High-Risk Opioid Prescribing and Nurse Practitioner Independence

Concerns around excessive opioid prescribing have been used to argue against the expansion of the scope of practice of nurse practitioners (NPs), but the association of NP practice independence with high-risk opioid prescribing is not well understood.

To assess whether the rates of high-risk opioid prescribing changed in association with NP independence legislation.

This difference-in-differences analysis compared rates of high-risk opioid prescribing in 6 states over 2 years following the adoption of NP independence compared with 10 neighboring nonadopting states from January 2012 to December 2021. Prescription insurance claims for 2 874 213 continuously enrolled individuals (members) aged 18 to 64 years from Blue Cross Blue Shield Axis were analyzed. Data analysis was carried out from 2021 to 2024.

Timing of the legislative effective date of NP independence in a state.

The primary outcome was the rate of opioid prescriptions that overlapped with a prescription for a central nervous system (CNS) depressant. Secondary outcomes included the number of days of opioid-CNS depressant overlap, as well as the dosage and days supplied of opioids among all members and among opioid-naive members.

Six states that adopted NP independence legislation and 10 nonadopting neighboring states were similar in terms of demographic characteristics and had comparable pretrends in prescribing. The estimated change in the rate of opioid prescriptions that overlapped with a CNS depressant was -0.03 per 100 members per month (95% CI, -0.11 to 0.05). Changes in the number of days of opioid-CNS depressant overlap and in the dosage and days supplied of opioids among all members and among opioid-naive members were also small and statistically insignificant.

The results of this difference-in-differences analysis suggest that there was no relative increase in rates of high-risk opioid prescribing during the 2 years following the adoption of independence for NPs.