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The Aromatic Message

By Shellie Enteen, RA, BA, LMBT

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When Does Aromatherapy Exceed Your Scope of Practice?

People in the healing arts want to help others. Massage therapists, like other professionals who work with the public in ways that affect their body, want to do as much as possible to insure their client's well-being. But, all health professions have their parameters, including an accepted legal scope of practice. As massage practitioners, we know that as much as we might like to, we don't adjust the bones of the neck and spine. If we do, we are working outside our scope of practice and doing that can have legal consequences. When does using essential oils cross that line?

Until now, aromatic massage oils, scented towels and face cradles and diffusion in the massage room or office have been standard and accepted ways to incorporate aromatherapy into a massage practice. When doing so, the practitioner is expected to know and follow safety guidelines, too. Standard safe practices includes always diluting essences before topical use and not applying the essential oils that are known to be phototoxic on the skin of a client that will be exposed to sunlight within 17 hours.

For more in-depth information on this, please refer to a previous article on skin sensitivity. One thing it is important to mention regarding topical application is that, when it comes to skin reaction and toxicity issues, it doesn't matter how pure the essential oils used are. For example, the purest, highest quality expressed lemon oil will have enough furocoumarin content to create an uncomfortable, long lasting burn (photodermatitis) or rash (berloque dermatitis) with sun exposure.

aromatherapy - Copyright – Stock Photo / Register Mark Most know that the scope of practice for massage does not include diagnosis and prescription.Therefore, when it comes to using aromatherapy, it's best not to directly prescribe a certain essential oil for your client's needs. Instead, offer to create a blend that has been suggested in books for alleviating pain, inflammation, etc.

What is probably the most controversial issue for massage scope of practice and in the practice of aromatherapy in general, is prescribing essential oils to be taken orally for any condition. In certain circles, it has of late, become a popular notion that it is safe to ingest essential oils, either as drops on the tongue, in water or in gel caps. Many of the people conveying this idea have had no medical background, no training in anatomy and physiology or aroma-chemistry and could easily be drawing mistaken conclusions from other information, like that issued by the FDA in guidelines for food preparation. But no matter where this information has come from, suggesting ingestion to a client is out of the scope of practice for a massage therapist and could be seen as practicing medicine without a license.

Can or will suggesting ingestion of essential oils have consequences? Some toxic reactions can be seen quickly, such as gastritis or burning of oral mucosa. Others, as is the case when habitually eating ingredients in certain kinds of fast foods, could take a while to show up. Even then, symptoms may not be quickly traced to the use of ingested essential oils. But still, it bears noting that consequences do exist and ingestion of these powerful substances is best left to a qualified medical practitioner who has also had a strong education in the use of essential oils.

When it comes to what happens when essential oils are ingested, Registered Aromatherapist and LMT, Katharine Koeppen, had this to say in a blog on her website, www.Aromaceuticals.com: "In this case, essential oils may have time to act upon some digestive system issues, but by the time they reach the small intestine, they are absorbed into the circulatory system and taken up by the liver. There, they are broken down into various phytochemicals, which are then further metabolized. Problems can occur when the liver decides it prefers to process other substances first, and phytochemicals accumulate in line waiting to be processed, sometimes accumulating in toxic amounts. For example, the liver doesn't 'like' 1,8 cineole, a common bioactive fraction of peppermint, tea tree, niaouli and many eucalyptus. Taken orally in improper doses, 1,8 cineole can quickly accumulate to the point where it causes liver failure. In a child, less than 2 milliliters are a deadly dose. In an individual with compromised liver function, even small amounts of oils containing 1,8 cineole taken orally can cause dangerously elevated liver enzymes in a matter of a few days.

"There is also the matter of drug interactions. All essential oils have some sort of effect upon P450 liver detoxification enzymes. Some inhibit or accelerate phase 1 enzymes, some inhibit or accelerate phase 2 enzymes, and still some interact with both phase 1 and 2 enzymes. This does not pose a problem with the majority of essential oils when inhalation therapy or topical application is used, but does create problems with oral ingestion. If a pharmaceutical medication has a narrow therapeutic window, it is undesirable (and may be downright dangerous) to limit the effectiveness of the drug by slowing or speeding up the way it is processed in the body.

"There are different protocols for ingesting essential oils, depending on the part of the body that the aromatherapy needs to target. If you don't know these protocols, don't take essential oils orally. Taking oils incorrectly may cause burning of the mucous membranes of the mouth and throat, upset stomach, heartburn, diarrhea or may be altogether ineffective.

A surprising number of consumers believe that all natural remedies are safe, and see no problem using essential oils with abandon. A person who would never consider taking half a bottle of aspirin in a sitting has no problem downing a teaspoon of highly concentrated essential oil."

Massage therapists work hard to get through school, pass exams, build a practice and take required CE courses. It is worth staying within the scope of practice to avoid jeopardizing this hard-earned privilege. I agree with Katharine that, "Unless you have the time and energy to devote to your own serious research, or wish to invest in classes covering aroma-chemistry, pharmacology, anatomy and physiology, don't experiment with ingesting essential oils. If you find this suggestion intimidating and still feel you must take aromatics orally, book a consultation with a qualified clinical aromatherapist for guidance." It certainly isn't a good idea to put a practice or another person in jeopardy by crossing the line and prescribing ingestion of essential oils for clients.

Author's Note: In a recent letter to Do-Terra, the FDA said, "Failure to implement lasting corrective action on violations may result in regulatory action being initiated by FDA without further notice." This regulatory action could affect the industry as a whole, not just individuals who choose to practice medicine without a license. Read the complete letter at http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2014/ucm415809.htm.

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