High-Risk Opioid Prescribing and Nurse Practitioner Independence

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.