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Laws Restricting Opioid Care Undermine Efforts to Curb Epidemic: Study

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Allowing nurse-practitioners more “independence” in prescribing opioids to treat patients could play a key role in curbing the opioid epidemic, according to a University of Alabama study.

Scope of Practice (SOPs) laws in many states restrict nurse practitioners— often the primary providers of health care in rural and under-served communities—from prescribing  opioids for treatment of patients without the supervision of a physician.

But such laws are counter-productive and may even “undermine patient safety,” concluded the study by Benjamin J. McMichael, an assistant law professor at the University of Alabama’s Hugh F. Culverhouse Jr. School of Law.

McMichael analyzed over 1.3 billion individual opioid prescriptions, representing about 90 percent cent of all opioid prescriptions filled at outpatient pharmacies between 2011 and 2017, to examine the impact SOP laws have on the quantity of opioids prescribed by both physicians and NPs.

Although SOP laws are strongly backed by the American Medical Association, among other groups, as a way to ensure patient safety, McMichael said he found no evidence to suggest that opioid patients’ health was compromised by NPs in states where such laws were not in existence.

In fact, he argued, the tendency of NPs to prescribe smaller doses or fewer prescriptions when they were not bound by what doctors ordered may be a significant factor in the successful treatment of addiction.

According to the data, the overall amount of morphine “milligram equivalents” prescribed by all providers during that period actually decreased slightly—by 1.2 percent— during that period.

“The clear majority of evidence demonstrates that granting NPs independence reduces the use of prescription opioids across three different measures of opioid prescribing,” wrote McMichael, in a working paper, entitled “Scope-of-Practice Law and Patient Safety: Evidence from the Opioid Crisis.”

He added: “Allowing NPs to practice independently, if anything, reduces the use of opioids, consistent with an improvement in patient safety, given the demonstrated harms associated with recent levels of opioid prescriptions.”

NPs are registered nurses who have undergone additional training to provide healthcare services historically provided by physicians, the study noted. In general, NPs may evaluate patients, provide diagnoses, offer treatment, and prescribe medications.

State scope-of-practice (SOP) laws—a subset of the occupational licensing laws that govern NPs and many other professionals—determine what services NPs may provide and the conditions under which they may provide those services.

Another significant effect of granting NPs more independence is lowering healthcare costs, McMichael noted.

McMichael cited other studies that have demonstrated that granting NPs more autonomy “can result in lower healthcare prices, increased access to care, and improved quality of care.”

“While SOP laws are not generally mentioned in the debate over the opioid crisis, the results… suggest that changing how the healthcare workforce is regulated via SOP laws could play a role in mitigating the effects of this crisis,” he wrote.

According to the Centers for Disease Control and Prevention, an estimated 40 Americans died each day from a drug overdose involving a prescription opioid during 2017.

Additional Reading: Can We Help Opioid Abusers Without Jailing Them?

A full copy of the report can be downloaded here.

Megan Hadley is a senior staff writer for The Crime Report.

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