DEPARTMENT OF HEALTH

(Board of Optometry)

[Filed February 1, 2019, 12:52 p.m., effective March 4, 2019]

Effective Date of Rule: Thirty-one days after filing.

Purpose: WAC 246-851-580 and 246-851-590, the board of optometry (board) is adopting an amendment to the drug list in WAC 246-851-580 and drug guidelines in WAC 246-851-590 to clarify the use of adjuvant analgesics, such as gabapentin and pregabalin, for the practice of optometry. This rule making is in response to a question from a Washington-licensed optometrist, who asked the board if adjuvant analgesics were included under the category "analgesics" in WAC 246-851-580 (1)(j).

These drugs were originally classified as antiepileptic medications, but are now more commonly prescribed to enhance treatment of pain. Adding adjuvant analgesics to the optometry drug list gives optometrists additional, safer pain treatments for addressing painful eye conditions, such as herpes zoster. Optometrists are currently authorized to prescribe hydrocodone combination products, which are potentially addictive opioids. Adjuvant analgesics by themselves do not carry the same risks for addiction.

Citation of Rules Affected by this Order: Amending WAC 246-851-580 and 246-851-590.

Statutory Authority for Adoption: RCW 18.54.070(2).

Other Authority: RCW 18.53.010(4).

Adopted under notice filed as WSR 18-22-071 on November 1, 2018.

A final cost-benefit analysis is available by contacting Loralei Walker, P.O. Box 47852, Olympia, WA 98504-7852, phone 360-236-4947, fax 360-236-2901, TTY 360-833-6388 or 711, email loralei.walker@doh.wa.gov.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 2, Repealed 0.

Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0.

Date Adopted: December 14, 2018.

Dale Heaston, OD, Chair

AMENDATORY SECTION(Amending WSR 16-16-017, filed 7/21/16, effective 8/21/16)

WAC 246-851-580Drug list.

Pursuant to RCW 18.53.010(4), the optometry board adopts the following drug formulary of oral Schedule II hydrocodone combination products, Schedule III through V controlled substances, and legend drugs for diagnostic and therapeutic purposes in the practice of optometry. No licensed optometrist may use, prescribe, dispense, purchase, possess, or administer these drugs except as authorized and to the extent permitted by the board. This section includes the approved oral drug formulary. Optometrists must consult WAC 246-851-590 for specific guidelines on these drugs or drug categories.

(1) Approved nonscheduled oral drugs include:

(a) Antibiotic agents excluding those listed in WAC 246-851-590(1).

(b) Antiviral agents.

(d) Antihistamine agents.

(e) Decongestant agents.

(f) Dry eye agents.

(g) Anti-emetic agents listed under WAC 246-851-590(3).

(h) Diuretic agents listed under WAC 246-851-590(4).

(i) Nonsteroidal anti-inflammatory agents excluding those listed in WAC 246-851-590(5).

(j) Analgesics and adjuvant analgesics.

(2) Approved controlled substances limited to Schedule II hydrocodone combination products and Schedules III, IV, and V.

(a) Schedule II hydrocodone combination products.

(b) Schedule III controlled substances.

(d) Schedule IV anti-anxiety/sedative agents.

(e) Schedule V controlled substances.

(3) Approved injectable substances.

Administration of epinephrine by injection for the treatment of anaphylactic shock.

AMENDATORY SECTION(Amending WSR 16-16-017, filed 7/21/16, effective 8/21/16)

WAC 246-851-590Guidelines for the use of oral Schedule II hydrocodone combination products and Schedule III through V controlled substances and legend drugs.

Nothing in these guidelines should be construed to restrict the recommendation of over-the-counter medications, vitamins, or supplements, nor restrict the ordering of any radiologic or laboratory testing necessary to the diagnosis of any eye related disease that is within the scope of practice of optometry.

(1) All oral forms and dosages of antibiotic agents will be available for use excluding: Vancomycin.

(2) Antifungal agents used in eye care shall fall into the following categories:

(a) All oral forms and dosages of polyene antifungals.

(b) All oral forms and dosages of imidazole antifungals.

(3) Anti-emetic agents used in eye care shall be the following medications:

(a) All oral forms and dosages of prochlorperazine.

(b) All oral forms and dosages of metoclopramide.

(4) Diuretic agents used in eye care shall fall into the following categories:

(a) All oral forms and dosages of carbonic anhydrase inhibitors.

(b) All oral forms and dosages of osmotic diuretics. Osmotic diuretics shall be used only in the case of acute angle closure glaucoma administered in-office, outpatient, and/or ambulatory procedures only.

(5) All oral forms and dosages of nonsteroidal anti-inflammatory agents will be available for use excluding: Ketorolac tromethamine.

(6) Benzodiazepines prescribed, as anti-anxiety agents, shall be used for in-office, outpatient, and/or ambulatory procedures. This family of medications will be utilized as one dosage unit per prescription.

(7) Schedule II controlled substance will only include hydrocodone combination products.

(8) Schedules III and IV controlled substances will have a maximum quantity count of thirty dosage units per prescription.

(9) Specific dosage for use and appropriate duration of treatment of oral medications listed in WAC 246-851-580(1) will be consistent with ((guidelines established by the)) Food and Drug Administration on- and off-label indications.

(10) Notation of purpose shall be included on all prescriptions.

(11) An optometrist may not:

(a) Use, prescribe, dispense, or administer oral corticosteroids; or

(b) Prescribe, dispense, or administer a controlled substance for more than seven days in treating a particular patient for a single trauma, episode, or condition or for pain associated with or related to the trauma, episode, or condition; or

(c) Prescribe an oral drug within ninety days following ophthalmic surgery unless the optometrist consults with the treating ophthalmologist. If treatment exceeding the limitation is indicated, the patient must be referred to a physician licensed under chapter 18.71 RCW.

(12) The prescription or administration of drugs as authorized in this section is specifically limited to those drugs appropriate to treatment of diseases or conditions of the human eye and the adnexa that are within the scope of practice of optometry. The prescription or administration of drugs for any other purpose is not authorized.

(13) Nothing in this chapter may be construed to authorize the use, prescription, dispensing, purchase, possession, or administration of any Schedule I or II controlled substance with the exception of Schedule II hydrocodone combination products.