Nurse practitioner's independent prescriptive authority and opioids abuse

Abstract

This paper investigates the impact of legislative changes allowing nurse practitioners to prescribe schedule II controlled substances independently. We find that this legal environment is associated with an increase in treatment admissions for opioid misuse and a decrease in opioid related mortality only when Mandatory Prescription Drugs Monitoring Programs are in place.

State Nurse Practitioner Practice Regulations and U.S. Health Care Delivery Outcomes: A Systematic Review

“…The researchers also found that this increase in prescriptions did not lead to a decrease in mental health care outcomes, measured as mental health-related mortality rates (Alexander & Schnell, 2019). This was further supported by Grecu and Spector (2019), who found that expanded NP prescriptive independence increased the number of opioid misuse treatment admissions.…”

“…Measurement of state NP practice regulations varied across studies, though the vast majority ( n = 25) classified these regulations by level of independence in diagnosing, treating, or prescribing medications using criteria from the American Association of Nurse Practitioners; Annual Legislative Update published in The Nurse Practitioner , or the National Council of State Boards of Nursing. Seven other studies focused on the level of prescribing independence (Alexander & Schnell, 2019; Grecu & Spector, 2019; Kleiner et al, 2016; Schirle & McCabe, 2016; Spetz et al, 2019) or the ability to prescribe controlled substances (Perry, 2012; Timmons, 2017) to classify NP practice regulations. Studies were conducted in various health care settings, including community health centers, nursing homes, hospitals, retail clinics, and rural and health professional shortage areas.…”

“…Studies were conducted in various health care settings, including community health centers, nursing homes, hospitals, retail clinics, and rural and health professional shortage areas. A majority of the studies focused on primary care practice overall, except for a few that were limited to a specific practice domain or population, such as mental health (Alexander & Schnell, 2019; Yang et al, 2017), opioid prescribing or addiction treatments (Grecu & Spector, 2019; Ladd et al, 2017; Schirle & McCabe, 2016; Spetz et al, 2019), Medicare beneficiaries (Kuo et al, 2013; Perloff et al, 2017), or Medicaid beneficiaries (McMichael et al, 2019; Mobley et al, 2017; Poghosyan et al, 2019; Timmons, 2017).…”

“…Three other studies focused on health status of a specific care domain (Alexander & Schnell, 2019; Grecu & Spector, 2019; Smith-Gagen et al, 2019). The researchers reported significant improvement in self-reported mental health status and a decrease in mental health (Alexander & Schnell, 2019) and opioid-related mortality rates (Grecu & Spector, 2019) after expansion of NP prescriptive authority. Smith-Gagen et al (2019) found twofold higher odds of being diagnosed with late-stage cervical cancer in states with no FPA compared with those with FPA.…”

Exploratory descriptive analysis of opioid prescribing prevalence of nurse practitioners and the specialties associated with the top prescribers

“…A detailed study of NP prescribing authority is beyond the scope of this paper. However, Schirle and McCabe (2016), Ladd, Sweeney, Guarino and Hoyt (2017) and Grecu and Spector (2019) found that NP practice scope is not a significant factor in the overall prescription of opioids.…”