WSR 07-20-101

PERMANENT RULES

DEPARTMENT OF HEALTH


[ Filed October 2, 2007, 11:32 a.m. , effective November 2, 2007 ]


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

Purpose: The rules implement 2005 HB 1546 which expanded the scope of practice of naturopathic physicians. The rules describe the expansion of naturopathic medicine to include legend drugs and controlled substances which are limited to codeine and testosterone products. The rules also describe the process by which naturopathic physicians are approved to add codeine, testosterone products, and intravenous therapy into their practice.

Citation of Existing Rules Affected by this Order: Amending WAC 246-836-210.

Statutory Authority for Adoption: RCW 18.130.050(1) and 18.36A.060.

Other Authority: Chapter 158, Laws of 2005.

Adopted under notice filed as WSR 07-14-127 on July 3, 2007.

Changes Other than Editing from Proposed to Adopted Version: WAC 246-836-210 (1)(e) has been amended to correct a typographical error when referencing chapter 69.50 RCW, and to add a reference to chapter 246-887 WAC. In addition, WAC 246-836-210(4) has been amended to correct an inconsistency with statutory language. The prohibition of treatment of neoplastic diseases has been removed.

A final cost-benefit analysis is available by contacting Susan Gragg, Department of Health, P.O. Box 47866, Olympia, WA 98504-7866, phone (360) 236-4941, fax (360) 236-2406, e-mail susan.gragg@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Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 2, Amended 1, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 2, Amended 1, Repealed 0.

Date Adopted: October 2, 2007.

Mary C. Selecky

Secretary

OTS-9344.6


AMENDATORY SECTION(Amending Order 247, filed 2/25/92, effective 3/27/92)

WAC 246-836-210   Authority to use, prescribe, dispense and order.   ((Licensed naturopaths may use, prescribe, dispense, and order certain medicines of mineral, animal, and botanical origin including the following:)) (1) Naturopathic medical practice includes the prescription, administration, dispensing, and use of:

(a) Nutrition and food science, physical modalities, minor office procedures, homeopathy, hygiene, and immunizations/vaccinations;

(b) Nondrug contraceptive devices;

(c) Nonlegend medicines ((derived from animal organs, tissues, and oils, minerals, and plants administered orally and topically)) including vitamins, minerals, botanical medicines, homeopathic medicines, and hormones;

(d) Legend drugs as defined under RCW 69.41.010 with the exception of Botulinum Toxin (commonly known as, among other names, Botox, Vistabel, Dysport, or Neurobloc) and inert substances used for cosmetic purposes; and

(e) Codeine and testosterone products that are contained within Schedules III, IV, and V in chapters 69.50 RCW and 246-887 WAC.

(2) In accordance with RCW 69.41.010(13), all prescriptions must be hand-printed, typewritten, or generated electronically.

(3) Prior to being allowed to administer, prescribe, dispense, or order controlled substances, a naturopathic physician must meet the requirements in WAC 246-836-211 and have obtained the appropriate registration issued by the Federal Drug Enforcement Administration.

(((2) Legend topical ointments, creams, and lotions containing antiseptics.

(3) Legend topical, local anesthetics applied to superficial structures for use during minor office procedures as appropriate. Topical local anesthetic means the local application of anesthetic which may be injected into the intradermal subcutaneous layers of the skin only to the extent necessary to care for superficial lacerations, abrasions and the removal of foreign bodies located in superficial structures not to include the eye.

(4) Legend vitamins, minerals, trace minerals, and whole gland thyroid.

(5) Nondrug contraceptive devices except intrauterine devices.

(6) All homeopathic preparations.

(7) Intramuscular injections limited to vitamin B-12 preparations and combinations when clinical or laboratory evaluation has indicated vitamin B-12 deficiency.

(8) Immunizing agents approved by the Bureau of Biologics, United States Food and Drug Administration and listed in the current Recommendations of the United States Public Health Services Immunizations Practices Advisory Committee (ACIP) or the Report of the Committee of Infectious Diseases published by the American Academy of Pediatrics.

(9) Legend substances as exemplified in traditional botanical and herbal pharmacopeia as identified by a list of substances to be developed by the secretary.)) (4) Naturopathic physicians may not treat malignancies except in collaboration with a practitioner licensed under chapter 18.57 or 18.71 RCW.

[Statutory Authority: RCW 18.36A.060 [(1)](a). 92-06-020 (Order 247), 246-836-210, filed 2/25/92, effective 3/27/92.]


NEW SECTION
WAC 246-836-211   Authorization regarding controlled substances.   (1) Upon approval by the department, naturopathic physicians may obtain a current Federal Drug Enforcement Administration registration. The department may approve naturopathic physicians who have:

(a) Provided documentation of a current Federal Drug Enforcement Administration registration from another state; or

(b) Submitted an attestation of at least four hours of instruction. Instruction must be part of a graduate level course from a school approved under chapter 18.36A, 18.71, 18.57, or 18.79 RCW. Instruction must include the following:

(i) Principles of medication selection;

(ii) Patient selection and therapeutics education;

(iii) Problem identification and assessment;

(iv) Knowledge of interactions, if any;

(v) Evaluation of outcome;

(vi) Recognition and management of complications and untoward reactions; and

(vii) Education in pain management and drug seeking behaviors.

(2) The naturopathic physician must retain training documentation at least five years from attestation date.

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NEW SECTION
WAC 246-836-220   Intramuscular, intravenous, subcutaneous, and intradermal injections.   Naturopathic physicians may administer substances consistent with the practice of naturopathic medicine as indicated in WAC 246-836-210 through the means of intramuscular, intravenous, subcutaneous, and intradermal injections.

(1) Naturopathic physicians may use intravenous therapy when they have submitted an attestation of training. Training must be at least sixteen hours of instruction. At least eight hours must be part of a graduate level course from a school approved under chapter 18.36A, 18.71, 18.57, or 18.79 RCW. Instruction must include the following:

(a) Indications;

(b) Contraindications;

(c) Formularies;

(d) Emergency protocols;

(e) Osmolarity calculation;

(f) Aseptic technique; and

(g) Proper documentation.

(2) The naturopathic physician must retain training documentation at least five years from attestation date.

(3) Intravenous chelation therapy is limited to use for heavy metal toxicity.

(4) All naturopathic physicians who use injection therapy must have a plan to manage adverse events including sensitivity, allergy, overdose, or other unintended reactions.

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Washington State Code Reviser's Office