Scope-of-Practice Laws and Patient Safety: Evidence from the Opioid Crisis

Abstract

Scope-of-practice laws that restrict Nurse Practitioners' (NPs) ability to deliver healthcare are justified as necessary to promote patient safety and protect patients from providers with less training than physicians. Analyzing a dataset of over 1.3 billion opioid prescriptions at the individual-provider level, I evaluate this justification in the context of the ongoing opioid crisis. I examine whether allowing NPs to practice independently of physicians increases opioid prescriptions. Granting NPs independence increases NP opioid prescriptions but decreases physician opioid prescriptions across three different measures of prescriptions. The net effect is an overall decrease of about 1.2 percent in morphine milligram equivalents prescribed across all providers. The results suggest that restrictive scope-of-practice laws are not necessary to protect patients from the overuse of dangerous drugs and that these laws may increase the use of these medications and undermine patient safety.

The effect of nurse practitioner scope of practice laws on primary care delivery

“…Since the SOP changes during my study period primarily granted full prescriptive and practice authority simultaneously, I chose to use one binary variable reflecting both. Other recent work has also adopted this approach (Koch & Petek, 2019; McMichael, 2018; Traczynski & Udalova, 2018). In sensitivity analyses I use a control group comprised only of states with restricted practice and prescribing authority, and the results are similar (Appendix ).…”