Nursing & Healthcare News

NP Autonomy May Reduce Opioid Deaths

Study points to increased access to care, treatment as possible reasons

Does nurse practitioner autonomy help or hurt the opioid epidemic? A new study finds lower opioid mortality in states that allow NPs to practice without physician supervision.

Dire Warnings from AMA

Back in September 2020, American Medical Association Executive Vice President and CEO James L. Madara, M.D., urged Gov. Gavin Newsom to veto A.B.890, California’s new path-to-autonomy law for nurse practitioners, offering the usual dire warnings about patient safety.

In particular, Madara cited a 2020 study claiming that NPs in states without physician supervision requirements overprescribe opioids more often than physicians do.

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A new study challenges that contention, arguing that nurse practitioner autonomy actually correlates with significant reductions in opioid mortality, particularly in rural areas.

Mortality Data

The new study, conducted by health law expert Benjamin McMichael, J.D., Ph.D., and released by the Mercatus Center at George Mason University, analyzed 2005–2017 mortality data from the National Vital Statistics System, which has detailed county-by-county information about all U.S. opioid deaths.

McMichael found that areas that allow NPs to practice independently had 9.3 percent lower per capita opioid mortality, even after correcting for factors like median income, unemployment rates and mandatory prescription drug monitoring programs.

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Rural counties with autonomous NPs saw even greater reductions in opioid mortality — by as much as 28 percent.

“Mounting Evidence”

Interestingly, NP autonomy correlated with lower mortality rates for all opioids, including illegal drugs like heroin as well as prescription opioids. This suggests that even if autonomous NPs do prescribe more opioids than physicians (a question this study, based on death certificate data, could not directly answer), the increased access to care and treatment that NP autonomy provides more than compensates, resulting in significantly fewer opioid deaths.

McMichael says this data “joins mounting evidence that NPs can safely care for patients independently.”

You can find the complete study here.


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