COMPLEMENTARY, ALTERNATIVE, AND INTEGRATIVE MEDICINE PRODUCTS

To promote awareness of the impact of complementary, alternative, and integrative medicine (CAM) products on patient care, particularly drug interactions, medication safety concerns, and the risk of contamination and variability in active ingredient content; further,

To advocate for the documentation of CAM products in the health record to improve transparency and optimize patient safety; further,

To advocate for the inclusion of up-to-date and readily available information about CAM products and their characteristics in medication-related databases; further,

To provide education on the impact of CAM product administration on patient care within healthcare organizations.

Rationale

The terms complementary, alternative, and integrative are sometimes used interchangeably to describe healthcare approaches that are not part of conventional medical care. When non-mainstream practice is used with conventional medicine, it is considered complementary. When a non-mainstream practice is used in place of conventional medicine, it is considered alternative. Integrative healthcare often brings conventional and complementary approaches together in a coordinated way and emphasizes a holistic, patient-focused approach to healthcare and wellness. CAM includes the use of natural products such as herbs, vitamins, and minerals sold as dietary supplements. According to the National Center for Complementary and Alternative Medicine (NCCAM), an estimated 38% of adults and 12% of children use some form of CAM.

In the ASHP Statement on the Use of Dietary Supplements, ASHP expresses concern that the widespread, indiscriminate use of dietary supplements presents substantial risks to public health and details the basis of those concerns. Some dietary supplements are inherently unsafe. Product content (both active ingredient and excipients) is not standardized, therapeutic goals are vague, and evidence of efficacy and safety is absent or ambiguous. Lax regulation of dietary supplement manufacturing presents the risk of contamination or adulteration with harmful substances. Numerous dietary supplements interact with medications and may therefore compromise, complicate, or delay effective treatment. Some patients, particularly those who cannot afford expensive medication regimens, may substitute ineffective alternatives for proven medical therapies.

Healthcare organizations take varying approaches to addressing CAM use. Some actively counsel patients against CAM use, others take a more integrative approach and accept the practice, and some even have clinics for referrals. ASHP has long encouraged healthcare organizations to develop an institutional policy regarding the use of dietary supplements that allows pharmacists and other healthcare practitioners to exercise their professional judgment while balancing patient autonomy and institutional concerns. Such policies should include promoting healthcare practitioner awareness of the potential impacts of CAM use and should encourage documentation of CAM use in the patient’s health record and expansion of CAM related data for documentation in the electronic health record (EHR), so pharmacists and other healthcare practitioners have the knowledge and information they need to safely treat and advise patients and the provider with clinical decision support tools already integrated to the EHR. Expansion of documentation CAM data will support medication reconciliation efforts to promote accurate documentation of CAM, CAM-drug related interactions, and CAM-disease state related interactions. ASHP recommends that all healthcare trainees, providers, and staff actively ask patients about their CAM use during the process of medication reconciliation.