with Vermont and Colorado paving the new path
This article comes from Guidepoints News from NADA Summer 2020 Issue. Sign-up to receive Guidepoints in your inbox quartlery. The Guidepoints newsletter is the only publication devoted to the sharing and dissemination of our NADA work on an international scale. Become a member to opt-in for a print copy. Check-out past issues.
Twenty-four states have statutes on the practice of the NADA protocol by a diversity of workers. On July 1, 2019, Vermont became the first to deregulate the practice of the protocol entirely. One year later, the state of Colorado followed suit, as part of changes made during the sunset review of the Mental Health Practice Act.
These changes point to a growing trend of the NADA protocol becoming more available and accessible in clinical and community spaces, and to state governments having a less fearful approach to NADA providers serving their communities.
In a letter sent out to all Vermont NADA providers, the state’s Office of Professional Regulation (OPR) notified them that their certifications were becoming inactive on July 1, 2019.
The newly revised regulations stipulate five requirements for someone to be able to practice “auriculotherapy” in Vermont:
- training in clean needle technique;
- using sterile, single-use needles;
- not claiming to treat any disease or disorder;
- not claiming to be an acupuncturist;
- and not implying any level of regulation of the practice of auriculotherapy by the state of Vermont.
The NADA community can easily get behind each of these stipulations as they are all part of the ethics pledge an acudetox specialist (ADS) signs. Even in this deregulated language, the Spirit of NADA persists, noting that trained providers are “not claiming to treat any disease or disorder.” Instead they serve to complement a network of other providers and services that may be more directly engaged in actual treatment of a disease or disorder, if one has been clinically identified.
We often refer to getting a NADA “treatment,” but this should not be confused with using the protocol to “treat” a medical condition. As Dr. Michael Smith wrote in NADA Changes the Dominant Paradigm, the protocol “helps problems outside of diagnostic boundaries, such as shame, grief and family violence,” and “successful programs reach adolescents, gang members, prisoners, refugees, victimized communities, and trauma survivors.”
“The state is in the business of regulating marketplace activities, and this is a community-level practice.
Very few people derive primary income from ear acupuncture. It exists on the level of popular folk therapy and peer assistance.”
Gabe Gilman, general counsel for the Vermont OPR, was interviewed for the Winter 2019 issue of Counterpoint where he shared: “The state is in the business of regulating marketplace activities, and this is a community-level practice. Very few people derive primary income from ear acupuncture. It exists on the level of popular folk therapy and peer assistance.”
Colorado’s network of community re-entry programs is a shining example of Gilman’s observation. Terri Hurst, an ADS and policy coordinator for the Colorado Criminal Justice Reform Coalition,described the NADA protocol as a bridge – for clients in re-entry programs such as halfway houses, and for the support staff that work in those programs, many of whom are NADA-trained. For both the clients and the support staff, the protocol facilitates a way to connect, build trust,and offer and receive support during the vulnerable moments of reintegrating back into the community.
According to Hurst, re-entry providers are having discussions about bringing the NADA protocol into the state prisons.Their vision will now be greatly supported by new legislation passed in Colorado this past summer.
Hurst closely followed the sunset review of the Mental Health Practice Act–a 10-year review of professions that are governed by the Department of Regulatory Agencies. When she learned that the structure for certifying addiction counselors had changed, and that registered psychotherapists would no longer be a regulated profession in the state, red flags went up for how the practice of NADA might be affected. “Thankfully I was able to step into the process,” said Hurst. She suggested amendments to the existing ADS bill that not only preserved the practice of NADA in the state, but greatly expanded it.
Now, rather than any single profession being listed as being able to be trained in NADA, the bill states that with proper training, a “professional” can practice the NADA protocol. What constitutes a professional? Someone who has taken the NADA training. Hurst made the case to state legislators that completing the training, and being part of the NADA community of providers, gives sufficient regulatory oversight. They agreed and exempted the bill from the Mental Health Care Act entirely. Hurst explains, “NADA has been in the state for eight years. People know about it and know how it’s being used.”
Both Colorado and Vermont can thank their progressive grandmother, Michigan. In Michigan anyone could be trained as a NADA provider as long as their practice followed the scope guidelines set out in a state funding policy – this had provided governance of ADSes for 25 years.
In 2019, Michigan’s acupuncturists succeeded in becoming a licensed, rather than simply a registered, profession. Along with that change came a formal inclusion of language in their practice act to expand the scope of the NADA protocol to include prevention of substance use disorder. Although Michigan ADSes are not required to file for any state registration, if a complaint is filed against them as a NADA provider, they would be accountable to the Michigan Department of Licensing and Regulatory Affairs.
In a letter of support submitted for the Michigan acupuncture practice act, Marilyn Miller, retired State Opioid Treatment Authority, wrote, “To date [September, 2018], over 800 Acupuncture Detoxification Specialists have been trained. There have been no negative incidents reported.” In the closing remarks of her letter, Miller urged the legislative community: “In this era with the alcohol and other drugs of abuse such as opioids and the escalating awareness of post-traumatic stress syndromes, it is imperative that this technique been not only allowed but fostered.”
In the last two years, West Virginia and Maine made history in their states by adding the number of healthcare professions eligible to increase access to the NADA protocol. Although the list of providers is quite broad in both states, it still excludes many from being able to help with NADA. Peer support specialists had been recommended in both states, but were not included in the final versions of the bills.
This year, massage therapists may petition the West Virginia legislature, so they, too, can be added to the list, says Barbara Weaner, a nurse and NADA advocate in West Virginia. “Colorado’s solution is elegant and can save money,” reflected Weaner. By broadening eligibility to anyone who takes the NADA training, a state can avoid the costs associated with entertaining repeated amendments to its statutory language.
Legislators in Arizona will be introducing a bill in 2021 to include trauma as part of an ADS’s scope, and to remove the restriction of state-funded and board-approved programs as the only places where the protocol can be practiced. Although not a full-scale deregulation, we applaud this forward-thinking change. Retired Judge Chuck Pyle, Arizona NADA advocate and frequent contributor to Guidepoints, tells us that “with trauma included as part of the scope, an acudetox practitioner could provide hundreds of treatments each year, if not more, at low cost and in conjunction with other therapies. Not only does this avoid the bottleneck of physician availability, it means members of the community are putting healing hands on other members of the community.”