Washington News: The Practice of Naturopathy Expands Drug Authority

Topics: Prescribing authority

Published in the April 2007 Washington State Board of Pharmacy Newsletter

The legislature recently expanded the authority of naturopathic physicians. The law was amended to replace the term “medicines of mineral, animal, and botanical origin” with the term “naturopathic medicines.” Licensed naturopathic physicians may now prescribe, administer, dispense, and use legend drugs and controlled substances (CS) consistent with the practice of naturopathic medicine.

The specific medicines must be established by the Secretary of Health in rule. The prohibition on the use of CS was revised to permit the use of codeine and testosterone in Schedules III, IV, and V. The law includes education and training requirements for the use of CS.

The recent change builds on prior law and rules regarding naturopathy. In 1991, the Washington State Legislature recognized the practice of naturopathy in statute. The ability to prescribe, administer, dispense, and use certain medicines of mineral, animal, and botanical origin became part of the naturopathic physician’s accepted scope of practice.

The following year, the state defined in rule the specific medicines the naturopathic physician may prescribe [(RCW 18.36A.020(10) and WAC 246-836-210(9)]. This included legend topical, local anesthetics, nondrug contraceptives except intrauterine devices, and intramuscular B-12 (cyanocobalamin) injections. Neoplastic drugs and CS were prohibited. The rule allowed the Secretary of Health to create a list of legend substances based on traditional botanical and herbal pharmacopeia. The first list was published in 1993 and updated in 2004, see www.doh.wa.gov/pharmacy. There is a “draft” revision of WAC 246-836-210 – Authority to use, prescribe, dispense and order – to incorporate the most recent changes. The draft recognizes naturopathic physicians as primary care practitioners with authority to use legend drugs consistent with naturopathic medical practice. Naturopathic physicians may not prescribe for malignancies or neoplastic diseases. They also may not prescribe botulinum toxin or other inert substances used for cosmetic purposes. Naturopathic physicians may prescribe codeine and testosterone products in Schedules III, IV, and V.

Two new rules are being drafted to implement the law. The first describes the education and training requirements for naturopathic physicians to use, prescribe, dispense, or order CS. The second sets education and training requirements for a naturopathic physician to use intravenous therapy. The rule authorizes naturopathic physicians to use intramuscular, intravenous, subcutaneous, and intradermal injections.

The rule to implement the new law will be finalized in June 2007.