A bill has been filed in Washington State (House Bill 2034) to substantially expand the prescriptive authority of naturopathic doctors (or "physicians," as they like to call themselves). If the bill passes, naturopaths will be very close to having the same authority to prescribe as MDs and DOs.
Intramuscular, intravenous, subcutaneous and intradermal injections are permitted, again "consistent with the practice of naturopathic medicine" but these rules are established by the secretary of the state department of health.
The contrast between the training rules established by the naturopathy board and the health department secretary is interesting. The naturopathy board has decided that a paltry 4 hours of instruction is sufficient to prescribe controlled substances. Note that this is "instruction" only, no clinical training is required. Apparently, whatever little training in pharmacology naturopaths get in naturopathy school is sufficient.
It is always instructive to see how the deficiencies of naturopathic education and training are inadvertently revealed in these additional educational requirements. Naturopaths adamantly maintain that they graduate from 4 years of school ready to practice primary care with the same level of competency as an MD or DO, even though the latter have been through at least 3 years of residency following graduation from med school. Yet, only one state (Oregon) actually gives naturopaths the same scope of practice, and in the few states where they are licensed or registered, the law often grants either limited or no prescription rights and requires additional training in various subjects (such as prescribing and delivering babies) before naturopaths can perform certain tasks all MD and DO PCPs already know how to do. This should speak volumes to the state legislatures about the veracity of their claims.
HB 2304 would allow naturopaths to prescribe and administer:
All legend drugs;
Hydrocodone combination products contained in Schedule II (under state law);
Controlled substances contained in Schedules III through V.
The naturopathy board "may" adopt rules relating to education and training requirements for legend drugs and controlled substances "in consultation with" the pharmacy quality assurance commission. If the bill passes, let's hope the commission does its homework on naturopathic education and insists on new rules that offer a real opportunity to overcome its deficiencies.
In one post, Hermes offered this startling information about how little pharmacology training naturopaths get in school:
BC 6305 Pharmacology for ND Students: "pharmacology for the ND student population"
55 lecture hours in one course
No additional pharmacology training provided in other courses
Minimal, if any, additional pharmacology training provided in clinical training hours
Legislators should be wary of the attitude toward prescription drugs expressed by the Washington Association of Naturopathic Physicians. One article on its website (which appears to be woefully out of date, the most recent article having been posted in 2014) bears the headline "Chinese herbal remedy 'just as effective as methotrexate against arthritis." The touted study which came to this conclusion had no placebo control and was unblinded, making it so flawed as to be meaningless. While the study's limitations are noted at the end of the article, why mention it if it is worthless as a guide to clinical practice?
The bill also requires the naturopathy board to adopt pain management rules appropriate for acute pain treatment based on the state's "interagency guidelines on prescribing opioids for pain . . . including, but not limited to, patient examination, screening for comorbidities and risk factors, and maximum dosage limits and treatment periods." Hopefully this will leave little wiggle room for the board to enact the sort of slack rules currently governing prescribing. In addition, naturopaths must register in the prescription monitoring program database.
Despite this minimal effort to protect the public from ill-advised prescribing by poorly trained practitioners, the best way to accomplish that goal would be the defeat of House Bill 2304. Washington residents can express their opposition to the bill on the legislature's website. (Including links to Britt Hermes's and Scott Gavura's posts is a great idea.)
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