As the world continues to grapple with new iterations of COVID-19, it’s easy for some to lose sight of other significant public health issues like the opioid crisis. The Centers for Disease Control and Prevention (CDC) note that opioid overdose deaths have continued to rise steadily over the past two decades, and recent research from the Mayo Clinic indicates that COVID has made the opioid epidemic even worse, with emergency room visits due to opioid overdoses up 29 percent last year.
Just like our efforts to combat COVID, dealing with opioid addiction requires an all-hands-on-deck approach, yet some policymakers insist on fighting this battle with one hand tied behind our backs when they limit activity by nurse practitioners (NPs). My own new research shows that by eliminating certain scope-of-practice restrictions, we may be able to prevent one out of 11 opioid-related deaths overall and as many as one out of four in rural areas.
The last time you physically went to a medical doctor’s office, you may not have even seen an MD, especially if you visited a pharmacy’s retail clinic or an urgent care center. There’s a good chance an NP provided your care. The number of NPs has increased rapidly over the last several decades, providing newer and more convenient health care options. They’ve also expanded access to care in rural areas while increasing capacity in urban and suburban areas.
Despite the success of NPs in addressing the access-to-care problem that has dominated health policy debates for over a decade, they’re not always treated equally. Currently, 20 states require that physicians supervise NPs when the latter care for patients. Without this supervision, which often requires a substantial fee paid to the physician, NPs aren’t allowed to practice.
States generally justify these scope-of-practice restrictions as necessary to protect patient safety, and physician groups are often the biggest proponents of these laws. One of the most recent arguments against allowing NPs to practice independently exploits the opioid crisis.
Before California passed a new law granting NPs independence last year, the American Medical Association argued that such a law would lead to a rise in opioid prescriptions, exacerbating the opioid crisis. The association made a similar argument when Mississippi considered granting independence to nurse practitioners earlier this year. If true, these troubling claims may warrant restricting the ability of NPs to care for patients, even at the expense of reduced access to care.
But recent research into these arguments and justifications found no empirical support. Instead, my new research finds the opposite — that allowing NPs to practice without physician supervision reduces all opioid-related deaths by about 9.3 percent. Prescription-opioid-related deaths decline by about 7.6 percent, and illegal-opioid-related deaths decline by about 5.5 percent when NPs are granted legal authority to practice independently. Even synthetic-opioid-related deaths decline. In rural counties, the effect is much more dramatic, with all opioid related deaths declining there by between 14 and 28 percent.
These reductions in opioid-related deaths follow legal changes to NPs’ authority and likely stem from two important sources: First, in stark contrast to claims that they might increase, the data show that opioid prescriptions generally decrease following grants of independence to NPs. Second, these legal changes allow NPs to increase treatment options for opioid use disorder. This contributes to an overall reduction in opioid-related deaths.
When some states bar NPs from practicing independently, they restrict access to care for millions of patients — and as COVID clearly demonstrates, these restrictions matter. To expand access to care rapidly during the pandemic, states such as New York, Kentucky and Louisiana temporarily suspended their restrictions on NPs. Yet as these temporary relaxations begin to lapse, the old laws once again bind the hands of NPs.
As the nation struggles to combat the COVID-19 pandemic, with all of the lessons about access to care that it has taught, states that took interim measures to empower NPs would be well advised to make those changes permanent. And states that have yet to liberalize their restrictive laws should begin to do so.
Granting nurse practitioners independence will not, by itself, solve the opioid crisis. But justifications for restricting their scope of practice, which erroneously appeal to the opioid crisis and patient safety, are simply not supported by the research. If we take access to care seriously, these simple legal changes offer an easy option for making important progress and lending a helping hand to those in need. In the end, the science says it will save lives.
Benjamin McMichael is an assistant professor at the University of Alabama Law School and author of the new study “Nursing the Opioid Crisis,” published by the Mercatus Center at George Mason University.