Latest version of California naturopathic prescribing bill removes physician supervision

Latest version of California naturopathic prescribing bill removes physician supervision

In yet another iteration of this contentious legislation, a bill allowing naturopaths to prescribe drugs free of physician supervision has been revived, after having survived a near-death experience a year ago and a number of amendments that would retain the current physician supervision requirements. The latest version of Senate Bill 538 would require physician supervision of naturopathic prescribing for only one year. After that, and with no input from the supervising physician or further determination of competency, naturopaths will be able to independently prescribe.

As state law now stands, naturopaths can prescribe drugs only under physician supervision. Drugs on Schedule III-IV of California's controlled substances law must be specifically agreed to by the supervising physician. Schedule III drugs can be prescribed only pursuant to a patient-specific protocols. Under California law, Schedules III-V include some heavy-hitters like barbiturates, narcotics (in limited dosages) and anabolic steroids.

Naturopaths must also have additional classwork to prescribe, although that requirement is minimal: only 48 hours of pharmacology, which can be taken at a naturopathic school. There is no state testing to determine if this additional education renders the naturopath actually competent to prescribe.

As originally introduced, Senate Bill 538 would have allowed naturopaths to order, prescribe and administer all drugs, including Schedule III through Schedule V drugs (but not Schedule I and II, which they are not allowed to prescribe at all) without any physician supervision. It would also have permitted naturopaths to use parenteral therapy and perform minor office procedures, as well as interpreting diagnostic imaging studies.

Later amendments to the bill pared back those privileges considerably.In the penultimate version, parenteral therapy, minor office procedures (except for care of superficial lacerations and abrasions) and diagnostic imaging interpretation were gone, as is the case with the current version. However, the latest amendment restores the original bill's independent prescribing authority for all drugs, including Schedule III-V, after one year of supervision by a physician.

In effect, the supervising physician will have to make up for the woeful lack of naturopathic education and training and he has only one year to do it. Naturopaths have less classroom pharmacology education than nurse practitioners or physician assistants and their clinical training offers little opportunity to actually prescribe drugs. Even at that, their judgment is clouded by the substantial pseudoscience that permeates naturopathic school. According to Naturopathic Diaries, naturopathic students have between 55 and 72 classroom hours in pharmacology, but 88-144 hours in homeopathy. How can someone who is taught the higher the dilution of a substance the more powerful the effect possibly grasp dose-response, which is essential to pharmacology education?

Their credulity when presented with pseudoscience shows in their practices. Naturopathic Diaries, in a post on the original bill, has screenshots of the treatments currently on offer by California naturopaths. Theses include ultra-violet blood irradiation, homeopathy, biotherapeutic drainage, detoxification and something called a "bioenergy patch." The latter is described by its manufacturer in this delicious word salad:

"The BioEnergy Patch" is a 1″ disk made from a poly vinyl blend material, infused with carbon and crystalline elements for the purpose of storing and transferring frequency in the form of sub-harmonic signals. . . It is designed to interact with the energy of the human body to balance cellular communication for a specific therapy that is infused into each BioEnergy Patch.

Anyone who believes that shouldn't be let anywhere near prescription drugs. 

The current bill has never been heard by a committee. In a previous iteration, the bill passed in the Senate and was sent to the Assembly, where it failed in the Committee on Appropriations and was presumed dead. Unfortunately, the Committee granted reconsideration. Since then, it has been amended by "the author" (per the state's Legislative Information website; presumably a reference to Assembly Member Adrin Nazarian) twice and each of those has gotten a second reading in the Assembly. Now it is in front of the Appropriations Committee again, where it will be heard on August 10.  Even if the bill is approved there and passes in the Assembly, one assumes it will have to go to some sort of conference committee to work out the differences between the Senate and Assembly versions. August 31 is the last day to pass bills in either house. Given how state legislatures operate, that's plenty of time.

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