treatment" in their practices. Homeopaths, on the other
hand, are limited to using only those medications that satisfy
NRS 630A.040 "in accordance with the principle that a substance
which produces symptoms in a healthy person can eliminate those
symptoms in an ill person, resulting in the elimination and
prevention of illness utilizing classical methodology and noninvasive
electrodiagnosis." Furthermore, an allopathic physician
may not call himself a homeopathic physician. NRS 630.020(4).
It is clear that the legislature intended homeopathy to be a
distinct style of medicine with a specifically defined pharmacopoeia
suited to the homeopathic practice of medicine.
The question of which drugs a homeopathic practitioner
can prescribe, possess, or administer is
answered by the three-part test in NRS 630A.040, namely that
the drug must be (1) given in micro- dosage (except that sarcodes
may be given in macro-dosage); (2) prepared according to homeopathic
pharmacology; and (3) prescribed by homeopathic physicians according
to the medicines and dosages in the Homeopathic Pharmacopoeia
of the United States. Generally, the dosages and forms of drugs
maintained by Nevada pharmacies would not be in "micro-dosages,"
and would instead be in forms that would be deemed "macro-dosages"
under NRS 630A.040. Thus NRS 630A.040 makes it clear that a
homeopathic physician practicing homeopathically could not prescribe
or administer the regular "macro-dosage" of any controlled
substance or dangerous drug unless that drug were a "sarcode."
No known allopathic drugs regularly stocked by Nevada pharmacists
would be "sarcodes."
A second question arises, though, as to whether
a homeopathic practitioner may obtain and possess controlled
substances and dangerous drugs for preparation of a homeopathic
remedy therefrom. First, it seems unlikely that most of the
regular stock of a Nevada pharmacy would qualify as the raw
materials for the preparation of homeopathic remedies. Homeopathic
remedies generally use organic materials and would not include
the highly refined modern pharmaceuticals stocked by Nevada
pharmacies. Nonetheless, it may be that some pharmaceuticals,
especially some controlled substances may be stocked or available
through Nevada pharmacies. For example, the monographs for homeopathic
remedies include the following remedies that would be made from
controlled substances: anhalonium lewinii (peyote), cannabis
indica/cannibis sativa (marijuana), cocainum (cocaine), cocainum
muriaticum (cocaine hydrochloride), codeinum (codeine), datura
arborea/datura metel (datura), morphinum (morphine), morphinum
muriaticum (morphine hydrochloride), and opium (opium). Additionally,
it may be that some homeopathic remedies are fashioned from
currently available dangerous drugs.
It is clear, therefore, that a homeopathic physician
practicing homeopathically could legally obtain, possess, and
administer some dangerous drugs and controlled substances for
the manufacture of homeopathic remedies. Additionally, a homeopathic
physician may also prescribe those dangerous drugs and controlled
substances allowed by NRS 630A.040, but as a practical matter
it is unlikely that any Nevada pharmacies stock dangerous drugs
or controlled substances in homeopathic dosages or know how
to prepare homeopathic remedies according to homeopathic methodology.
To possess controlled substances, the homeopathic practitioner
would be required to obtain a registration with the Drug Enforcement
Administration (DEA) and a registration with the Nevada Board
of Pharmacy pursuant to NRS 453.226. Additionally, any order
for a controlled substance in Schedules I and II would need
to be via a DEA Form 222; any order for other controlled substances
would need to be via a valid order form, and all record-keeping,
storage, and security statutes and regulations would also be
Of course, possession and administration of the
controlled substances and dangerous drugs
obtained by a homeopathic practitioner must also comply with
the terms of NRS 630A.040. Administration of a controlled substance
or dangerous drug in contravention to the dictates of NRS
630A.040 would subject a homeopathic practitioner to discipline
by the Board of Homeopathic Examiners pursuant to NRS 630A.370(3)
and (5), and to discipline by the Board of Pharmacy pursuant
to NRS 453.241.
We suggest that representatives from the Boards
of Pharmacy and Homeopathy meet to develop
a comprehensive pharmacopoeia of drugs that Nevada pharmacists
could provide to homeopathic practitioners or their patients
that could be circulated among the members of the two professions.
The pharmacopoeia should include at least the following categories:
(1) those dangerous drugs that are "sarcodes" and
could be prescribed by the homeopathic practitioner to be filled
at a Nevada pharmacy; (2) those controlled substances that are
in Schedules I and II that could be ordered by homeopathic practitioners
from Nevada pharmacies for the manufacture of homeopathic remedies;
(3) those controlled substances in Schedules III, IV, and V
that could be ordered by homeopathic practitioners from Nevada
pharmacies for the manufacture of homeopathic remedies; and
(4) those dangerous drugs that could be ordered by homeopathic
practitioners from Nevada pharmacies for the manufacture of
The second conclusion contained in the letter
opinion of January 7, 1985, remains essentially
unchanged; namely that a homeopathic physician who is also licensed
in Nevada as an allopathic or osteopathic physician may write
prescriptions for controlled substances for allopathic or osteopathic,
not homeopathic, purposes. NRS 453.381(1), the statute that
is the basis of this part of the letter opinion, has not been
changed in the interim since 1985. Similarly, a dangerous drug
cannot legally be prescribed by a homeopathic physician except
for allopathic or osteopathic, not homeopathic, purposes. See
NRS 454.211, NRS 454.221.
Of course, the dually-licensed practitioner could
also prescribe, obtain, possess, and administer those dangerous
drugs and controlled substances for homeopathic purposes according
to the homeopathic method as has already been discussed. In
other words, when a dually-licensed practitioner is practicing
allopathically or osteopathically, he could prescribe any dangerous
drug or controlled substance, but when he is practicing homeopathically,
he can only avail himself of the more narrow homeopathic pharmacopoeia
of dangerous drugs and controlled substances.
The 1985 amendment to NRS 0.040 authorizes exclusively
homeopathic physicians to possess,
dispense, or administer those controlled substances and dangerous
drugs that are recognized by the Homeopathic Pharmacopoeia of
the United States and otherwise comply with NRS 630A.040. To
possess, dispense, or administer any controlled substances,
a homeopathic physician must obtain a federal DEA registration
and a Nevada controlled substances registration. Homeopathic
physicians who are also licensed in Nevada as allopathic or
osteopathic physicians, in addition to the limited abilities
to possess, dispense, administer, and prescribe certain dangerous
drugs and controlled substances according to homeopathic practice,
may also possess, dispense, prescribe, or administer controlled
substances and dangerous drugs as appropriate and necessary
to their allopathic or osteopathic practices.
FRANKIE SUE DEL PAPA
By: LOUIS LING
Deputy Attorney General