Giving nurse practitioners broader opioid prescribing authority did not improve outcomes, a new study found. Some states let nurse practitioners prescribe buprenorphine for opioid use disorder. Those states saw no rise in high-risk prescriptions. They also saw no significant change in health outcomes compared with states that did not.
Summary: Some US states let NPs prescribe buprenorphine for OUD. A new study compared states that allow it with states that do not. It found no rise in high-risk prescriptions. It also found no significant change in health outcomes.
A few US states have let nurse practitioners (NPs) prescribe opioids to fight the opioid epidemic. One of the latest studies shows this did not lead to better outcomes.
A few US states, not all, let NPs prescribe buprenorphine to treat opioid use disorder (OUD). The goal was to make treatment easier to get. It did not lead to better outcomes.
The study appeared in the JAMA Health Forum. It compared states where NPs can prescribe opioids with states where they cannot. The experts found no statistically significant benefit.
Giving NPs these rights may sound like a good idea. Not everyone agrees. Many believe NPs lack the training to handle hard OUD cases. Treating OUD is more than writing a buprenorphine script. It is hard work, and it takes a deep grasp of the disease.
Supporters of these changes disagree. They say getting into treatment is still one of the biggest hurdles.
Researchers compared opioid prescribing and outcomes in six states where NPs can prescribe opioids. They set these against 10 nearby states where NPs cannot. The study ran from January 2012 to December 2021. It used insurance claims from Blue Cross and Blue Shield Plans. The team looked at adults aged 18 to 64 years.
They found that the states that let NPs prescribe did not share the same population traits or opioid prescribing patterns.
The researchers saw no change in opioid prescribing to high-risk people. That also means they found no problem with NPs prescribing these drugs. Risk did not go up. There was no overprescribing and no prescribing to the wrong patients.
Opioid prescribing for chronic pain has dropped. Yet OUD is still one of the biggest problems we face. Prescription opioids may have played some role in this epidemic. But many other forces drive it. That is why the problem has not gone away. Many health experts now question the push to cut opioid prescribing for chronic pain. They say it may cause more harm than good.
So to manage OUD, people need better access to treatment. There are a few ways to do that. One is letting NPs prescribe certain opioids. Another is allowing some opioids to be prescribed through telemedicine.
These new ways to widen access may not be making significant gains. But studies also show these rule changes are not causing harm. Easier access to drugs like buprenorphine did not raise high-risk prescriptions.
So it is fair to say these new approaches may not significantly improve OUD treatment. But they are not causing harm.
Source:
Cusimano, L. D., & Maestas, N. (2024). High-Risk Opioid Prescribing and Nurse Practitioner Independence. JAMA Health Forum, 5(12), e244544. https://doi.org/10.1001/jamahealthforum.2024.4544
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