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Expanding nurse practitioner (NP) independence did not increase high-risk opioid prescribing. This study found no significant association between NP practice independence and opioid-CNS depressant co-prescriptions.

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Area of Science:

  • Health Policy
  • Pharmacology
  • Nursing Practice

Background:

  • Concerns exist regarding excessive opioid prescribing potentially linked to nurse practitioner (NP) scope of practice.
  • The relationship between NP practice independence and high-risk opioid prescribing patterns remains unclear.

Purpose of the Study:

  • To investigate whether the rates of high-risk opioid prescribing changed following the implementation of NP independence legislation.
  • To analyze the association between NP practice independence and opioid prescribing behaviors.

Main Methods:

  • A difference-in-differences analysis compared prescribing rates in 6 states that adopted NP independence with 10 neighboring nonadopting states.
  • Prescription insurance claims data for over 2.8 million individuals aged 18-64 were analyzed from January 2012 to December 2021.
  • The primary outcome was the rate of opioid prescriptions overlapping with central nervous system (CNS) depressants.

Main Results:

  • No statistically significant increase in the rate of opioid prescriptions overlapping with CNS depressants was observed after NP independence legislation.
  • Changes in the duration of opioid-CNS depressant overlap and opioid dosage/days supplied were also minimal and not statistically significant.
  • Demographics and pre-existing prescribing trends were comparable between adopting and non-adopting states.

Conclusions:

  • The adoption of NP independence legislation was not associated with an increase in high-risk opioid prescribing.
  • Findings suggest that expanding NP scope of practice does not necessarily lead to elevated rates of concurrent opioid and CNS depressant prescriptions.