Federal law (by FDA) only refers to licensed practitioners and so it is left up to each State licensing board to decide the scope of practice. Of course, physicians, dentists, podiatrists and nurse practitioners can order Alpha-Stims in all States, but in some States physical therapists can see patients off the street without a referral and they use and order Alpha-Stim for pain (but not anxiety or depression). In most States, psychologists and social workers order them for anxiety, insomnia and depression, but not pain. Acupuncturists, chiropractors and naturopaths can usually order them also, I am sure I left somone out but the general idea is that practitioners who can see patients for the condition for which it is prescribed can order them, i.e., within their scope of practice. Outside of the USA it is available worldwide without a prescription but some countries require a physcian's order for reimbursement by third parties such as insuance or governmant healthcare.