Proposed bill would let WA naturopaths prescribe opioids, other controlled meds

Naturopathic doctors say they’re well-positioned to help address Washington’s opioid crisis and provide comprehensive health care in rural parts of the state. But they say a change in state law is needed to practice medicine to the full extent of their training.

Naturopathic doctors go to a four-year naturopathic medical school and are licensed primary care providers in Washington — but here, as in most states, they don’t have the authority to prescribe all medications. They aren’t licensed to prescribe drugs that are classified as “controlled substances” and can be used to treat, for example, pain, anxiety, ADHD, and sleep disorders.

A bill currently before the Washington State Legislature would change that. It’s the newest version of a bill that naturopaths in the state have been championing for about a decade.

Angela Ross is a naturopath and the executive director of the Washington Association of Naturopathic Physicians. She said one big reason to give naturopaths more prescribing authority is that it’s hard to help people wean off opioids if you don’t have the authority to prescribe opioids.

Ross said naturopathic doctors would like to help people with addiction by giving them buprenorphine, a drug that helps reduce people’s dependence on opioids, along with progressively smaller opioid prescriptions, while also helping them manage their pain using non-pharmaceutical methods like breathing exercises, acupuncture, and dietary changes.

But to do that, Ross said, naturopaths need the authority to prescribe buprenorphine and opioids.

“We are uniquely positioned to provide really comprehensive care for people struggling with addictions,” Ross said. “We are going to be the ones that are super closely following up with our patients.”

In 2009, Oregon granted naturopathic doctors the authority to prescribe most drugs, including many controlled substances; it’s one of the few states where they have this authority. But naturopaths there still focus on non-pharmaceutical pain management, according to a letter written by two Oregon-based naturopaths published in the journal Pain Medicine.

Ross said the other reason to license naturopathic doctors to prescribe controlled medications is to increase access to medical care in rural Washington.

There are remote places where naturopathic doctors fill a gap, she said: “where they may be the only health care provider within a 100-mile radius.”

In those places, if a patient needs opioid painkillers after a surgery or sleeping drugs during an episode of high anxiety, “You are just really burdening those patients with forcing them to drive hours out of their way to get the care that they need,” she added.

The state health department did an extensive review of naturopathic medical training and recommended in its report to the legislature that naturopathic doctors not have unlimited prescribing authority, but rather be granted the authority to prescribe a subset of controlled drugs, including buprenorphine, as well as anxiety and sleep medications. The report also recommends that naturopathic doctors be allowed to prescribe hydrocodone products for acute pain — prescriptions that last less than a week — but not for chronic pain management.

The primary opposition to giving naturopaths broad prescriptive authority comes from the Washington State Medical Association.

“A naturopath’s educational emphasis on the self-healing process does not include the comprehensive medical and pharmacological background needed to properly and accurately prescribe potentially dangerous prescription drugs,” the association wrote on its website, which details the group's opposition to the bill (as well as to bills that would give psychologists some prescriptive authority, optometrists some ability to perform surgery, and nurse practitioners the same reimbursement as physicians for the same services).