Washington State

House of Representatives

Office of Program Research

BILL

ANALYSIS

Health Care & Wellness Committee

HB 2304

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

Background:

Prescriptive Authority for Naturopaths.

Naturopathic medicine involves the diagnosis, prevention, and treatment of disorders through stimulating and supporting the natural processes of the body. The practice includes the prescription, administration, dispensing, and use of naturopathic medicines. Naturopathic medicines include vitamins; minerals; botanical medicines; homeopathic medicines; hormones; and legend drugs and controlled substances that are consistent with the practice of naturopathic medical practices in accordance with rules established by the Board of Naturopathy (Board). The controlled substances that a naturopath may prescribe are limited to codeine and testosterone products in Schedules III through V of the Controlled Substances Act.

Naturopaths must obtain authorization from the Board prior to obtaining federal Drug Enforcement Agency (DEA) registration to prescribe, administer, and use specifically-authorized controlled substances. To obtain authorization, the naturopath must have either: (1) current DEA registration from another state or (2) attestation of at least four hours of graduate-level instruction related the principles of medication selection, patient selection and therapeutics education, problem identification and assessment, knowledge of interactions, evaluation of outcome, recognition and management of complications and untoward reactions, and education in pain management and drug seeking behaviors.

A 2015 Sunrise Review by the Department of Health did not recommend prescriptive authority for naturopaths with respect to all schedule II through V controlled substances. The report recommended an alternative approach to allow for prescriptive authority only for schedule III through V controlled substances and schedule II hydrocodone combination products. The report also made recommendations with respect to the duration of prescriptions, maximum dosages, training and education requirements, participation in the Prescription Drug Monitoring Program, and the adoption of pain management rules.

Controlled Substances.

Controlled substances are categorized into five types according to their potential for abuse, the extent of currently accepted medical use in the United States, and the potential that use of the drug may lead to physical or psychological dependence. Schedule I drugs are those drugs with a high potential for abuse, no currently accepted medical use in treatment, and a lack of accepted safety for use in treatment under medical supervision. At the other end of the spectrum are Schedule V drugs which are those drugs with a low potential for abuse relative to the other categories, a currently accepted medical use in treatment, and a likelihood that abuse may lead to only limited physical or psychological dependence relative to the other categories.

Summary of Bill:

The authority of naturopaths to prescribe, administer, dispense, and use only controlled substances that are schedule III through V codeine and testosterone products is expanded. The expanded authority allows naturopaths to prescribe and administer the following medications as necessary in the practice of naturopathy: schedule II hydrocodone combination products and schedule III through V controlled substances.

Naturopaths who prescribe controlled substances are required to register with the state's Prescription Drug Monitoring Program.

The Board of Naturopathy (Board) shall adopt pain management rules for acute pain treatment that address patient examination, screening for comorbidities and risk factors, and maximum dosage limits and treatment periods. The rules must be based on the pain management guidelines adopted by the Washington State Agency Medical Directors' Group. In addition, the Board, in consultation with the Pharmacy Quality Assurance Commission, may develop education and training requirements related to legend drugs and controlled substances.

Naturopaths are added to the list of practitioners who may sell, deliver, or possess legend drugs, and receive and distribute drug samples. Naturopaths are added to the list of persons exempted from iodine purchasing restrictions.