HB 1888
In CommitteeHouse
Naturopathic physician scope
Concerning naturopathic physician scope of practice.
This status may be delayed. See Action History below for the latest updates.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill expands the authority of licensed naturopathic physicians in Washington to prescribe a wider range of controlled substances—including Schedule II stimulants—and to complete legally recognized medical documentation. It also clarifies their role in primary care and aligns their prescribing rules with safety requirements like competency exams and prescription monitoring.
- Expands the scope of practice for naturopathic physicians to include prescribing and administering Schedule II stimulant medications (e.g., ADHD medications like Adderall), in addition to existing authority for Schedules III–V controlled substances.
- Requires naturopathic physicians to pass a board-approved pharmaceutical prescribing exam and register with the state’s prescription monitoring program before prescribing most controlled substances (excluding testosterone and codeine products).
- Authorizes naturopathic physicians to sign and attest to legal medical documents such as disability determinations, physician orders for life-sustaining treatment (POLST), hospice orders, and guardianship papers—so long as the task falls within their scope of practice.
- Amends definitions in the naturopathy chapter to clarify that 'minor office procedures' include injections and other common diagnostic procedures, and that 'naturopathic medicines' include a broader range of compounds beyond controlled substances.
- Clarifies that naturopathic physicians are authorized to prescribe legend and controlled substances under RCW 69.41.030 (the legend drug law), and are included in the list of professionals allowed to possess and use such drugs.
Who is affected
- Naturopathic physicians — Naturopathic physicians gain expanded authority to prescribe and administer a broader range of controlled substances, including Schedule II stimulants, and to sign legal medical documents such as disability determinations and physician orders for life-sustaining treatment.
- Patients, especially in underserved or rural areas — Patients gain access to more comprehensive primary care from naturopathic physicians, including the ability to manage medication tapers for controlled substances like opioids and benzodiazepines, potentially reducing emergency department visits and improving continuity of care.
- Board of Naturopathy — The Washington State Board of Naturopathy gains rulemaking authority over prescribing competencies and training requirements for controlled substances, and must ensure at least one board member has prescribing experience.
- State health programs and insurers — State agencies and health plans (e.g., Apple Health, Indian Health Service) may see increased utilization of naturopathic services as providers expand their scope, potentially reducing overall system costs through preventive care and reduced ER visits.
Pro/Con Analysis
Stronger case for benefits
Potential Benefits (5)
Expanding naturopathic physicians’ authority to prescribe Schedule II stimulants and sign legally recognized medical documents—including disability determinations and POLST forms—improves access to comprehensive, continuity-based primary care, especially in underserved and rural areas where naturopathic physicians may be the only available providers.
HealthcarePeopleRef: Sec. 4(1) and Sec. 5Allowing naturopathic physicians to administer and deprescribe controlled substances (e.g., opioids, benzodiazepines) and perform injections and other common diagnostic procedures enhances their ability to manage complex chronic conditions and support safe medication tapers—critical for addressing the opioid and benzodiazepine crises and reducing emergency department visits.
HealthcarePeopleRef: Sec. 4(1) and Sec. 2(10) (amended 'minor office procedures')Explicitly including naturopathic physicians in the list of professionals authorized to possess and dispense legend drugs under state law removes ambiguity that may have previously hindered insurance reimbursement, prescription fulfillment, and integration into state health programs like Apple Health and Indian Health Service—improving care coordination and continuity.
HealthcarePeopleRef: Sec. 6 (amending RCW 69.41.030)Mandating registration with the state’s prescription monitoring program and requiring board-approved pharmaceutical competency exams for prescribing most controlled substances introduces important safety checks—though implementation will depend on rigorous rulemaking and enforcement.
Public SafetyPeopleRef: Sec. 4(2)(b) and Sec. 4(3)Clarifying that minor office procedures include injections and other common diagnostic procedures (e.g., venipuncture, radiography) aligns naturopathic practice with actual clinical needs and training—supporting more complete primary care delivery and reducing unnecessary referrals or duplicative testing.
HealthcarePeopleRef: Sec. 2(10) (expanding 'minor office procedures' to include injections and common diagnostic procedures)
Potential Concerns (5)
Expanding prescribing authority for Schedule II stimulants (e.g., Adderall) to naturopathic physicians—despite their training being primarily in holistic and natural medicine rather than pharmacology—may increase risks of misprescribing, adverse drug events, or diversion, especially in rural or underserved areas where oversight is limited.
Public SafetyPeopleRef: Sec. 4(2)(a)The requirement that naturopathic physicians pass a board-approved pharmaceutical exam and register with the prescription monitoring program before prescribing most controlled substances is a safeguard, but the board’s rulemaking authority over competency standards and the lack of mandatory continuing education requirements for ongoing prescribing privileges may result in inconsistent implementation and variable quality of prescribing safety across providers.
HealthcarePeopleRef: Sec. 4(2)(a) and Sec. 4(3)Authorizing naturopathic physicians to sign legal medical documents—including disability determinations, POLST forms, and guardianship papers—without requiring them to hold additional certification or licensure in those specific areas (e.g., geriatrics, psychiatry, or long-term care planning) may increase legal and clinical risks, particularly for vulnerable populations like seniors or people with serious mental illness.
Public SafetyLean peopleRef: Sec. 5The bill broadens the definition of 'naturopathic medicines' to include 'other nutrients, compounds, and natural substances' beyond controlled substances, but does not require evidence-based validation for these substances—potentially enabling use of unproven or unsafe treatments, especially in vulnerable populations with limited access to conventional care.
HealthcareLean peopleRef: Sec. 2(12) (amended definition of 'naturopathic medicines')While the bill claims minimal fiscal impact, the Board of Naturopathy and Department of Health will need to develop and enforce new prescribing rules, monitor prescription monitoring program compliance, and conduct oversight—costs that may fall disproportionately on state and local agencies with limited resources, potentially diverting funds from other public health priorities.
Local GovernmentLean peopleRef: Fiscal Impact section (summary) and Sec. 4(3)
Who Is Most Affected
Naturopathic physicians gain expanded prescribing and legal authority, enabling them to practice more fully within their scope of training. However, they now face new responsibilities—including competency exams, prescription monitoring registration, and increased liability exposure—that may require additional training and administrative burden.
Patients—especially in rural, low-income, or underserved communities—benefit from increased access to integrated primary care, including medication management and deprescribing support. However, those in areas with limited oversight or who receive care from less-experienced providers may face higher risks of misprescribing or fragmented care.
Apple Health and other state health programs may see increased utilization of naturopathic services, potentially reducing emergency department visits and improving chronic disease management. However, if quality assurance mechanisms are weak, this could lead to higher rates of adverse events or inappropriate prescribing—increasing long-term system costs.
The Board of Naturopathy gains rulemaking authority and oversight responsibilities, strengthening its role in public protection. However, limited staffing or political constraints may hinder effective implementation—especially if the board lacks sufficient prescribing-experienced members despite the governor’s directive.
Conventional physicians and clinics may benefit from clearer scope-of-practice boundaries and potential reductions in patient overflow, but may also face increased competition in primary care markets—particularly in areas where naturopathic providers are the only available primary care option.